Hk-' 
 
KC3// R 14 
 
 mtljeCttpofUmgork 
 CoQese of l^ffpsitmns anh ^urseonsi 
 
 I^ibrarp 
 
Digitized by the Internet Archive 
 
 in 2010 with funding from 
 
 Open Knowledge Commons 
 
 http://www.archive.org/details/consumptioncurabOOrama 
 
CONSUBfPTION CURABLE; 
 
 AND THE MANNER IN WHICH 
 
 NATURE AS WELL AS REMEDIAL ART 
 
 OPERATES IN EFFECTING A HEALING PROCESS IN 
 
 CASES OF CONSUMPTION; 
 
 EXPLAINED AND ILLUSTRATED BY 
 
 NUMEROUS REMARKABLE AND INTERESTING CASES: 
 
 TO WHICH IS ADDED 
 
 A MODE OF TREATMENT. 
 
 BY WHICH 
 
 THE DEVELOPMENT OF TUBERCLES MAY BE PREVENTED 
 
 IN PERSONS LIABLE THERETO j 
 
 FROM HEREDITARY PREDISPOSITION, OR A BAD STATE OF THE SYSTEM, 
 
 INDUCED BY VARIOUS CAUSES. 
 
 " La guerison dans les cas de phthisic pulmonaire oil llorgane n'a pas 
 et6 entiSrement envahi, ne presente, ce me semble, aucun caract^re d'im- 
 possibilit6, ni sous le rapport de la nature du mal, ni sous celui de I'organe 
 affecte."_Tom. ii. p. 112. 
 
 Laennec, NouveUe Edition. 
 
 BY 
 
 FRANCIS HOPKINS RAMADGE, M.D., 
 
 FELLOW OF THE ROYAL COLLEGE OF PHYSICIANS, 
 SENIOR PHYSICIAN TO THE INFIRMARY FOR ASTHMA, CONSUMPTION AND 
 OTHER DISEASES OF THE CBEST, &C. 
 
 LONGMAN, REES, ORME, BROWN, GREEN, AND LONGMAN, 
 
 PATERNOSTER ROW. 
 
 1836. 
 
/ B '^ 6 ^> 
 
 By the same Author, 
 ASTHMA ; its species, and complications, elucidated in 
 
 a Practical Treatise. 
 Longman, Rees, Orme, Brown, Green & Longman. 
 
 C. J. SOUTH, Printer, 205, Shoreditcli, 
 
CONTENTS. 
 
 PAGE. 
 
 Preface to the First Edition vii 
 
 Preface to the Second Edition , xi 
 
 Preface to the Third Edition lii 
 
 Introduction 6 
 
 CHAP. I. 
 General Observations on Consumption l6 
 
 CHAP. II. 
 Causes of Consumption 24 
 
 CHAP. III. 
 
 The Symptoms of Pulmonary Consumption^, local 
 and sympathetic. — Physical Signs of the 
 Disease 32 
 
 CHAP. IV. 
 
 Morbid appearances of Consumption 55 
 
 CHAP. V. 
 
 Prophylactic Treatment^, by which the develop- 
 ment of tubercles in the lungs may be pre- 
 vented in persons liable thereto from heredi- 
 ary predisposition;, or a cachectic state of the 
 system 83 
 
 CHAP. VI. 
 The Treatnjent of Consumption 140 
 
CONTENTS. 
 
 APPENDIX, 
 
 PAGE. 
 
 Cases 194 
 
 Description of Plates 204 
 
 Cases given by Dr. Hohnbaura, in the Preface to 
 
 his Translation of "Consumption Curable." 213 
 
PREFACE 
 
 TO THE FIRST EDITION. 
 
 Most men have some one darling wish, which 
 forms the central point to which all their ideas 
 and feelings verge. My attention was directed 
 at my outset in the profession to that tremendous 
 disease, which, from its wasting effects on the 
 human frame, too truly and appropriately bears 
 the name of Consumption. I found those to 
 whose experience I looked to direct and guide me, 
 themselves walking in the dark. Books only 
 displayed to me a mass of crude, ill-arranged, 
 unreasoned-upon facts, or the fanciful chimeras 
 of medical visionaries. I saw that those branches 
 of knowledij-e which had been redeemed from the 
 
VI PREFACE. 
 
 wastes of empiricism, and brought within the 
 pale of art, had been indebted for this successful 
 issue to the system of induction which owns 
 Bacon as its father. The assemblage of facts 
 without classification, and this last without care- 
 ful investigation of specific differences, might, and 
 did, I perceived, pass for labour and observation, 
 but was certainly not science. I felt mortified 
 and degraded at the utter ineflicacy of medicine, 
 and of medical art, in this the commonest of dis- 
 eases ; and I was soon convinced that the only 
 means of rescuing my profession from this " dark- 
 ness visible" was to make the physician subordi- 
 nate to the anatomist. I had yet a higher object 
 in view — that of mitigating human suffering. I 
 have toiled to this end, and what I felt to be my 
 duty has been my reward. In no boastful spirit 
 do I speak, but in a thankful one. I have proved 
 that there is a cure for what has hitherto been 
 deemed incurable ; and this, no drug known but 
 to its compounder, but a simple mechanical pro- 
 cess available to all. That which has been as 
 
PREFACE. VII 
 
 yet confused, is, I would hope, rendered clear : 
 and I trust that modes of treatment resulthig up 
 to this period from conjecture, and leading but 
 too often to confirm the disease they were in- 
 tended to cure, will soon pass away with other 
 exploded practice, that now moves but our pity, 
 
 or our disgust. 
 March, 1834. 
 
 PREFACE 
 
 TO THE SECOND EDITION. 
 
 "It is passing strange" that medical attention, 
 in this country, should have been so little directed 
 to the pathological consideration of Consumption. 
 Nor is it less so, that consumptive patients are ex- 
 pressly excluded by the regulations, from more 
 than one of the metropolitan hospitals. We are 
 chiefly indebted to foreign writers for anatomical 
 investigations of the various diseases connected 
 
VIII PREFACE. 
 
 with the chest ; although they have done but little 
 towards developing any plan of treatment, holding 
 out decided hopes of success, in Consumption. 
 The ill fortune which characterized the means 
 usually pursued by the profession, in consumptive 
 cases, early struck my attention. My medical 
 brethren appeared, with respect to this disease, to 
 be as rigid fatalists as the Mahommedan ; and to 
 resign themselves calmly to the belief, that when 
 once Consumption appeared, human efforts could 
 be of no avail. Yet this apathetic resignation 
 was neither consistent with reason, nor with sound 
 philosophy. No man could feel more deeply than 
 myself that the issue is ever in the hands of the 
 Omnipotent ; but I could not bring myself to the 
 conclusion, that, because failure had hitherto at- 
 tended human agency, to cure was therefore im- 
 possible. I could not sit down like our Oriental 
 prototypes, with the exclamation, "Allah Akbar," 
 and do nothing. Such were my impressions, and 
 such my reasoning, twenty years ago. It appear- 
 ed tome, that not only the treatment of Pulmonary 
 
PREFACE. IX 
 
 Consumption was ill-understood, but that the pa- 
 thology of most of t'he affections of the chest;, had 
 not received that investigation which they deserv- 
 ed. Yet none are more important, or indeed, tak- 
 ing their number into consideration, so much so ; 
 seeing that the heart and lungs constitute the two 
 main props of what, together vv^ith the brain, Bor- 
 deu felicitously terms the tripod of life. For the 
 time just mentioned, it has been one of the chief 
 objects of my professional labours to advance our 
 knowledge of this interesting class of diseases. 
 The vacancy which the resignation of Dr. Buxton 
 (for several years Physician to the London Hospi- 
 tal,) left at the Infirmary for Diseasesof the Chest, 
 presenting the only favourable opportunity Lon- 
 don affords for seeing, in large numbers, every 
 variety of case connected with pulmonary and 
 other affections of the chest, was eagerly em- 
 braced by me. I was fortunate enough to obtain 
 the situation of Physician to the Infirmary; and 
 trust that the present work will prove I liave not 
 misemployed the abundant facilities it holds cut, 
 
X PREFACE. 
 
 for investigating the pathology of these diseases. 
 
 I feel a sincere pleasure in stating the reception 
 which the first edition of " Consumption Curable" 
 has met with, from the liberal portion of my pro- 
 fession. The letters I have received, from intel- 
 ligent practitioners in every part of the United 
 Kingdom, have gratified me in more than a selfish 
 point of view. They have proved to me that, 
 however interested motives may bias some, there 
 is an active and honourable spirit abroad in the 
 profession at large, which induces a frank and 
 manly openness to conviction. The owls, who 
 shut their eyes to the light of truth, because it 
 would guide others through the " palpable ob- 
 scure," are likely soon to be left alone in their 
 blindness. An amended medical education will 
 rectify all these things. 
 
 It will not be thought that I overrate the im- 
 portance of the diseases affecting the chest, when 
 it is considered that scarcely any part of the body 
 can be indisposed without the chest's participating. 
 Yet it is consolatory to reflect, to employ the words 
 
PREFACE. XI 
 
 of Laennec, that "Quelquedangereusesque soient 
 les maladies de la poitrine elles sont cependant 
 plus souvent curables qu' aucune autre maladie 
 interne grave." 
 
 September^ 1834. 
 
PREFACE 
 
 TO THE THIRD EDITION. 
 
 ■EaoQnssQSQBssiai 
 
 In answering the demand for a new edition of 
 the present work, it is gratifying to state that I 
 find my opinions are rapidly gaining ground 
 abroad, and steadily extending at home. To the 
 German translators, especially, of " Consumption 
 Curable," for it has been honoured by several 
 distinct translations into that language, and to 
 Dr. Hohiibaum, in particular, 1 am much indebt- 
 ed. The preface of this justly celebrated indivi- 
 dual is liberal and philosophic. Too thoroughly 
 informed in his art to deny the curability of 
 Phthisis, he was of too enlarged a mind to refuse 
 my system a fair trial, merely on the score of its 
 
PREFACE. XIII 
 
 novelty, and too high principled to withhold his 
 testimony to its success. In the Appendix will 
 be found the cases with which he has enriched his 
 translation. 
 
 I may mention it as a proof of the earnestness 
 of the foreign medical press in the diffusion of 
 our common art, that translations of my work 
 have been forwarded to me from the most oppo- 
 site parts of the continent. The last I have re- 
 ceived is from the pen of- Dr. Schmidt, and was 
 published at Pesth, Hungary: it is a second 
 edition of my first edition. 
 
 In this country, likewise, I am proud and anx- 
 ious to acknowledge, that if I have encountered 
 much prejudice, I have also met with great liber- 
 ality. The cases submitted to me by country 
 practitioners, would alone be satisfactory evidence 
 of the spread of sounder opinions on the pathology 
 and treatment of Pulmonary Consumption. But 
 this acknowledgement is not to be confined to the 
 provinces. Were it not for the fear of exposing 
 them to ungenerous attacks and the vexations of 
 
XIV PREFACE, 
 
 professional controversy, I might name several 
 eminent physicians of the metropolis, who coin- 
 cide with my views frankly and fairly; others 
 there are, who quietly imitate my practice, and 
 thus tacitly pay it the best compliment ; whilst 
 the numerous cases to which I am called in by the 
 general practitioner, warrant me in believing that 
 I was not too sanguine when I ventured to say 
 in my first preface — '*I trust that modes of treat- 
 ment resulting up to this period from conjecture, 
 and leading but too often to confirm the disease 
 they were intended to cure, will soon pass away 
 with other exploded practice that now moves but 
 our pity, or our disgust." 
 
 Still, as must ever be expected in the outset, 
 there is no lack of opposition to these views. 
 Many refuse to examine their validity : many ex- 
 amine, with a fixed determination not to be con- 
 vinced. Others again esteem themselves too 
 much, to credit the possibility of cure where they 
 have failed : it would be to deny their own ta- 
 lent, to confess their inferiority, in short— a bad 
 
PREFACE. XV 
 
 compliment to self. Some there may be— but 
 this is hypothetical, — who regard the increasing 
 reputation of another as so much subtracted from 
 their own treasury. With such, the abridging 
 the duration of disease, and still more the pre- 
 venting its ingression is to "bring down the rate 
 of usance here :" to cure, above all to avert the 
 need of cure is not in their " bond." 
 
 Since the publication of the present treatise, 
 three works have issued from the press on the 
 same subject, or partly so. It would be uncourt- 
 eous to pass them over in silence ; and I am quite 
 willing to give them the " honour due." They 
 differ in point of literaiy, and are unequal as re- 
 gards their medical merit ; but, in one respect, 
 they are on the same level. Their authors agree 
 that they cannot cure Consumption, which is 
 highly probable ; they likewise agree that it can- 
 not be cured, which is directly opposed to the 
 highest authority on the subject, and is the re- 
 verse of my own experience. To begin with the 
 work of Dr. James Clark. Since this gentle- 
 
XVI PREFACE. 
 
 man passed the greater part of his professional 
 life, (at least before I had the honour of being 
 one of his Examiners at the College of Physi- 
 cians) among the English resident in Rome, his 
 field of observation must, I presume, have been 
 rather limited. However.^ taking Laennec, Louis, 
 and Andral for his guides, he has produced a very- 
 neat compilation from their admirable volumes. 
 His work is destitute of originality ; to which, I 
 should suppose, its author hardly lays claim. The 
 point on which he insists most strongly is, that 
 "the constitutional origin of tubercles, by far the 
 most important part of the subject, has been ne- 
 glected ; "and he would appear by the context to 
 imagine that he was fixing attention for the first 
 time on an essential principle, since he adds " if 
 we succeed in giving a satisfactory exposition of 
 this, the most important, but hitherto most neg- 
 lected part of our subject, we may hope to lay the 
 foundation of a sounder pathology of tuberculous 
 disease." Nothing can be more true; but, with- 
 out referring to the writers who precede us both. 
 
PREFACE. XVII 
 
 had he bestowed a glance on my pages, he would 
 have seen the same doctrine strenuously insisted 
 upon. To adduce one, out of various passages 
 of like tenour, I observe p. 21, "Many writers are 
 of opinion, that various thoracic diseases are a 
 fruitful cause of Consumption ; but I am satisfied 
 that this supposition is groundless. It is merely 
 owing to the loss of health entailed by them, 
 that the development of those accidental pro- 
 ductions, called tubercles, takes place. To enu- 
 merate the various causes of Consumption would 
 be endless ; for, in fact, whatever is capable of 
 impairing the constitution is liable to produce 
 a phthisical state." Surely, the Doctor's "ex- 
 position" and mine are convertible— a/^^r et 
 idem. 
 
 Would it not lead to too great a length, I 
 should feel proud to bring forward the coinci^ 
 dences which occur between Dr. Clark's work 
 and mine, whenever he propounds any notion 
 bearing the appearance of novelty. Yet, by a 
 strange predilection for the despairing side of the 
 
XVIII PREFACE. 
 
 question, he invariably declines following out 
 such notions to their practical results. He ap- 
 pears to labour under a morbid dread of the cura- 
 bility of Consumption ; although, in deference to 
 Laennec, he is constrained to admit those patho- 
 logical facts on which I ground the rationale of 
 my practice. Thus he confesses, that "although 
 caverns generally tend to increase in size, yet not 
 infrequently when they occur singly, and when 
 no fresh depositions of tubercles take place, they 
 remain a long while stationary. In cases still 
 more uncommon, they gradually contract and be- 
 come obliterated." — Again, " in a very large pro- 
 portion of cases, it is only in the early stage we 
 can hope to effect a cure." There are some then, 
 that may be cured at a more advanced stage "? 
 Euge ! the Doctor after this may surely go a step 
 further, and exclaim with Laennec— "cure in 
 cases of Pulmonary Phthisis, in which complete 
 disorganization of the lungs has not taken place, 
 ought not to be considered impossible either as 
 regards the nature of the disease, or the organ 
 
PREFACE. XIX 
 
 affected." It is singular that a medical man 
 should deny the curability of Phthisis, after ex- 
 cepting "the small proportion of cases in which 
 the tuberculous deposit is confined within narrow 
 limits. " If we believe this writer, Consumption is 
 not curable— but there are exceptions it seems. 
 Truly there are ; and had these cases of except- 
 ion been thoroughly investigated, and the process 
 by which they were effected diligently traced, the 
 instances of failure would long since have taken 
 their place, and have themselves become the ex- 
 ceptions. I speak confidently on this head, as my 
 experience warrants it. 
 
 The Doctor too, by some unhappy slip of 
 memory, is at variance with another writer, a co- 
 adjutor of his in the " Cyclopaedia of Practical 
 Medicine," for whom he professes a profound de- 
 ference. This gentleman, Dr. Carswell, observes 
 in his article on "Tubercle," speaking of Con- 
 sumption, " the important fact of the curability 
 of this disease has, in our opinion, been satisfact- 
 orily established by Laennec." And let me add 
 
XX PREFACE. 
 
 in the opinion of every one who has read the im- 
 mortal work of that great man— and understood 
 it. Dr. Clark, however, does not absolutely 
 deny the possibility of curing the disease, but 
 "damns with civil sneer." Cases of cure do 
 happen — rare exceptions. Ofcourse— rare enough 
 with those who do not know how to treat the dis- 
 ease. Rare and fortuitous, I grant, previously to 
 the appearance of my publication. Yet, although 
 his own treatment may be productive of anything 
 but satisfactory results, why not state with La- 
 ennec, that there is no valid reason, " either as 
 regards the nature of the disease, or the organ 
 affected," why Consumption should not be cured 1 
 Why so lachrymose, when his chief authority 
 holds out such hope '? 
 
 The above writer is " followed to the field" by 
 Dr. T. Davies; the motto to whose Lectures on 
 Diseases of the Chest might aptly be " ahandon- 
 natesperanzdvoi cli entratey This work seems to 
 be a synopsis of that of Laennec ; and is inferior 
 to Dr. Clark's, inasmuch as it is chiefly h^ri'owed 
 
PREFACE. XXI 
 
 from one authority, instead of from three or four. 
 But, on the one favorite point. Dr. Davies has de- 
 viated from his sworn guide still further than Dr. 
 Clark. The one is reluctant to admit the curabili- 
 ty of Consumption, allowing, however, that such 
 an event does occasionally happen ; the other bold- 
 ly proclaims, in the teeth of his exemplar, that it 
 is not curable. He speaks, I presume, from his 
 own experience : he may have been uniformly 
 unsuccessful, and hence his claim to be so positive. 
 Yet, incurable as he may have found the disease, 
 it is singular that after following Laennec with 
 almost servile idolatry, he should arrive at directly 
 opposite conclusions. Laennec supposed, and 
 truly, that he had not only discovered a series of 
 signs throwing the clearest light on the diagnosis 
 of Consumptive disease, but, that by establishing 
 its pathology on a broader and sounder basis, he had 
 proved the possibility of cure and paved the way 
 for important practical results. Dr. Davies, how- 
 ever, although he has lit his own rushlight, 
 
 (" And lights his farthing cantllo at tlic sun") 
 
XXH PREFACE. 
 
 at the lamp of that great man, and painfully picks 
 his steps by its assistance, suddenly extinguishes 
 it as he approaches his labours' end, and jumps 
 for safety into the Slough of Despond. ' Follow 
 Laennec,' he exclaims to his pupils, ' I can give 
 you no better guide ; but do not go straight to the 
 mark with him and attempt to cure Consumption ; 
 stop short and be warned by me,— for I have en- 
 joyed a liberal'allowance of failure, — that it cannot 
 be cured.' 
 
 Another of our medical illuminati. Dr. Latham, of 
 St. Bartholomew's, hascondescended to complete 
 the triumvirate, and has just published his version 
 of Laennec, under the title of "Lectures on Sub- 
 jects connected with Clinical Medicine." After 
 an introduction, in which he informs us that sur- 
 gery is more popular than medicine, " because it 
 is easier," he proceeds to treat of the signs afford- 
 ed by auscultation. These he divides into the 
 moist and dry, and appears to conceive, that he 
 has thus made a novel and important distinction. 
 So in fact he would, did he not labour under the 
 
PREFACE. XXIII 
 
 disadvantage of having been anticipated by La- 
 ennec. As a specimen of the innocent method in 
 which he assumes the tone of a discoverer, I quote 
 his conjectures as to the causes productive of the 
 sign which is termed sihilus. " Sibilus may then, 
 (in' spasmodic asthma,) if ever, be truly called a 
 dry sound. But I am not sure that the sibilus di- 
 rectly results from the mere condition of dryness ; 
 I doubt whether simple dryness alone would na- 
 turally produce it. In consequence of its dryness 
 the mucous membrane may lose its elasticity, and 
 become to a certain degree unyielding ; or it may 
 undergo wrinklings, or puckerings, at various 
 spaces; or its general tumefaction may produce a 
 narrowing of the smaller tubes, and thus present 
 obstacles to the passage of air, and impart to it 
 new vibrations ; and hence the sibilus." Let us 
 see what Laennec said touching the same sign 
 some eighteen years before. According to this 
 writer, that variety of the dry sibilous rhonchus 
 which is " more strictly sibilous, is probably oc- 
 casioned by a local contraction of the smaller 
 
XXIV PREFACE. 
 
 bronchi, from thickening of their inner membrane." 
 This short sentence is the key note on which Dr. 
 Latham rings the ampHfications, which he ushers 
 in with the modest "lam not sure that," "I 
 doubt whether," until he arrives- at Laennec and 
 the root of the matter with his " it may undergo 
 wrinkhngs, or puckerings, at various spaces, or 
 its general tumefaction may produce a narrowing 
 ofthe smaller tubes." Proceeding to illustrate 
 the said sibilus still further, he describes the case 
 of a little boy, in whose chest a shrill sibilus had 
 taken place of the natural respiratory murmur, — 
 " wherever you applied your ear to the chest, you 
 might fancy you heard the piping and screaming 
 of a nest of unfledged birds." How delightfully 
 this simile is brought in as a new and felicitous 
 illustration with the "you might fancy:" and 
 how poetically has he decorated the dry, matter 
 of fact, detail of Laennec, who writes — " the dry 
 sibilous rhonchus is of very various character. 
 Sometimes it is like a prolonged whistle, flat or 
 sharp, dull or loud ; sometimes it is very mo- 
 
PREFACE. XXV 
 
 mentary, and resembles the chirping of birds." 
 Truly, Dr. Latham deserves credit for his inge- 
 nuity. It would be amusing enough to show, 
 page by page, how dexterously the Baitholomew 
 professor twists Laennec into a new shape. 
 Sometimes he swells a few words into a mass of 
 well-rounded periods ; at others, he reverses the 
 process, and compresses, with crushing effect as 
 to sense and information, a series of nicely evolv- 
 ed deductions into a few disjointed sentences. In 
 fact, he has put Laennec into his literary mill, 
 ground him down, and then leavened him with 
 his own leaven, with that peculiar skill in the 
 process which might excite the envy of a "book- 
 seller's hack." His art in appropriating good 
 things, is only to be equalled by his aptitude to 
 spoil them while in the act of " conveying." 
 
 Dr. Latham is equally guiltless with his co- 
 mates, of enlarging the boundaries of science ; 
 and is also equally anxious to announce his want 
 of success in the treatment of Consumptive dis- 
 ease. He has very wisely devoted a volume to 
 
XXVI PREFACE. 
 
 shew thfe marvels he can achieve by means of 
 auscultation, with what precision he can calculate 
 the ravages of the disease, and oh ! the art of sink- 
 ing,— how utterly unable he is to cope with it. 
 "AH the world," he exclaims, "is asking us 
 whether Consumption he curable \sic in original.) 
 Indeed ! It has come to this, has it "? I am per- 
 sonally obliged by the confession. Dr. Latham 
 has now only one more step to make, and he will 
 discover some fine morning that Consumption is 
 Curable. The pressure from without will jog 
 him and his brethren on. All the world asks the 
 question ! This coincides with my own opinion ; 
 and I find people come a long way to ask it. I 
 have had individuals of this inquisitive turn of 
 mind, who have come from Sweden, from Russia, 
 from both the East and West Indies, and from other 
 distant quarters, to ask the aforesaid question, 
 and, they were satisfied with my answer; al- 
 though I must think they would have repented 
 their trouble had I given them Dr. Latham's. 
 Dr. Latham is much more elaborate than his 
 
PREFACE. XXVII 
 
 non-curing coadjutors, in displaying his disbelijef 
 of the curabiHty of Consumption. He reasons I 
 at some length on this, to these gentlemen, all 
 important point. So eager indeed are the trio 
 to prove to their patients their inability to cure 
 Consumption, that I verily believe they wottld 
 willingly ^contract the disease, were it possible, 
 and die in order to support their doctrine. They 
 would be cheerful martyrs to their professional 
 faith, and perish honorably secundum artem. 
 
 But to return to Dr. Latham's reasoning. It 
 is so exquisite a thing of the kind, that I should 
 do him injustice, were I not to give it in his 
 own words. "In examining by dissection the 
 bodies of those who die of Pulmonary Consump- 
 tion we occasionally find the traces of a vomica 
 healed. But in those who have not died of any 
 pulmonary symptoms,](die of symptoms !) and who 
 were never known during their lives to have any 
 symptoms apparently ; the same evidences have 
 been found after death of what was once a vomica. 
 This is a cure, or tantamount to a cure, but it 
 
XXVIII PREFACE. 
 
 was a Consumption which nobody knew to exist." 
 Proceeding then to the question which he des- 
 cribes all the world to be asking, he rejoins " itis 
 a mockery to answer ' Consumption is a curable 
 disease;' because, forsooth, its entire process from 
 beginning to end — its formation, progress, cure, 
 may be secre^/^ transacted within the body with- 
 out our knowing, or suspecting anything about 
 it." This is superlative. I meet a person whose 
 face is seamed with the scars left by small pox, 
 and because I did not see him when labouring under 
 the disease, I deny that he ever had it. I am in 
 company with another who has lost an eye, and 
 because I did not witness the loss, I assert that it 
 is in his head. A patient dies, as is supposed, of 
 eruptive fever, for which he has been treated, but 
 dissection proves that pneumonia was the more 
 immediate cause of death ; still as the pneumonia 
 was not discoverable during life — ergo^ says Dr. 
 Latham, exist it did not. In short, according to 
 this writer's newly invented logic, there can be 
 no such thing as latent disease because it is "se- 
 
PREFACE. XXIX 
 
 cretly transacted within the body," and as he in- 
 genuously adds, *' without our knowing or sus- 
 pecting anything about it"— a circumstance which 
 an ordinary man would suppose implied in the 
 word secretly. 
 
 Should we be rash enough to affirm that Dr. 
 Latham exists without brains, because no traces 
 of them are at present discernible "? Far from us 
 be such rigid logic— we will not test the Doctor 
 by his own rule. 
 
 Did I leave the above quotations from Dr. La- 
 tham's work as they now stand, I should act, as 
 Dr. Latham has done by the question at issue, 
 most disingenuously. I will quote his special 
 pleading verbatim et literatim^ and give him all 
 the benefit of it. By the abstract made above, 
 CTcry word of which is his— although separated 
 from the context, I have been enabled to shew 
 the naked folly of his reasoning. The context 
 will render manifest either his disingenuousness, 
 or, if written in good faith, his ignorance. 
 
 " Does Consumption ever admit of cure'? If 
 
XXX PREFACE. 
 
 ever, it must surely be when it occurs in the form 
 which we are now considering. — (i. e. in the form 
 termed by Dr. Latham unmixed phthisis)— het 
 us, therefore, now give a few moments to this in- 
 teresting question. A vomica certainly does admit 
 of reparation so far as not to be a vomica any longer, 
 but not so far as to leave behind it no trace with- 
 in the lungs. It leaves behind it a scar— that is, 
 the disease ceases in the part, but the part is not 
 restored to the exact condition in which it was 
 before the disease began. In examining by dis- 
 section the bodies of those who die of Pulmonary 
 Consumption, among many existing Vomicae we 
 occasionally find the traces of a Vomica healed. 
 At the apex of the lung we find an indentation, 
 and descending from it, for half an inch or an 
 inch, a thick perpendicular line of tough liga- 
 mentous substance. Sometimes this substance, 
 by being pulled asunder, is discovered to contain 
 the remains of a cavity, and sometimes not. But 
 what imports this reparation of a single Vomica, 
 if so many besides still exist '? A reparation of a 
 
PREFACE. XXXI 
 
 twentieth part of the existing disease cannot be 
 called a cure. But in those who have not died 
 of any pulmonary symptoms, and who were never 
 known during their hves to have had any symp- 
 toms apparently phthisical, the same evidences 
 have been found after death of what once was a 
 Vomica, but no existing Vomica together with it. 
 This is a cure, or tantamount to a cure. It is 
 as much a cure as when a single scrofulous cer- 
 vical gland goes on to suppuration, and heals 
 with a scar. A single Vomica, you may say, is as 
 much of the essence of Consumption as a hundred ; 
 and if the morbid structure (no matter how small) 
 in which the disease essentially consists be re- 
 paired, the disease is cured ; that is, the Con- 
 sumption is cured. But it was a Consumption 
 nobody knew to exist. Now all this may be 
 very fine reasoning ; but it does not meet the 
 plain meaning of the inquiry, whether Consump- 
 tion be curable. It is not proof enough to com- 
 mon sense of its being so, that a few isolated Vo- 
 mica?, which gave no sign of their existence, 
 
XXXII PREFACE. 
 
 should have undergone reparation. All the world 
 is asking us whether Consumption be curable 1 
 Indeed, all the world is interested in the ques- 
 tion : for there is hardly a family into which Con- 
 sumption, sooner or later, does not enter : and 
 when a man makes the inquiry (as it were) specu- 
 latively, or indifferently, he has most likely a 
 real practical interest in it at home. He says, 
 *Is Consumption a curable disease '?' But he would 
 say, * I have a wife or a child, a brother or a sister, 
 who is decidedly consumptive ; is there the least 
 possible hope left me that they can recover V To 
 the question proposed with such intent, it is a 
 mockery to answer ' Consumption is a curable dis- 
 ease' ; because, forsooth, its entire process from 
 beginning to end — its formation, progress, cure — 
 may be secretly transacted within the body with- 
 out our knowing or suspecting anything about it. 
 If you ask me, as a Physician, whether I have 
 ever had experience of a perfect and satisfactory 
 recovery taking place, where there have been all 
 the best known popular symptoms, which (as far 
 
PREFACE. XXXI II 
 
 as they go^ no Physician could possibly say were 
 not those of Phthisis '? I answer, 'Often.' But 
 if you ask me whether I have ever had experience 
 of the Hke perfect and satisfactory recovery where 
 there were all these popular symptoms, and, 
 withal, the conditions proper to Phthisis, ascer- 
 tained by auscultatory signs to exist beyond a 
 doubt within the lungs % I answer, ' Hitherto, 
 never.' What shall we say then 1: How shall we 
 answer the popular question in the popular sense, 
 and still answer it truly '? We cannot say that Con- 
 sumption is curable ; but we can say, and truly, 
 that there are cases of mjai^^ec/ Consumption which 
 put on such anaspectoftherea/disease, that they 
 are with difficulty distinguished from it, yet have 
 not its essence. These are all within the possibili- 
 ty of cure." p. 254, et seq. The chain of reason- 
 ing, such as it is, in the above, is substantially 
 the same as in the abstract first given — its gist 
 being the consoling discovery that whatever we 
 are ignorant of does not exist. But there is this 
 addition ; that traces of a healed vomica are said 
 
XXXIV PREFACE. 
 
 to be found among existing vomiccB in the bodies 
 of those who die of Pulmonary Consumption, but 
 to exist in a solitary state when occurring in 
 those who were never known during their Hvesto 
 have had any symptoms apparently phthisical. 
 The interpretation designed by the Doctor to be 
 put on this statement is, of course, that the vo- 
 mica in the one case belongs to real Consumption, 
 and in the other is accidental. 
 
 In Dr. Clark's treatise, I find so apt an illus- 
 tration of one probable cause of Dr. Latham's 
 egregious errors (and, indeed, of his own limited 
 views) that I am tempted to transcribe it. He 
 observes, "it often happens that a patient pre- 
 senting all the indications of tuberculous disease, 
 is said, and believed to be, merely threatened 
 with disease of the lungs, or to have an affection 
 of the trachea or bronchi ; and it is commonly 
 added that 'with care, all will do well.' This 
 arises from the habit of trusting to symptoms 
 alone for a knowledge of disease, neglecting pa- 
 thological anatomy^ by which the physician is 
 
PREFACE. XXXV 
 
 enabled to connect the external phenomena of 
 disease with the morbid condition of the organ." 
 
 Even were the facts as Dr. Latham states, 
 his inferences would be supremely absurd ; but 
 being utterly unsupported by the results of dis- 
 section, they must be put forward either design- 
 edly or ignorantly. To appeal to my own expe- 
 rience only, would be to rebut assertion by asser- 
 tion. I shall therefore adduce proof of this 
 accusation from the pages of Laennec, Andral, 
 and Louis. 
 
 Dr. Latham has, indeed, found it convenient to 
 copy Laennec in all save his conclusions, to which 
 I shall presently draw his attention. However, 
 I shall first quote Laennec's remarks on the cases 
 he describes in his chapter on Phthisis Pulmo- 
 nalis : for the cases themselves, I must refer the 
 reader to his " Traite de V Auscultation Mediate'' 
 He writes then as follows: "In my opinion, the 
 foregoing cases prove that tubercles in the lungs 
 are not in every case a necessary and inevitable 
 cause of death, and that after an ulcerous exca- 
 
XXXVI PREFACiii. 
 
 vation has been formed by their softening down, 
 a cure may take place in two ways : in one, by 
 the conversion of the ulcer into a fistula, lined, 
 hke all those which may exist without injuring 
 the general health, by a membrane analogous to 
 the tissues of the healthy body ; in the other, by 
 means of a cicatrix, more or less complete, and 
 consisting of cellular, fibro-cartilaginous, or semi- 
 cartilaginous substance. The identity of the 
 cavities recorded in the 19th, 20th, 21st, 22nd, 
 and 24th cases, leaves no doubt as to the simila- 
 rity of their origin, and their production by the 
 softening of tubercles which had occupied their 
 place. The 19th case may be looked upon as a 
 cure, since no more tuhercles existed in the lungs. 
 The same may be said of the 25th, since there was 
 hit one small tubercle met with. The subjects of 
 the 20th, 21st, and 22nd cases would undoubted- 
 ly have undergone relapses, since there were 
 crude, or miliary tubercles in their lungs which 
 must have been subsequently developed ; al- 
 though this might have been protracted to a late 
 
PREFACE. XyX-VII 
 
 period, and have still left the hope of a long life. 
 It has been truly remarked by Bayle that crude, 
 and in particular miliary tubercles, often exist for 
 a series of years without seriously affecting the 
 health." A little fiirther on he writes, " Pulmo- 
 nary fistulas and cicatrices are extremely common 
 * * * * no one can follow a six months' course of pa- 
 thological anatomy without meeting with then)." 
 (vol. II. pp. 98, 9, 100.) Will the learned pro- 
 fessor at Bartholomew's step forward with his 
 "we occasionally find," and deny this— Latham 
 versus Laennec '? 
 
 The Doctor has indeed very coolly reversed 
 the order of Laennec's reasoning. He infers, as 
 has been seen, that since cicatrizations are found, 
 at one time, combined with cavities and tuber- 
 culous deposits in the lungs of those who have 
 exhibited symptoms of Phthisis, and, at another, 
 without these adjuncts in the lungs of those who 
 are said not to liave betrayed such symptoms, the 
 cicatrices in the last are lusiis natures^ chance crea- 
 tions, " delusions of the evil one." Now Laennec 
 
XXXVIII PREFACE. 
 
 argues thus : " Notwithstanding I have fourid 
 tubercles, in different stages of development, 
 in most lungs that have presented pulmonary- 
 fistulas or cicatrices, which would presume the 
 certain, although perhaps remote return of the 
 disease; yet, as in cases 19 and 25, I have like- 
 wise frequently met with the same marks of 
 cure, in subjects who have been entirely free 
 from tubercles in the lungs or any other organ. 
 In such cases it may, perhaps, be supposed that 
 the cicatrices result from abscesses produced by 
 inflammation of the lungs, and not from tuber- 
 cles. Such a supposition, however, would be 
 perfectly gratuitous. Whoever is in the habit 
 of constant post-mortem examinations^ may trace 
 day hy day as it were the formation of the semi- 
 cartilaginous membrane on the surface of tu- 
 berculous cavities ; but the production of a col- 
 lection of pus, or of a true abscess in the lungs 
 by inflammation, although not an impossibihty, 
 is yet so rare as to be utterly insufficient to 
 account for so common an occurrence." (Vol. 
 
PREFACE. XXXIX 
 
 II. p. 104, 5.) Dr. Latham and Laennec are 
 thus at issue both as to facts, and as to inferences 
 from those facts. It does not require the techni- 
 cal knowledge of the practitioner to decide be- 
 twixt them. The common sense of the general 
 reader may be safely entrusted with the delivery 
 of the verdict. 
 
 The conclusions drawn by Laennec from the 
 experience of his vast practice, from his patholo- 
 gical investigations, and from the extensive field 
 of observation laid open by his immortal discove- 
 ry, are passed over by Dr. Latham ; or rather, 
 are flatly contradicted by the " learned Theb an." 
 This, too, as in the case of Drs. Clark and Davies, 
 is the more astounding, as Laennec has furnished 
 the staple of his book. However '■'■majora ca- 
 namus' — Laennec thus sums up : "I here con- 
 clude what I had to say on the possibility of 
 curing Pulmonary Phthisis ; and trust the im- 
 ])orlance of the subject will excuse the length of 
 my observations. With regard to the facts I 
 have brought forward to prove its curability, I am 
 
XL PREFACE. 
 
 convinced that every attentive observer will fre- 
 quently meet analogous ones by employing the 
 same means — mediate auscultation and dissec- 
 tion. My experience makes me believe them to 
 be extremely common. I met with the cases I 
 have adduced in the course of a few months ; I 
 have since seen many others in the same period ; 
 and it appears to me much more rational to refer 
 this to their frequency, than to my having by 
 chance fallen upon such a collection of cases that 
 are naturally rare. I have mentioned my having 
 often observed similar appearances formerly, 
 without paying much attention to them ; as in 
 the natural sciences, an object may be daily seen 
 and yet remain unknown, unless our notice be 
 particularly directed to it. A gardener is sel- 
 dom acquainted with a tenth part of the plants 
 growing in the very ground he cultivates ; and 
 to borrow a comparison from medical science it- 
 self, an anatomist may be utterly ignorant of the 
 organic changes which occur in the human body, 
 notwithstanding he sees them every day while 
 
PREFACE. XLl 
 
 tracing the blood-vessels, or the nervous filaments. 
 From my own experience I can affirm that a man 
 in the daily habit of opening dead bodies, may 
 nevertheless partly forget descriptive anatomy. 
 To conclude, the cure of Consumption, when the 
 lungs have not been entirely disorganized, ought 
 not, I think, to be considered at all impossible, 
 either as regards the nature of the disease, or of 
 the organ affected. Pulmonary tubercles are in 
 no wise different from those found in scrofulous 
 glands ; the softening of which is, we know, 
 often followed by a cure. On the other hand, the 
 destruction of a 'part of the substance of the 
 lungs is not necessarily mortal ; since even 
 wounds of this organ are frequently healed, not- 
 withstanding their distressing complication with 
 the perforation of the walls of the chest, and the 
 admission of air into the pleura." (vol. ii, p. 
 110, 1, 2.) 
 
 To illustrate the difference betwixt the can- 
 did allowances made by a man of genius, even 
 when his experience has been contrary to the 
 
XLII PREFACE. 
 
 existence of a reported fact, and the supercilious 
 gainsayings of a sciolist, I cannot do better than 
 quote the following admission made by Louis. 
 He is closing his remarks on a case in which he 
 had met with an excavation of middle dimen- 
 sions, lined by a false membrane of moderate 
 consistence a quarter of a line in thickness, and 
 lying upon healthy pulmonary tissue: "But 
 may it not be asked with some show of pro- 
 bability, whether this excavation were really the 
 product of tubercles and if the patient had 
 phthisis^ since no tubercles or grey granulations 
 existed in the lungs ; and there were no ulcera- 
 tions in the larynx, trachea, or intestines — alter- 
 ations of such frequent occurrence in this affec- 
 tion '? To this I would reply, that the purulent 
 matter of the excavation was identical with that 
 commonly found in tuberculous cases; that the 
 false membrane had equally analogous properties; 
 lastly, and the fact is a powerful one, a cervical 
 gland was evidently tuberculous : and, in the 
 course of these researches, it will be seen that I 
 
PREFACE. XLIII 
 
 have never met with the tuberculisation of 
 lymphatic glands, except in the Consumptive. 
 i, ^, i, ^, To conclude what I have to remark on 
 the subject of tuberculous excavations, I may 
 add that I have not met in a single instance 
 with cavities, surrounded by healthy pulmonary 
 parenchyma, communicating with the bronchi, 
 and lined with a light grey , semi-cartilaginous, 
 semi-opaque false membrane, as tuberculous ex- 
 cavations of long standing are. M. Laennec, 
 however, has found them in subjects who had 
 presented the symptoms of Phthisis during life, 
 for a longer or shorter time. Judging, too, from 
 their structure, it would be difficult not to believe 
 that their formation was preceded by tubercu- 
 lous softening. This fact, indeed, receives con- 
 firmation from the foregoing case ; since, in this, 
 as well as in the other cases to which I allude, 
 there was only a solitary excavation ; the sub- 
 stance of the lungs was healthy ; and it may be 
 concluded that if the individual's life had been 
 prolonged for some weeks, or months, the false 
 
XLIV PREFACE. 
 
 membrane which lined the cavity would have 
 presented the above-mentioned characters." 
 
 How different this from the animus^ how wide- 
 ly different from the reasoning powers of the man 
 who writes, " but it was a Consumption which 
 nobody knew to exist." How opposite the spirit 
 of the patient searcher after truth, and of the 
 sophist who seeks to quibble it away. Thus we 
 have Dr. Latham versus Louis ! 
 
 Proceeding now to the author from whom Dr. 
 Latham has taken the best point in his argument, 
 I will give him an answer, drawn from the same 
 source, to his " Consumption which nobody knew 
 to exist." Andral then writes as follows : "Look- 
 ing collectively at the facts now cited, the result 
 would seem that cavities of greater or less size 
 which have at some period existed in the pulmo- 
 nary parenchyma, may at times perceptibly di- 
 minish, and even be completely obliterated. La- 
 ennec has described excellently the progress of 
 this obliteration ; and this being a well-ascer- 
 tained fact, the question may a7'ise as to whether 
 
PREFACE. XLV 
 
 they were tuberculous excavations. To this we 
 may answer in the affirmative'' (Andral, Cli- 
 nique Medicale.) The point which I have just 
 said Dr. Latham has conveyed from this author, 
 is founded on the assumed fact that cicatrisations 
 are generally observed existing simultaneously 
 with tuberculous deposits; from which Andral 
 infers " we must not confound the certain cure of 
 a cavity, with the cure of the tuberculous affec- 
 tion itself." This is converted by Dr. Latham 
 into the similar, but exaggerated proposition — 
 " what imports this reparation of a single vomica, 
 if so many besides still exist 1 A reparation of 
 a twentieth part of the existing disease cannot be 
 called a cure." Had he stopped at this conver- 
 sion it would have been wise. But he must im- 
 prove it by his discovery, in the first place, that 
 the Consumption in such cases is not known to 
 exist ; and, in the second, by his still greater dis- 
 covery that whatever is unknown does not exist. 
 This, indeed, is the doctrine of the materialists ; 
 and a sorry one it is. 
 
XLVI PREFACE. 
 
 Dr. Latham I have ah-eady answered. In reply 
 to Andral's more feasible reasoning it is sufficient 
 to observe, that if a single tubercle may be cured, 
 the same process may obliterate an indefinite 
 number. 
 
 It may be urged that I have misunderstood, or 
 misrepresented Dr. Latham's argument; that he 
 does not deny the existence of Consumption in 
 the cases in question, but our knowledge of its 
 existence. What then becomes of auscultation 1 
 Or does he argue that because a case is cured 
 unknown to us, a cure, under similar circumstan- 
 ces of affection, can never be effected with our 
 knowledge, or by our guidance ! I enquire of 
 the learned professor by what means the science 
 of medicine has arrived at its present state. Is 
 it by seeking in the dead body for an explanation 
 of what has been going on in the living '? And if 
 so, to what end is this investigation instituted ; 
 to learn the means of cure by what we see, or to 
 reject the lesson offered by nature as an insult to 
 art? 
 
PREFACE. XL VII 
 
 I had previously shewn that his facts were un- 
 tenable. I have now, I trust, proved that his 
 arguments understood in any sense, and with 
 every advantage of quibbling to boot, are equally 
 groundless. However, he is, I dare say, correct 
 in one particular— his want of success in Con- 
 sumptive cases. 
 
 I have entered at this length into a considera- 
 tion of the three writers who have published 
 since the first edition of my ' Consumption Cura- 
 ble,' not from any weight I attach to their 
 authority, or from any doubt of the validity of my 
 own doctrines, but from a sense of duty. They 
 would contract ; I would enlarge the boundaries of 
 science. Their opinions are at variance with the 
 positive testimony of pathological anatomy ; mine 
 in accordance with it. They belie the art they 
 practise ; I give it all honour. They refuse hope 
 to the sufferer ; I certainly would not awaken 
 it in vain, but as certainly should deem it criminal 
 to crush it when its realisation is countenanced 
 by nature, and effectuable by art. 
 
XLVIII PREFACE. 
 
 It must be startling to the non-medical reader, 
 at least, to be assured that it is next to an im- 
 possibility to open a dozen bodies without meet- 
 ing with positive proof of the curability of Con- 
 sumption. Such, however, is the fact. Yet here 
 are three gentlemen, it will be urged, physicians 
 of some standing and of decent repute, Drs.Clark, 
 Davies, and Latham, each of whom too is attach- 
 ed to some public institution, who positively deny 
 that this disease can be cured. Is it to be sup- 
 posed that if the proofs furnished by dissection be 
 so common, they have never met with them'? 
 To this it may be answered, that there are few, 
 very few medical men who trouble themselves to 
 open bodies, and that not a tithe of these few rigor- 
 ously examine them. I might rest my case here, 
 and the really scientific would fully understand 
 me. But to bring conviction home to the general 
 reader, who might imagine I was merely opposing 
 theoretical opinions by theory of my own, I shall 
 bring forward the testimony of a gentleman, fre- 
 quently eulogized by Dr. Clark and late medical 
 
PREFACE. XLIX 
 
 writers, who is, I imagine, as eminent a patholo- 
 gist as any in this country— no excessive praise 
 by the bye— and who, though he has not added 
 that I am aware of to our stock of knowledge, 
 has at least reported truly the appearances with 
 which his dissections have made him acquainted. 
 Dr. Carswell, then, writes as follows: — 
 
 " The important fact of the curability of the dis- 
 ease has, in our opinion, been satisfactorily estab- 
 lished by Laennec. All the physical signs of 
 tubercular phthisis have been present^ even those 
 
 WHICH INDICATE THE EXISTENCE OF AN EXCAVATION, 
 
 yet the disease has terminated favourably^ and 
 its perfect cure has been demonstrated by the 
 presence of a cicatrioe in that portion of the lung 
 in which the excavation had formerly existed. 
 i,i,i,i. There must be few practical pathologists 
 who will not consider these anatomical facts as 
 evidence that tuberculous phthisis is a curable 
 disease. No objection has been brought forward 
 calculated in the slightest degree to invalidate the 
 conclusion to which we have been led by the re- 
 
PREFACE. 
 
 peated observation of the changes we have de- 
 scribed,— viz. : that these changes are positive 
 indices of the removal of the material element of 
 the disease, and also of the cure of the lesions of 
 structure to which it gives rise, even at an ad- 
 vanced period of its progress. ^ * *+ We cannot 
 avoid repeating the fact, that pathological ana- 
 tomy has, perhaps, never afforded more conclu- 
 sive evidence in proof of the curahility of a dis- 
 ease than it has in that of tubercular phthisis'^ 
 Cyclopaedia of Practical Medicine, {^Art. Tuber- 
 cle,) p. 265, 6, 1. 
 
 In order to give the general reader a clue by 
 which he may unravel some of the workings of 
 our medical press, I subjoin the following anecdote. 
 Dr. James Johnson, Editor of the Medico-Chi- 
 rurgical Review, sent some few months since a 
 medical work lately published in Germany to 
 Dr. Spillan, a contributor to the above periodical, 
 begging him to furnish a review and analysis of 
 its contents. Dr. Spillan, of course, proceeded to 
 his task, and at first conceived the work to be 
 
PREFACE. LI 
 
 full of promise for his purpose, but was per- 
 plexed to find, on further reading, that the Ger- 
 man physician advocated in the strongest terms 
 the views and plan of Treatment laid down by 
 Dr. Ramadge, of London. For further illustra- 
 tion, the German reader was referred to the 
 translation of " Consumption Curable," as to a 
 publication well known throughout Germany. 
 This put the climax to Dr. Spillan's perplexity; 
 and it was quietly resolved that it would be the 
 more prudent plan to give no notice of the work. 
 
INTRODUCTION. 
 
 I AM induced, from my long connexion with 
 the Infirmary for Asthma, Consumption, and other 
 Diseases of the Chest, the only institution of the 
 kind in this country, and as far as I have been 
 able to ascertain, in Europe, to publish my opinions 
 on the treatment of Pulmonary Consumption — a 
 disease unfortunately too well known to the in- 
 habitants of this clime, by its prevalence and fa- 
 tality. Having been thus for above fifteen years 
 placed in a situation which has given me unrival- 
 led opportunities of seeing numerous cases of this 
 disease, I conceive it a duty I owe the public, 
 through whose philanthropic aid the above charity 
 has been long and liberally supported, to present 
 them with the fruits of my labours, and unreser- 
 vedly to state how far medical art is capable of 
 arresting a disease to which nearly one-third of 
 the adult population falls a sacrifice. 
 
2 INTRODUCTION. 
 
 The results which have hitherto attended the 
 treatment of phthisis, have added but Httle to the 
 reputation of the medical profession. I am fully 
 satisfied, however, from the experience of years 
 in treating this important malady, as well as from 
 the deductions of unremitting pathological re- 
 search, that it is in our power to adopt a line of 
 practice more scientific, and successful, than any 
 hitherto employed. 
 
 Though great attention has been bestowed by 
 several distinguished Continental writers, especi- 
 ally by Laennec, Andral, and Louis, on the phy- 
 sical signs and morbid appearances of consump- 
 tion, and notwithstanding cases have been mi- 
 nutely detailed by them in which nature has 
 effected a cure, still they seem to me to have had 
 little idea that we can do more than relieve indi- 
 cations purely symptomatic. 
 
 A modern writer on consumption in this coun- 
 try, the late Dr. Young of St. George's Hospital, 
 who did not pay that attention to morbid anatomy 
 so commendable in our Gallic neighbours, but 
 whose opportunities of treating the disease were 
 considerable, favours us with an opinion as to its 
 curability, which is very discouraging. He says, 
 " It is probable that without assistance, not one 
 case in a thousand of the disease would recover ; 
 
INTRODU CTION . 3 
 
 and with the utmost power of art, perhaps, not 
 more than one in a hundred will be found curable." 
 It is my intention, in the succeeding pages, briefly 
 to shew that this statement is unfounded in fact ; 
 and that medical treatment has, in not a few in- 
 stances, tended to prevent rather than advance 
 recovery. I trust, too, I shall demonstrate, in 
 the histories of some of my cases, that recovery 
 has been owing in a great measure to the super- 
 vention of some catarrhal disease, occurring spon- 
 taneously, or which has been contracted, after 
 the failure of remedial agents, by an apparently 
 imprudent exposure to cold. 
 
 The reader will probably learn with surprise, 
 that no inconsiderable number of catarrhal and 
 asthmatic disorders are, indeed, the sequelae of 
 the disease, which forms the subject of this work, 
 more or less perfectly cured. Had the learned 
 Doctor, whose name I have recently quoted, 
 been at the pains to investigate the primary 
 symptoms of such disorders, he would have found, 
 in many instances, that they displayed all the 
 common symptoms of pulmonary consumption; 
 and had this hospital physician been accustomed 
 to the examination of dead bodies, he would have 
 discovered, in more than one-fourth of the adult 
 subjects examined after death, cicatrizations indi- 
 
4 INTRODUCTION. 
 
 cative of cured consumption ; and on finding these 
 appearances, had he enquired of some near rela- 
 tive of the deceased if the individuals, at any 
 period of their lives, had for a time expectorated 
 blood — had been troubled with indomitable cough, 
 night-sweats, diarrhoea, with emaciation of the 
 body — or had been regarded by their medical at- 
 tendants as consumptive, his opinion as to the 
 curability of phthisis would probably have been 
 more favorable. 
 
 It is, indeed, strange that medical men have 
 not noticed the non-liability of the asthmatic in- 
 dividual to pulmonary consumption ; and that 
 various species of catarrh are the instruments by 
 which nature chiefly arrests that disease. It has 
 been observed by me for years past, and on many 
 occasions I have particularly remarked to my pu- 
 pils, that asthmatics (I mean those persons whose 
 lungs are emphysematous), however long exposed 
 to circumstances that favour the tubercular deve- 
 lopment in the lungs, never become consumptive. 
 Indeed I have long found, and it is a remarkable 
 fact, that, whenever the general health has been 
 impaired by some ailment of a chronic and even 
 incurable nature, no phthisical state supervenes, 
 (which is unhappily in too many cases the more 
 immediate cause of death,) provided the individual 
 
INTRODUCTION. 5 
 
 have a voluminous and catarrhal state of the 
 lungs. 
 
 From the numerous proofs, dissection has 
 afforded me, of the asthmatic state of the lungs in 
 persons, who, having recovered from consumption, 
 have died from some other cause, I am induced 
 to recommend the early employment of artificial 
 means for the healing of ulcerous phthisis. After 
 the careful examination of at least three thousand 
 dead bodies, and after having had under my care 
 many thousand consumptive cases, my fixed 
 opinion is, that ulcers of the lungs are most effec- 
 tually cured, and a fresh formation of tubercles 
 prevented, by an expansion of the vesicular struc- 
 ture of the lungs ; which it will be seen hereafter 
 is, in many instances, brought on by chronic ca- 
 tarrh. Before tuberculous excavations have taken 
 place, and even after their existence is ascertain- 
 ed by stethoscopic signs, there is an absence, ex- 
 cept towards the close of the disease, of any 
 catarrhal affection, or at least its continuance is 
 only of short duration. I know this statement of 
 the non-existence of a catarrhal state accompany- 
 ing phthisis, is opposed to what appears in the 
 'excellent work of M. Laennec ; but I am satisfied 
 of its general correctness, and that extended 
 research will confirm my assertions. 
 
INTRODUCTION. 
 
 Independently of the extensive experience ob- 
 tained through my situation in the Infirmary for 
 Diseases of the Chest, I have enjoyed the advan- 
 tages afforded by no inconsiderable share of pri- 
 vate practice, as well as a wide field of inquiry 
 opened to me for several years at the Central In- 
 firmary and Dispensaiy, an institution established, 
 and in a great degree upheld, at my own expense 
 for all classes of diseases ; and where, from my 
 being physician to the first mentioned charity, I 
 had a more numerous assemblage than is gene- 
 rally seen in any institution of a similar kind, of 
 patients affected with some disease or other of the 
 chest. 
 
 It affords me pleasure to state, that my practice 
 at both Institutions has been attended by nume- 
 rous and intelligent classes of pupils, who had op- 
 portunities, equally with myself, of witnessing the 
 recovery of many consumptive persons, and of 
 ascertaining that peculiar condition of the lungs, 
 which I have already pointed out as invariably 
 occurring when a cure has been effected. 
 
GENERAL OBSERVATIONS 
 
 CONSUMPTION. 
 
 The mortality which annually takes place in this 
 country through consumptive disease is a melancholy 
 truism^ although its extent, familiar as it may appear, 
 is yet imperfectly known. The ordinary estimate, and 
 this as I shall subsequently prove far from an exag- 
 gerated one, gives one-fourth of the deaths yearly oc- 
 curring in this ever-varying climate, as consequent 
 on pulmonary consumption alone. Dreadful as this 
 amount seems, yet since, in numerous instances, patients 
 who have laboured under chronic diseases, as dyspepsia, 
 cancer, severe diseases of the bones, joints, &c., or 
 any other affection by which the general system may 
 have been deteriorated, owe the immediate cause of 
 their death, not to these complaints, but to the super- 
 vention of consumption, it is evident that the propor- 
 
a GENERAL OBSERVATIONS ON CONSUMPTION. 
 
 tion of one-fourth is much lower than the truth. Again, 
 considering the frequency of cases in which asthmatiC;, 
 or catarrhal;, complaints arise in the first instance from 
 consumption, which, though arrested or finally cured, 
 occasions these very complaints as its consequences, I 
 may fairly assume that the startling proposition I have 
 laid down is corroborated by fact. To individuals, 
 unaccustomed to extended pathological researches, my 
 assertions will, at first sight, undoubtedly appear rash 
 and hypothetical. The pathologist, who is deserving 
 of the name, will either from his own experience be 
 ready to acquiesce in my views, or at least will can- 
 didly endeavour, by further inquiries, to verify con- 
 clusions arrived at by the labours of years ; and this 
 at a sacrifice both of time and money, which none 
 but the very few who cultivate this branch of science 
 with the zeal anil assiduity its importance deserves, 
 are prepared to estimate. 
 
 In addition to the reasons I have just given, to show 
 the inaccurate statement presented by the bills of mor- 
 tality, I could enumerate numerous instances in which 
 the real, as distinguished from the apparent causes of 
 the patient's death, would offer conclusive testimony 
 to my position. Frequent are the cases in which an 
 individual will suddenly expire after violent expecto- 
 
GENERAL OBSERVATIONS ON CONSUMPTION. 9 
 
 ration of blood, and his decease be attributed to a 
 ruptured blood-vessel, when indeed this hemorrhage 
 has been consequent solely on latent and unsuspected 
 phthisis. My readers must not misconceive me to 
 state, that every case of sudden death from spitting of 
 blood arises from the little suspected presence of this 
 destroyer ; but that, in not a few instances, consump- 
 tion is indisputably the pre-existing cause. It were 
 easy to adduce -further arguments corroborative of the 
 soundness of my conclusions ; but I have, I should 
 think, stated sufficient to induce conviction of their 
 reasonableness, if not of their entire validity. 
 
 The first questions to be considered are, to what the 
 frequency of this disease is owing, how it is produced, 
 and in. what manner its ravages are unfortunately ex- 
 tended ? The prevalence of consumption has long 
 been attributed to the proverbial variableness of our 
 climate ; but the mode by which this operates upon 
 the constitution has not been clearly explained. It 
 seems to me, however, that the action of the climate 
 on the system may be reduced to three distinct heads, 
 each equally common, and equally fatal : checked per- 
 spiration, retaining the superfluous humours, and thus 
 vitiating the fluids of the body — constant fluctuations 
 of health, resulting from constant atmospheric changes 
 
 c 
 
10 GENERAL OBSERVATIONS ON CONSUMPTION. 
 
 — and dejection of spirits^ caused by mental troubles. 
 To these may be subjoined an unfortunate configura- 
 tion of the body^ consisting in an undue narrowness of 
 the chesty especially in its upper part, less observable 
 in foreigners than among ourselves. It is not neces- 
 sary to dilate upon the process by which checked per- 
 spiration lays the foundation of this dreadful malady ; 
 since it must be evident to the tyro, that when those 
 humours which pass off insensibly in a healthy state 
 of the body are retained, and the natural functions 
 thus disturbed, disease more or less extensive will in- 
 evitably ensue. With respect to the second of these 
 heads, it may to the ordinary observer appear super- 
 fluous to insist upon the ill effects generated by con- 
 stant change of weather, in persons not only of delicate 
 but even of robust habits ; still, obvious as these effects 
 are, it is not quite so apparent in what they consist, or 
 rather how they are produced. Now, when we take 
 into consideration the peculiarly delicate conformation 
 of the lungs, and their immediate susceptibility of 
 every alteration in the atmosphere, we at once arrive 
 at a resolution of the question. It is essential, in or- 
 der to maintain a healthy action and proper configu- 
 ration of the chest, that our inspirations should be 
 uniformly deep and full ; but, from the great inequality 
 
GENERAL OBSERVATIONS ON CONSUMPTION. U 
 
 of atmospheric pressure resulting from the constant 
 fluctuations of the weather the depth and fullness of 
 the inspiration are exposed to frequent diminution ; 
 and that play of the chest which is as requisite to 
 a healthy state of the lungs as exercise to muscular 
 development, is consequently subject to repeated checks. 
 Thus, owing to the want of due excitement, or, more ■ 
 strictly speaking, of proper exercise, the healthy 
 functions of the chest become deranged, its expan- 
 sion restricted, its action languid, and by degrees 
 its shape alters ; so that, instead of the bony com- 
 pages of the chest being forced boldly out in a some- 
 what semicircular form, and the sternum pushed 
 forward, the ribs fall in, drawing the breast-bone back- 
 ward to a position nearer the spinal column than is the 
 case in its natural movement. Now, to bear out and 
 verify the foregoing remarks, by showing how requisite 
 the expansible power of the chest is to the healthy 
 constitution of the lungs, I would state, as an almost 
 invariable law, that the commencement of pulmonary 
 consumption will be found to take place in the supe- 
 rior lobes of the lungs, owing doubtless to the small 
 extension of the upper ribs as compared with the more 
 complete movement of the lower. Another singular 
 instance, comfirmatory of the novel view I am now 
 
12 GENERAL OBSERVATIONS ON CONSUM:i?TION. 
 
 taking of the subject, is to be found in the exemption 
 of asthmatic patients from consumptive disorder. From 
 the pecuhar nature of their complaint, gasping for 
 breath, and forced to respire frequently, their lungs 
 are ever fully exercised ; and the expansion of the 
 chest, which follows as a necessary consequence, pre- 
 serves the sufferer free from the attacks of this still 
 more dreadful malady. To come to the third head- 
 depression of spirits, or mental anxiety, — we shall meet 
 with the same cause still producing the same effects. 
 The unfortunate who lives in the world as if he 
 were not of it, and to whom, whether his cares be the 
 offspring of disappointed ambition, hopeless love, or 
 ruined circumstances, the world displays nothing but a 
 cheerless blank — the tenant of the sick chamber, whose 
 distemper improper medical treatment has unduly pro- 
 longed, or confirmed ; in fine, all, who from any cause 
 labour under prostration of strength or general debi- 
 lity, are prone to fall victims to the insatiable tyrant, 
 consumption, for reasons precisely similar — inability to 
 take inspirations of depth sufficient to keep up the 
 necessary changes produced by the air on the venous 
 circulation. I have adverted to another cause, which 
 in my opinion contributes, at least in a degree, to 
 render the inhabitants of this country more peculiarly 
 
GENERAL OBSERVATIONS ON CONSUMPTION. 13 
 
 liable to phthisis — a malformation of the chest, which, 
 after repeated and numerous examinations, that I have 
 been enabled to make in considerable manufactories, 
 where I had the opportunity of comparing foreigners 
 of different countries with our own countrymen, would 
 seem to be more prevalent in England than elsewhere. 
 As a corrollary to the above remark, I may note, that 
 the children of consumptive parents generally inherit 
 the narrowness of chest, and depression of the ribs, 
 which characterize the victims of this malady ; and that 
 thus the range of its influence is indefinitely increased. 
 Following up the tenor of the preceding obser- 
 vations, we shall find that the benefit usually derived 
 from a sea voyage, or change of air, is not so much 
 due to the removal from an impure to a purer at- 
 mosphere, per se, as to the stimulating eifects pro- 
 duced on the respiratory organs, and the increased 
 energy of the muscular powers of the chest, on which 
 pulmonary dilatation is of course consequent. Let us 
 compare the muscular frame, expanded chest, and ro- 
 bust health of the mariner, or of the husbandman, with 
 the emaciated figure, contracted chest, and general 
 want of vigour betrayed by the artizan of manufactur- 
 ing cities ; and, on attentive consideration we shall 
 own that these differences are tiie consequences of the 
 
14 GENERAL OBSERVATIONS ON CONSUMPTION. 
 
 superior expansion and activity of the pulmonary ap- 
 paratus enjoyed by the former. 
 
 I must now advert to a very remarkable circum- 
 stance, upon the propriety of advancing which I have 
 long hesitated ; yet as it serves not merely to elucidate" 
 and strengthen, but to prove the truth of the pro- 
 positions advanced above, and is a phenomenon as 
 fatal in its effects as it is singular in a physiological 
 point of view, I should, after mature reflection, deem 
 myself the slave of a false and injurious shame were 
 I to withhold it. When we are the prey of other 
 disorders, the desires are deadened, and lie compara- 
 tively dormant ; but even in the last stage of con- 
 sumption the love of the sex seems to increase with 
 the decay of the strength, and the disease, while it 
 kills, is still propogated in the future life of an un- 
 born being. The same holds true, though in a less 
 degree, with respect to the gentler part of the crea- 
 tion. 
 
 Among the many distressing cases which the medi- 
 cal practitioner has to encounter, the premature and 
 rapid decline of the young of both sexes, more par- 
 ticularly of the weaker, is without doubt the most 
 painful. The fragility of woman's constitution, as 
 compared with that of man, the delicacy of her frame. 
 
GENERAL OBSERVATIONS ON CONSUMPTION. 15 
 
 her retired and domestic habits^ and the sensitiveness 
 of her mind, all contribute to render her a mark at 
 which consumption too frequently aims his deadly darts. 
 No sight is more painfully interesting than that of a 
 female on the very verge of womanhood, yielding 
 unconsciously to the fatal decree, and, like a drooping 
 flower, nipped untimely in the bud, graceful and lovely 
 to the latest breath. Independently of her greater 
 liability to pulmonary disease from delicacy of consti- 
 tution, there exist other causes which increase her 
 susceptibility in a fearful manner. The style of her 
 dress — which, in compliance with the fantastic usages 
 of fashion, seems devised to alter the free and grace- 
 ful outlines, traced by the hand of Nature, into a 
 wasp-like angularity, alike injurious to the tender struc- 
 t\ixp of her body and unpleasing to the eye of taste, — 
 has been often pointed out as a pregnant source of 
 disease, and justly so. It has been already observed, 
 that a full and free dilatation of the chest is absolute- 
 ly necessary to preserve the lungs in a sound and 
 healthy state ; but how can a female, her chest com- 
 pressed by an artificial support, the convexity of the 
 ribs incapable of being extended upwards and outwards, 
 and the sternum consequently without the power of 
 coming sufficiently forward, enjoy this requisite ex- 
 
16 GENERAL OBSERVATIONS ON CONSUMPTION. 
 
 pansion? She is '^cribb'd, "confin'd," and " curtailed 
 of Nature's fair proportion." However^, to counter- 
 balance these inconveniences, it has fortunately hap- 
 pened, that owing to a power she possesses of ab- 
 dominal respiration, more decided in her than in the 
 male, the unnatural restraint she has imposed upon 
 herself is divested of some portion of its ills elFects. 
 Still, so mischievous are the consequences entailed 
 upon woman by her adherence to this baneful part 
 of her costume, that in consumptive cases there is 
 this striking distinction between the sexes, that the 
 female thus deprives herself of the great, indeed the 
 sole chance of recovery, — a due expansion of the 
 chest. Thus the probability of spontaneous and per- 
 manent recovery, which is attended by an increase in 
 the volume of the lungs, is sensibly lessened to the 
 female sufferer ; and they who need most aid may be 
 said "to take arms against themselves." 
 
CAUSES OP 
 
 CONSUMPTION. 
 
 A Cold, resulting either from imprudent exposure to 
 the air when the body has become heated, or from the 
 wearing of too light and insufficient clothing, is deemed 
 one of the most general and powerful causes of con- 
 sumption. Yet, in many instances, I am persuaded 
 that the real and efficient cause is to be found in the 
 pre-existence of latent tubercles in the lungs; and 
 when these become softened by general indisposition, 
 produced by the action of the cold, phthisis ensues. 
 Frequently, indeed, the irritation occasioned by latent 
 tuberculous disease will determine a catarrh, and the 
 patient will be treated for this complaint without any 
 suspicion on the part of the medical attendant of the 
 real state of the case. Should the catarrh continue, 
 the consumptive disease masked by it, will be eiFect- 
 ually cured ; and if a cavity has been formed, this will 
 be obliterated by the increase that takes place in the 
 volume of the lungs. At other times tuberculous deposits 
 will be found insulated, and rendered innoxious, as I 
 
 D 
 
18 CAUSES OF CONSUMPTION. 
 
 shall hereafter expiain^, by the secretion of black 
 pulmonary matter. I have verified these facts by nu- 
 merous autopsies^ and. it is very recently, that, open- 
 ing the body of an asthmatic individual who died 
 at the advanced age of seventy, I found distinct 
 traces of a former consumptive state, which, having 
 been arrested by the supervention of asthma, had 
 existed unknown to himself, his family or his physician. 
 Still, where an hereditary tendency to consumption 
 exists, or the constitution has been previously debilita- 
 ted, taking cold is most certainly a frequent exci- 
 ting cause of pulmonary phthisis. The transmission 
 of this disease from parent to child, is a melancholy 
 fact to which I have already adverted. The generic 
 marks of this sad heir -loom may be traced in the san- 
 guine yet delicate hue of the countenance, the un- 
 usual brightness of the eyes, the confined and narrowed 
 waist, the sharp projection of the scapulae or shoulder- 
 blades, and the fragility of the bony structure of the 
 body, not unfrequently united with a disposition to an 
 unhealthy stoutness. In laying down the causes of 
 consumption, it becomes requisite to distinguish be- 
 twixt those which are direct, and the far greater class 
 commonly confounded with them, but which in point 
 of fact are indirect. Amongst the latter, may be enu- 
 
CAUSES OF CONSUMPTION. 19 
 
 merated inflammation of the lungs, pleurisy, conta- 
 gious eruptive fever, repelled eruptions, badness and 
 deficiency of food, amenorrhoea, unhealthy localities, 
 affections of the abdominal viscera (sometimes caused 
 by excessive drinking,) spitting of blood, constitutional 
 syphilis, and a long list of disorders, whose sole in- 
 fluence in producing consumption consists in the de- 
 bilitated state of the body they induce. I have said 
 that it is requisite to distinguish betwixt the direct, 
 and indirect causes of consumption, not that there 
 are any that can with propriety be termed direct, but 
 in order to impress thoroughly upon the mind the 
 grand truth, that phthisis is, for the most part, the se- 
 quence of debilitated bodily health alone. When the 
 general health becomes impaired, a total change 
 takes place in the fluids and secretions of the body, 
 and there is consequently an aberration of nutriment : 
 on this, the formation of tubercles soon follows. 
 
 Laennec gives an interesting account of the effect 
 of depressing passions in producing phthisis, in the 
 case of a religious association of females, all of whom 
 became consumptive from the ascetic spirit which re- 
 gulated their minds, rather than the austerity of their 
 diet. Confinement, most likely, contributed to this 
 result. Since this society was bound by no vow.. 
 
20 CAUSES OF CONSUMPTION, 
 
 Laennec persuaded the members, as soon as consump- 
 tion was clearly indicated in each, to change to ano- 
 ther place of abode, and he expressly declares that 
 nearly all who took his advice recovered. The possi- 
 bility of consumption's being cured is even yet denied 
 by many practitioners, although the light of truth is 
 beginning to dawn upon them ; and yet the above 
 relation is a proof, that, some years previously to the 
 appearance of the present work, the greatest medical 
 authority on the disease had stated opinions similar 
 to mine. A parallel circumstance has occurred, in 
 the course of my practice, within the last two%ears. 
 Two young ladies were removed from a school in the 
 neighbourhood of London, in order to be put under 
 my care for consumption. I ascertained that ten or 
 twelve of their school-fellows had sunk under decline, 
 within the preceding twelvemonth : and, on inquiry, 
 I found that the only exercise they were allowed, and 
 this but seldom, was the prim, formal walk, two by 
 two ; which pernicious and false decorum, it is to be 
 hoped, will soon be banished from these establishments. 
 To such an excess were the fantastical restrictions 
 of the school carried, that the poor girls were not 
 allowed to hold their heads erect, or maintain a pro- 
 per carriage, being told that so to do was a sign of 
 
CAUSES OF CONSUMPTION. 21 
 
 pride. By this enforced humility, conjoined with the 
 radical error — want of exercise — both my young pa- 
 tients not only stooped, but, I am sorry to add, had 
 contracted chests, and lateral curvature of the spine. 
 
 I should mention the sequel of Laennec's account, 
 in order to establish more fully the coincidence be- 
 tween the circumstances, and to direct attention to 
 the ill-effects of such absurd confinement. He pro- 
 ceeds to narrate, that he witnessed, in the course of 
 ten years, two or three renewals of the religious so- 
 ciety, by the admission of new members to replace 
 the loss of the old ones ; and that the only individu- 
 als attached to it, who withstood its depressing influ- 
 ence, were the superior, the grate-keeper, and the 
 sisters who had charge of the kitchen, the garden, 
 and the infirmary. In addition to the exercise given 
 by these offices, the same individuals were called upon, 
 occasionally, to visit the city on the concerns of the 
 establishment. This narrative requires no comment. 
 
 Many writers are of opinion, that various thoracic 
 diseases are fruitful causes of consumption ; but I 
 am satisfied that this supposition is groundless. It is 
 merely owing to the loss of health entailed by them, 
 that ^the developement of those accidental productions, 
 called^ tubercles, takes place. To enumerate the indi- 
 
22 
 
 CAUSES OF CONSUMPTION. 
 
 rect -causes of consumption, would be endless; for;, in 
 fact, whatever is capable of impairing the constitution 
 is liable to produce a phthisical state. Thus mental 
 anxiety, or any depressing passion long continued, as 
 well as chronic diseases of various kinds, engender a 
 consumptive predisposition. In this country the fre- 
 quency and prevalence of this disease are attributed, 
 in no small degree, to the great and sudden vicissi- 
 tudes of atmospheric temperature, and the moist nature 
 of our climate. These, as I have already explained, 
 operate powerfully in effecting changes in the human 
 body, more or less calculated to affect the general 
 health ; especially in those who are naturally of a deli- 
 cate make, and who inherit a tendency to scrofula. 
 Particular employments, in which dusty particles and 
 noxious fumes are inhaled, have long been regarded as 
 producing this disease ; but experience has taught me 
 that some catarrhal affection, and not consumption, is 
 what most frequently supervenes, and that the former 
 complaint is a preservative against the latter. 
 
 The distinguished French writer I have lately quoted, 
 denies that Phthisis pulmonalis is a frequent conse- 
 quence of pulmonary catarrh ; which opinion approxi- 
 mates to, although it does not go so far as my own : but 
 it is strange that so acute an observer, with all the facts 
 
CAUSES OF CONSUMPTION. 23 
 
 before him — facts first promulgated by himself— should 
 have stopped short of the truth just as he was on the 
 point of reaching it. He clearly saw that catarrh was 
 not the cause of consumption, and aflirms, "We re- 
 cognize a thousand instances of catarrh for one of 
 phthisis." One step further would have led him to 
 the discovery, that catarrh was the remedy of nature 
 for the cure of phthisis. In the same paragraph, he 
 alludes to Broussais, as supporting the once established, 
 but I trust now exploded, doctrine of " Phthisis pul- 
 monalis being the consequence of pulmonary catarrh." 
 Broussais, indeed, had the temerity, or rather folly, to 
 assert, that a pupil of his used to bring on consump- 
 tion — in fact, generate tubercles in the' lungs of a dog — 
 by irritating the trachea in some extraordinary manner, 
 and thus producing catarrh. The contrary would hap- 
 pen. The catarrh would prevent the appearance of 
 consumption. But what will not writers advance to 
 support a favourite theory ! 
 
 Contagion has been considered in the southern parts 
 of Europe, especially in the Italian States, as a fre- 
 quent source by which large families of children have 
 been destroyed by consumption. For my own part, it 
 has never appeared to me to spread amongst indi- 
 viduals having the same hereditary constitution, by 
 
24 CAUSES OF CONSUMPTION. 
 
 ahy infectious medium ; but by other circumstances 
 operating upon an inherent predisposition to tuber- 
 culous disease, which;, as I have already said, is indi- 
 cated by a particular conformation of the body ; such 
 as a long neck, slender trunk and extremities, con- 
 tracted chest, high shoulders, delicate and transparent 
 complexion, weak voice, and great sensibility. The 
 same locality and the same manner of living, no doubt, 
 have often an influence in propagating it in certain 
 families ; and to this cause, and not to contagion, we 
 may attribute its remarkable fatality. In my neigh- 
 bourhood there are many Italians resident, who, for 
 the most part, live huddled together in small and ill- 
 ventilated rooms, and are apparently liable, from their 
 peculiar and not very nutritive diet, a neglect of clean- 
 liness, and misery and disappointment in every shape, 
 to have a consumptive constitution, yet I have not been 
 able to trace any case of the disease's being dissemi- 
 nated. Still, notwithstanding my firm belief that con- 
 sumption is not contagious, I would not be understood 
 to recommend neglect in separating consumptive from 
 healthy persons; on the contrary, for the sake of the 
 personal comfort of the sufferer, and to forward the 
 chances of his recovery, I would have every precaution 
 taken that prudence can suggest, or kindness inspire. 
 
THE SYMPTOMS OF 
 
 PULMONARY CONSUMPTION, 
 
 LOCAL AND SYMPATHETIC. 
 PHYSICAL SIGNS OP THE DISEASE. 
 
 It has long been acknowledged that the symptoms, 
 on which practitioners generally rely in the incipient 
 stage, as indicative of consumption, are extremely va- 
 riable and uncertain. Its attack indeed is, in many 
 instances, so deceitful that before the patient is in the 
 least aware of his danger the case has become despe- 
 rate. Again, it seldom happens that pain, or any other 
 uneasy sensation, is felt in the part which is well known 
 to be the primary seat of the disorder, although it re- 
 sults from tubercles, disseminated at first in the sub- 
 stance of the upper part of one, or both lungs. At 
 other times, we see cases in which its progress is latent 
 and altogether unheeded ; still a slight cough is gene- 
 rally the first symptom, and this is attributed to some 
 uneasiness in the throat, produced by a common cold. 
 After a time the cough increases, and from being either 
 
26 SYMPTOMS OF PULMONARY CONSUMPTION. 
 
 hard or dry^ is followed by the expectoration of a little 
 mucus often devoid of colour^, as in common catarrh. 
 This is succeeded by some degree of weight and slight 
 pain felt in the chesty along with difficulty of breath- 
 ing, general weakness;, and an accelerated pulse;, which 
 seldom ranges below 90 ; during the hot stage of the 
 hectic fever, it is generally 120. A sense of chilli- 
 ness along the course of the spine, commonly experi- 
 enced towards noon, is the next symptom; this is fol- 
 lowed by an augmented temperature of the body on 
 the approach of evening, and finally by perspirations, 
 which usually come on profusely after midnight and 
 greatly attenuate the body. When spitting of blood 
 occurs with the foregoing symptoms, or when the mat- 
 ter expectorated begins to assume the appearance of 
 pus, we have strong grounds to suspect the presence 
 of pulmonary consumption. The occurrence of cough 
 in any case, in which the general health has been im- 
 paired, ought to be regarded with no small suspicion. 
 Cases are not wanting: in which the disease manifests 
 itself most irregularly. For instance, the usual charac- 
 teristic symptoms are not uncommonly preceded, for 
 a short time, either by mesenteric enlargment, aphthae, 
 severe diarrhoea, amenorrhoea, or by an affection of 
 the larynx, attended with a slight alteration of the 
 
SYMPTOMS OF PULMONARY CONSUMPTION. 27 
 
 voice. Though in the early stages there may be some 
 doubt as to the existence of phthisis^ without the aid of 
 physical signs^, there can be however little chance of 
 mistake in the advanced stages. As soon as hectic 
 fever is fully established^ the Avasting of the flesh be- 
 comes remarkable, and rapidly increases, if perspira- 
 tion, diarrhoea, and expectoration have been abundant. 
 To me, who have been for so many years accustomed 
 to see this disease daily, the very look of the patient is 
 in most instances sufficient. 
 
 The nose and cheeks assume a striking prominency, 
 and the bluish paleness and emaciated appearance of 
 the face are remarkable, when contrasted with the 
 sufiused, and at other times, circumscribed flush, which 
 quickly goes and comes, together with the shining 
 white or pearl-blue appearance of the conjunctiva of 
 the eyes; the shoulder-blades project, so as to be 
 likened to wings, while, at the same time, the chest 
 is narrowed in its lateral as well as transverse diameter, 
 in consequence of the increased convexity of the ribs, 
 which has a greater inclination downwards, and which 
 thus likewise admits of the nearer approach of the 
 sternum towards the back. On the upper and anterior 
 part of the chest, the intercostal spaces appear widen- 
 ed and depressed, and the belly is at the same time 
 
28 SYMPTOMS OF PULMONARY CONSUMPTION. 
 
 flat and retracted; — the fingers seem lengthened, 
 and the joints of these, as of other parts, are appa- 
 rently enlarged; incurvation of the nails takes place, 
 and where large tuberculous excavations have long 
 existed, an actual enlargement of the ends of the 
 fingers is observable ; the neck seems elongated and 
 impeded in its movements, and the angles of the lips 
 are drawn back, and produce a bitter smile. 
 
 Phthisis is not difficult to be recognized in that 
 stage in which the tuberculous mass, becoming soften- 
 ed, finds an opening into some of the neighbouring 
 bronchia, and finally leaves a cavity, whose existence 
 is clearly indicated by its characteristic symptom — 
 pectoriloquy. This peculiar phenomenon is generally 
 first heard in the upper portion of the right lung, 
 when the tubercles which first appear there are soften- 
 ed down ; and it may be detected by applying the ear 
 over the uppermost ribs, or over the infra-spinal fossa 
 of the shoulder-blade. When the voice of the pa- 
 tient, on applying the ear either alone, or armed 
 with the stethoscope, to that part of the chest cor- 
 responding with the supposed seat of an excavation, 
 is heard much louder than natural, and seems to 
 issue uninterruptedly from within, with a thrilling 
 sound, it constitute.s what is termed a satisfactory pec- 
 
SYMPTOMS OF PULMONARY CONSUMPTION. 29 
 
 toriloquy, and is an indubitable sign of a tuberculous 
 cavity ; the contents of which we even hear not 
 unfrequently by the same method of diagnosis;, agitated 
 by the action of coughing. Whenever the walls of an 
 old, and nearly emptied excavation, are dense and firm, 
 a severe fit of coughing gives to the ear a metal- 
 lic resonance, or a sound as of some empty glasses 
 slightly shaken against each other. If the excavations 
 are numerous, and communicate one with another, the 
 liquid, matter within is heard changing its situation 
 every time the patient breathes. 
 
 The plan I always pursue, and indeed a most ready 
 one, to distinguish consumption from pulmonary ca- 
 tarrh, with which it is liable to be confounded, is 
 to apply the ear to the posterior part of the chest, 
 about two or three inches below the inferior angle of 
 the scapula. Should the respiration be almost natural, 
 or slightly puerile here, we may at once and early 
 proclaim the case to be phthisical, if the patient 
 have a troublesome cough, though he may present few 
 of the other common symptoms belonging to a con- 
 sumption. Except near the fatal termination of the dis- 
 ease when the great emaciation, confirmed hectic fever, 
 diarrhoea, and other bad symptoms manifest themselves, 
 we have no physical sign of any bronchial inflamma- 
 
30 SYMPTOMS OF PULMONARY CONSUMPTION. 
 
 tion; save in cases in which some progress towards 
 recovery has taken place. When the sonorous rattle 
 occurs before the lower lobes of the lungs are affect- 
 ed with tubercles, it is to be considered as a highly 
 favourable symptom. In other caseS;, however violent 
 and long the cough may be, auscultation gives us 
 no signs of the catarrhal state which precedes and 
 follows complete recovery. Having daily oppor- 
 tunities of seeing new consumptive cases, I readily 
 come to a conclusion, by the absence of catarrh, 
 that they are undoubtedly consumptive, without taking 
 the trouble to ascertain the state of the upper part 
 of the chest; for if an individual coughs up blood, 
 or muco-purulent matter, is subject to chills, acces- 
 sions of fever, and night sweats, wastes away and com- 
 plains of debility, and no catarrh is heard in the in- 
 spirations, we may be perfectly satisfied that tuber- 
 culous cavities exist. When there is a cough which is 
 not influenced by remedies, and the sympathetic signs 
 of consumption and the auscultatic results beneath 
 the clavicles are somewhat unsatisfactory, while the 
 lower part of the chest has the murmur of respiration 
 almost natural, I should then, satisfied with the expe- 
 rience derived from exploring the chests of several 
 thousand consumptive patients, unhesitatingly pro- 
 
SYMPTOMS OF PULMONARY CONSUMPTION. 31 
 
 nounce the case to be genuine consumption. In nu- 
 merous instances;, much to the surprise of my pupils^, 
 and of those practitioners who have witnessed my 
 practice;, I have pronounced a patient to have tuber- 
 culous disease in the superior lobes, while he exhibited 
 no look indicative of such serious illness, but had 
 merely an annoying cough. This prompt decision after 
 I have ascertained by the ear the sanity of the respira- 
 tory murmur, and absence of bronchial irritation in the 
 inferior part of the chest, has generally proved correct. 
 In some instances, obscure respiration in the upper part 
 of the chest, arising from tubercles and pulmonary 
 induration; in others, a tuberculous cavity, affording 
 the most perfect pectoriloquism, has been ascertained; 
 and, on closely questioning the patient, the symptoms 
 he has detailed have usually been corroborative of 
 what might be termed, if we were guided by the appa- 
 rently unimpaired state of health, latent phthisis. 
 
 It were easy to enter into a more full and minute 
 detail of the symptoms which characterize this com- 
 plaint; but as my present object is to elucidate the 
 preventive and sanatory treatment to be observed, I 
 deem it advisable to reserve many observations of a 
 curious nature connected with this branch of my sub- 
 ject. However, should I have occasion to reprint this 
 
32 SYMPTOMS OF PULMONARY CONSUMPTION- 
 
 work, I may be tempted to enlarge the present chapter, 
 and publish many interesting, and, as far as my know- 
 ledge extends, original facts. 
 
 I suffer this passage to remain as it stood in the 
 former editions, as a renewed pledge to fulfil the promise 
 thus given. The call made upon me for a new im- 
 pression, as well as a pressure of literary and profe^ 
 sional labour, prevents me from redeeming my word 
 at present ; but as I am now engaged in an ex- 
 tensive work on the "Diseases of the Chest," I shall 
 have an opportunity of pursuing the enquiry through 
 all its ramifications. There is no branch of my sub- 
 ject on which more contradictory opinions have been 
 emitted. Facts themselves have been so differently 
 described, as to assume the most opposite aspects. 
 The founder of the science of auscultative examina- 
 tion was induced not infrequently into error by over 
 anxiety to complete his system ; and too many of 
 his followers have repeated his oversights, or com- 
 mitted fresh mistakes from inaccurate observation, and 
 want of a proper field for its exercise. 
 
MORBID APPEARANCES 
 
 OJB" 
 
 CONSUMPTION. 
 
 The most common morbid appearances met with in 
 the lungS:, are a peculiar species of accidental produc- 
 tion, known under the generic name of tubercles. 
 These, according to the different appearances they pre- 
 sent, may be distinguished into two primary forms — 
 that of insulated bodies, and that of interstitial infil- 
 tration or secretion. In the former are classed miliary 
 tubercles, so named from their size, which usually 
 corresponds with that of a millet seed, although 
 they are sometimes found much larger. In their 
 origin they are observed to be semi-transparent, and of 
 of a greyish colour, sometimes nearly colourless and 
 transparent. On superficial inspection, they are ap- 
 parently orbicular, but, when more minutely observed. 
 
34 MORBID APPEARANCES OF CONSUMPTION. 
 
 occasional angularities and infractuosities are visible. 
 So closely are they interwoven with the fibre of the 
 lungS;, that it is found impossible to separate them 
 without bringing away^ at the same time, a part of the 
 former. They gradually approximate to^ and unite 
 with each other, forming semi-cartilaginous groups or 
 masses, which in time acquire a light straw colour, 
 and change into a substance of the consistency of 
 cheese. When they thus spread and unite by intus- 
 susception, they form what is technically denominated 
 crude tubercles, or yellow crude tubercles. Their pro- 
 gress to this state commences with the appearance of 
 yellow, opaque specks occurring generally, but by no 
 means uniformly as has been erroneously stated, in 
 their centres. These tubercles increasing by degrees, 
 either unite in the manner described above, or remain, 
 when thus converted into the crude state, separate and 
 ' isolated. A strong proof of the soundness of the prin- 
 ciple I am anxious to inculcate throughout this work, 
 namely, that pulmonary consumption is seldom met 
 with in individuals of large and expanded chests, will 
 be found in the fact that these nodules, or tubercles, 
 almost invariably commence in the upper portion of 
 the lungs, which, by the very structure of the thorax, 
 is their most confined part. From the summit they 
 
MORBID APPEARANCES OF CONSUMPTION. 35 
 
 spread downwards, and in their single formation will 
 enlarge to the size of a hazel nut, although rarely ; 
 indeed, I consider it probable, that when they appa- 
 rently reach these dimensions they are not in point of 
 fact single, but an aggregation, so compacted as to 
 defy separation. 
 
 A second form of insulated bodies are the granular 
 tubercles, first pointed out by Bayle, who regarded 
 them as an accidental cartilaginous iformation, different 
 from tubercles ; but without sufficient reason, since, 
 on dividing them, we find that they present the same 
 colour and opacity as the common tubercle, and their 
 growth evidently proceeds through the same stages : 
 therefore, I am of opinion that they are unquestionably 
 the same. The principal distinction between the two, 
 consists in their external form. The granular tubercles 
 are roundish or ovoid, of the size of a millet seed, 
 which they seldom exceed, and germinate singly in 
 immense numbers over an entire lung, or its greater 
 portion, so that even where apparently blended, the 
 granules are found, on examination, to be entirely 
 distinct. They differ still further, by their being 
 transparent and colourless. Their induration and car- 
 tilaginous structure may arise, it is not unreasonable to 
 suppose, from their remaining during a long period 
 
36 MORBID APPEARANCES OF CONSUMPTION. 
 
 without showing any disposition to suppurate, which 
 they are sometimes however found to do. 
 
 I have stated, that one of the principal differences 
 between the miliary and the granular tubercles con- 
 sists in the latter being colourless and transparent; 
 yet this is not an invariable distinction, since they oc- 
 cur at times of a greyish tint, and are not invariably 
 diaphanous, but in conjunction with this grey colour 
 are also semi-transparent, thus furnishing an additional 
 proof of their assimilation with the miliary tubercle. 
 
 The second form, in which tuberculous matter exhibits 
 itself in the lungs, is that of interstitial infiltration; 
 this, like the first, may be divided into two classes, 
 one of which may be denominated grey tuberculous in- 
 filtration, and the oiher jelly-like tuberculous infiltra- 
 tion. The former is found, in this the second stage of 
 the tubercular progress, infiltrated around tubercular 
 cysts, and incorporated, if I may use the term, with 
 the pulmonary tissue. Occasionally it is met with in 
 a separate deposit, independent of the previous forma- 
 tion of miliary tubercles, and forms large masses of a 
 moist compact substance, impenetrable by the air. Its 
 greyish hue is derived from the secretion of black pul- 
 monary matter in minute particles. Softening gradu- 
 ally, in a manner similar to the insulated tubercle. 
 
MORBID APPEARANCES OF CONSUMPTION. 37 
 
 it passes into a state of crudity, which is indicated by- 
 minute yellow and opaque points, or specks. On 
 making a section of this mass, the matter contained in 
 these minute specks oozes out, and there remain small 
 orifices similar to so many holes left by the mark or 
 prick of a pin. The jelly-like substance, termed the 
 jelly-like tuberculous infiltration, is discovered in the 
 intervals of the miliary tubercles, and is for the most 
 part colourless, although occasionally it is tinged with 
 red. Gradually gaining greater consistency (says Laen- 
 nec), it becomes converted into yellow tuberculous 
 matter ,• and this indeed, according to him, at times so 
 rapidly, that, on inspecting large masses of the sub- 
 stance thus changed, we are often unable to find any 
 trace of its original state : but, according to my own 
 opinions, which have been based on observations con- 
 tinued for a series of years, this view is altogether er- 
 roneous, since the jelly-like infiltration is, I conceive, 
 the result of specific chronic inflammation. Nor does 
 this jelly-like infiltration, or, more correctly speaking, 
 secretion, ever become, as far as I am aware, converted 
 into yellow tuberculous matter. Again, the secretion, 
 of which we are now speaking, is precisely similar to 
 that morbid deposit frequently found beneath the 
 serous surface of the lungs, in cases of chronic pleu- 
 
38 MORBID APPEARANCES OF CONSUMPTION. 
 
 risy ; and in chronic inflammation of the heart I have 
 repeatedly seen the same gelatinous matter— beneath 
 the serous investure of the auricles and that of the 
 ventricles^ within the laminae of the pericardium, and 
 underneath the serous surface of parts within the ab- 
 dominal cavity. These facts are strong corroborations 
 of my opinion as to the specific chronic nature of this 
 secretion ; but when we find the presence of capillary 
 vessels, extending themselves into this gelatinous mat- 
 ter, which minute vessels are also traced in the jelly- 
 like secretion of the different parts above-mentioned, 
 I think my assertion fully borne out. To extend my 
 proofs still further, I may observe, that, in some severe 
 chronic diseases of the joints, I have seen a like secre- 
 tion on the exterior surface of the sinovial capsule, ex- 
 tending itself to no inconsiderable distance into the 
 surrounding cellular membrane. 
 
 The process, by which both the insulated and diffused 
 tuberculous matter becomes softened into a fluid state, 
 is similar. Generally, a number of small, yellow, opaque 
 specks make their appearance in the centre of several- 
 coalesced tubercles, and in different parts of the dif- 
 fused tuberculous matter, until, by degrees, the whole of 
 the substance is converted into a uniform yellow mass, 
 which after an uncertain period becomes softened, and 
 
MORBID APPEARANCES OF CONSUMPTION. 39 
 
 is changed into thick and curdy pus. However, the 
 consistency of this pus is by no means invariably the 
 same, a portion assimilating to the secretion from an 
 ordinary sore, and being thin and watery. In expe- 
 diting this change in the tuberculous mass from hard 
 to soft, the secretion from the lining surface of the 
 membrane circumscribing it, I entertain no doubt, 
 contributes not a little. I find in a work, published 
 by M. Lombard of Geneva, that he supposes each por- 
 tion of tuberculous matter to act like a foreign body 
 on the tissues with which it is in contact, thus pro- 
 ducing a secretion of pus mechanically dividing the 
 tubercle into clots ; but I conceive that this gentleman, 
 though partially correct, attributes too much to the 
 action of this fluid, since we find a particle, or par- 
 ticles of pus, contained within the solitary tubercle, 
 and evidently not in contact with any tissue having 
 the power of generating pus — nay more, we find de- 
 posits of pus in the large tuberculous masses, in which 
 the natural alveolar structure of the lungs is by no 
 means discernible. When a secretion of pus takes place, 
 and (partly established by a process of irritation) to an 
 amount sufficient to effect a solution of continuity, an 
 opening is made into some of the neighbouring bron- 
 chial tubes, or into some tubercular cavity, of previous 
 
40 MORBID APPEARANCES OF CONSUMPTION. 
 
 formation, communicating with them. By this com- 
 pound process, according to the foregoing view, the 
 elimination of tuberculous granules is effected. The 
 interior of such cavities, when of large extent, has 
 columnar bands extending across it; these are formed 
 of condensed pulmonary tissue, and they are sometimes 
 coated with the tuberculous degeneracy ; it should be 
 observed, that none of the bronchial ramifications 
 traverse these excavations, and that the few vessels, 
 occasionally seen within the bands, are in almost every 
 instance obliterated. In the parietes of the large an- 
 fractuous excavations of long standing, the blood-ves- 
 sels are frequently observed in a flattened state, and 
 those that are obliterated are covered by a thin, semi- 
 cartilaginous membrane: the bronchial ramifications, 
 on the contrary, with the exception of those necessary 
 for the discharge of sputa, though found obliterated, 
 and invariably discovered to be cut off, yet would ap- 
 pear to have heen originally enveloped by the tuber- 
 culous matter, and to have traversed the space it 
 occupies. As soon as these cavities have discharged 
 their contents, they become lined by a soft, thin, and 
 nearly opaque morbid membrane, or are merely in- 
 vested by an exudation, which is in some parts defi- 
 cient, and varies in density. At times, we meet with 
 
MORBID APPEARANCES OF CONSUMPTION. 41 
 
 cases in which laminae of a light blue colour^ and 
 semi-cartilaginous nature, line these excavations, in- 
 terspersed here and there with slight eminences, and 
 in intimate connexion with the pulmonary tissue, being 
 continuous also with the lining membrane of the 
 bronchia. At others, the boundaries of the excava- 
 tions are found without either of the false membranes, 
 and are formed by the natural texture of the lungs 
 merely condensed, or infiltrated with tubercular mat- 
 ter. In concluding my remarks on the formation of 
 the tuberculous cavities, I must express my concur- 
 rence with the view taken by M. Bayle, of the. false 
 membrane's secreting the pus which is expectorated, 
 instead of its being the product of the bronchial 
 secretion. The grounds on which I rest my opinion 
 are these— in the first place, that no bronchial aiFec- 
 tion is perceptible until the disease is drawing to a 
 close, or unless nature attempts to effect a cure by 
 the supervention of catarrh ; and, in the second place, 
 that, on dissection, we do not find these excavations 
 frequently empty, as stated by Laennec, but that they 
 generally contain no inconsiderable quantity of puriform' 
 matter, similar to the sputa which had been ejected 
 by the patient. 
 
 The stage of my subject at which I have now 
 
 G 
 
42 MORBID APPEARANCES OF CONSUMPTION. 
 
 arrived, leads me to the consideration of encysted 
 tubercles. Although seldom met with, except in the 
 bronchial glands, yet, in at least a dozen instances, 
 I have found these tubercles surrounded previously to 
 softening, by an accidental membranous formation, 
 and sometimes by condensed pulmonary tissue. Still, 
 seldom as this occurs. Nature, ever prone to dis- 
 cover and apply a remedy to her own infirmities, 
 has benignantly provided that the black deposit, 
 caused by the tuberculous irritation, shall answer every 
 purpose of a cyst. It has often happened to me to have 
 had opportunities of examining patients of my own, 
 who, after having recovered from consumption, and 
 enjoyed a good state of health for years, have ex- 
 pired of diseases not referrible to the pulmonary 
 organs. In many of these instances, in which ulcers 
 of the lungs have been transformed into semi-carti- 
 laginous fistulae, or in which perfect cellular cicatri- 
 zation has taken place, I have remarked, that such no- 
 dules of tubercles as then existed have become enveloped 
 by black pulmonary matter, which by isolating them, 
 and rendering them innoxious, has evidently produced 
 the same beneficial effects as would have resulted from 
 the encysted state. Indeed, I have reason to believe, 
 from enquiring into the history of the cases of many 
 
MORBID APPEARANCES OF CONSUMPTION- 43 
 
 persons^ who in their youth had laboured under con- 
 sumption;, from which they afterwards recovered, and 
 on whose demise I have been called in to examine 
 the body, that latent nodules, in the state described 
 above, have existed upwards of thirty years. Again, 
 in individuals in whom consumption has been arrest- 
 ed by the spontaneous occurrence of chronic ca- 
 tarrh, or by treatment adapted to render the disease 
 chronic, similar nodules similarly situated, together 
 with wrinkled depressions on the exterior surface of 
 the lungs, signs of internal cicatrices, are of no in- 
 frequent occurrence. Without intending to enter too 
 far into the debateable ground of hypothesis, I yet 
 feel induced to observe that I regard tubercular de- 
 position as a specific vitiated secretion, arising from 
 an aberration of nutrition. In confirmation of this 
 opinion, I have strong grounds for believing that tu- 
 bercles of very recent date, and not arrived at a 
 state of crudity, undergo absorption, and that upon this, 
 restoration from incipient phthisis soon follows. Thus 
 I have indicated two modes by which recovery from 
 phthisis occurs ; the one is the re-absorption of tu- 
 bercles in their early state, and the other is their in- 
 sulation, even in a state of crudity, by black pul- 
 monary matter. I now approach what I consider the 
 
44 MORBID APPEARANCES OF CONSUMPTION. 
 
 most interesting portion of my subject connected 
 with the morbid anatomy of phthisis, the mode of 
 union and cicatrization of ulcerous excavations^, which 
 seems by no means understood. Whenever nature 
 operates a cure, there is an extension of irritation 
 from the lining of the cavity into the neighbour- 
 ing bronchial tubes; and the consequence of this is, 
 supposing there exist one or more cavities, in the 
 summit of the right lung for example (since the right 
 is the one generally first attacked), an emphysema- 
 tous state of the vesicular structure of that portion 
 of the lung, through imprisonment of the air in the 
 act of expiration. Hence, through enlargement of 
 the aerial cells, and consequent voluminous state of 
 the pulmonary tissue, the pressure is so constantly 
 exerted from without inwards on the exterior of the 
 cyst, that in time an apposition of the parietes of the 
 cavity takes place, and the ulcerous excavation be- 
 comes healed by the first intention. If the healing 
 occurs early, and the cavity is of not of old date, cell- 
 ular cicatrization is the consequence ; but if no pul- 
 monary catarrh supervenes until after phthisis has 
 existed for a length of time, the cicatrizations are com- 
 monly formed of fibro-cartilaginous lamellae., or there 
 is left an imperfect cicatrix with [semi-cartilaginous 
 
MORBID APPEARANCES OF CONSUMPTION. 45 
 
 fistula. Whenever vesicular emphysema exists, recent 
 tubercles are rarely seen; hence it happens that fresh 
 crops of tubercles have no disposition to appear in the 
 cicatrized summit of the newly-healed lung ; but if, 
 after recovery has taken place through this change^, 
 any circumstance should arise to injure the patient's 
 health, the summit of the other lung, not being em- 
 physematous, may be the seat of a fresh formation of 
 tubercles; and the fresh successive crops of tubercles 
 may even appear beneath the emphysematous portion 
 of the summit of the right lung, as well as in other 
 parts. In the progress of the disease, when unchecked, 
 these crops proceed downwards by progressive stages. 
 No sooner has a cavity been formed in the summit of 
 either lung, than, after an indefinite period, a suc- 
 ceeding eruption appears lower down, so that the 
 appearances, presented on dissection, show the inroads 
 of the disorder from its direst ravages down to its 
 latest attacks. Thus, an anfractuous cavity is gene- 
 rally found in the summit, [surrounded by tubercles 
 in an advanced state of crudity ; somewhat lower down 
 are smaller cavities containing portions of undissolved 
 tuberculous matter, and around them small nodules 
 assuming the yellow appearance ; beneath these the 
 crude miliary tubercles are apparent, . having their 
 
46 MORBID APPEARANCES OF CONSUMPTION. 
 
 centres already occupied with yellow points ; and 
 lastly, the transparent miliary tubercles, which form 
 the first morbid tuberculous appearance in pulmo- 
 nary consumption, occupy the inferior portion of the 
 lower lobes of the lungs. I ought here to mention 
 that, if, after tubercles are deposited, or a cavity is 
 formed in the summit of the lung, general vesicular 
 emphysema arises in consequence of catarrhal affection, 
 or of irritation spreading through the ramifications of 
 the bronchi from the seat of the disease, there will 
 be no disposition to the formation of tubercles. This 
 strange, and singular exception may be probably the 
 result of the extraordinary exercise of the pulmonary 
 apparatus, caused by the frequency of respiration in- 
 separable from catarrh or asthma. Most truly does 
 Laennec observe, what my own extended experience 
 confirms, that tubercles are less frequently met with 
 in the muscles of voluntary motion than elsewhere ; 
 and in this we find a strong confirmation, given by 
 the hand of Nature herself, of the value of artificial 
 means to increase the action of the lungs, and thus 
 arrest any new development of tuberculous eruptions. 
 
 Before I conclude my observations on the morbid 
 appearances, I deem it necessary to notice the organic 
 changes which accompany phthisis ; many" of which are 
 
MORBID APPEARANCES OF CONSUMPTION. 47 
 
 entirely dependant on the particular treatment to which 
 the patient may be subjected. The intestines, more es- 
 pecially the small;, are, next to the lungs the most liable 
 to tuberculous degeneration, leading to the ulcerous 
 state, which in its turn keeps up profuse and wasting 
 purgation. This troublesome condition may, in many 
 instances, be avoided by a plan of treatment which the 
 reader will find laid down in another part of this work. 
 More than one-fourth in a hundred adult subjects, ac- 
 cording to Dr. Lombard, had tubercles in the intes- 
 tines ; but I have found, that, under judicious manage- 
 ment, this proportion may be considerably decreased. 
 Being desirous, however, to see how far phthisical 
 patients were liable to this intestinal affection, I found 
 that, out of the same number of adult subjects who 
 came under my notice, less than a sixth part had in- 
 testinal tubercles: yet, though such was the result of 
 my inquiry with respect to these particular cases, I 
 cannot but allow that the relative proportion, as stated 
 by M. Lombard, is, generally speaking, correct. 
 Next in order of frequency, as subject to the tubercu- 
 lous state, are the mesenteric, the bronchial, and the 
 cervical ganglions; the viscus most liable to be affected 
 after the intestines, is the spleen ; then the kidneys, 
 and less rarely the liver. A wide difference, how- 
 
48 MORBID APPEARANCES OF CONSUMPTION. 
 
 ever, in the proportions above estimated, and in the 
 liability of the several parts to tubercles, according to 
 the order I have just set down, is met with in young 
 as compared with adult subjects. Thus intestinal tu- 
 bercles are more rare in the former than in the lat- 
 ter, but the mesenteric, as well as the bronchial gang- 
 lions, are much more frequently the seat of this 
 disease in children than in adults; and the result of 
 repeated examinations has proved to me, that the 
 presence of tubercles is oftener detected in the nervous 
 centres of children than in those of adults- Were I 
 to follow the bias of my inclination, I should will- • 
 ingly extend my remarks on this interesting branch of 
 my subject still further; but the plan of the present 
 work precludes me from entering upon a more de- 
 tailed notice. I am thus necessarily restricted to 
 brevity, in my observations on the principal lesions 
 which accompany 'phthisis pulmonalis. 
 
 It is with no small degree of surprise, that I perceive 
 it stated by a French physician of eminence, M. Louis, 
 that peripneumony and pleurisy were found by him 
 to occur in so small a proportion as one-tenth of the 
 cases ; whereas I am fully persuaded that, in the 
 last stage of consumption, not less than one-fourth, 
 nor should I exaggerate by stating the proportion 
 
MORBID APPEARANCES OF CONSUMPTION- 49 
 
 as greater, display, on dissection, one or both of 
 these diseases. Another strange error into which a 
 medical writer of the same country, M. Andral, has 
 fallen, is his supposition that peripneumony is com- 
 mon in the early stages of the disease ; the contrary 
 being decidedly the fact. I admit that partial peri- 
 pneumonies, around the nodules of tubercles, are not 
 uncommon; but the cases are rare indeed in which 
 this disease occupies the lower lobes of the lungs, the 
 usual seats of inflammation. Were phthisical patients 
 so frequently affected with pulmonary inflammation as 
 M. Andral describes, the duration of consumption 
 would be wonderfully shortened. One diseased state 
 or other of the mucous membrane of the trachea, 
 of the larynx, and of the epiglottis, occurs in the 
 same ratio as pneumonia ; but these affections are 
 of infrequent occurrence until phthisis has made con- 
 siderable progress. Fortunate indeed would it be for 
 consumptive patients, to be early attacked with inflam- 
 mation of some part of the great air passage, since, in 
 such case, the progress of their disease would be effec- 
 tually checked. I would here particularly draw atten- 
 tion to an important circumstance, which, if left unex- 
 plained, might appear subversive of the very principles 
 and practice I would inculcate throughout this work, 
 
 H 
 
50 MORBID APPEARANCES OF CONSUMPTION. 
 
 It may reasonably be enquired, if inflammation of the 
 air passage, in one part or other, oppose so completely 
 the progress of consumptive disease, how does it hap- 
 pen, that in numberless cases we find the first symptoms 
 of phthisis, exhibited by the patient, to consist in loss 
 of voice, hoarseness, and, in short, all the apparent 
 evidences of laryngeal affection, and yet the pulmo- 
 nary disorder receive no visible relief? Now auscul- 
 tative experience has clearly demonstrated to me that, 
 in cases of this kind, latent tubercular disease invari- 
 ably exists in the lungs previously to this aphonia ; 
 and that this very loss of voice, and accompanying 
 hoarseness, are the results of a thickening and ulceration 
 of the mucous membrane of the ventricles, and vocal 
 chords of the larynx alone, which, however, do not pre- 
 sent an obstruction to the expiration so as to excite the 
 action of the lungs, in the decided manner effected by 
 catarrhal, or asthmatic complaints. There exists, indeed, 
 an essential difference in the character and effects of this 
 distressing aphonia, and of catarrhal disorder. However 
 notwithstanding all the various symptoms of phthisis 
 proceed uninterruptedly, in patients so afflicted ; 
 yet, through a subacute irritation in the ventricles of 
 the . larynx, at last producing a swefling of the sur- 
 rounding mucous tissue, so as to encroach sufficiently 
 
MORBID APPEARANCES OF CONSUMPTION. 51 
 
 on the area of the windpipe to cause a slight obstruc- 
 tion to the expiratory process^ consumptive subjects 
 of this class live at least twice as long as the gene- 
 rality of those whose disease is not accompanied by 
 such laryngeal affection. 
 
 The stomachj liver;, spleen^ and pancreas deviate not 
 unfrequently from a healthy state. In consequence of 
 remarking the hardness^, enlargement^ and other struc- 
 tural alteration in the liver, the late Mr. Abernethy, 
 to whom the department of surgery owes so much, 
 was induced to believe that consumption frequently 
 originated in a diseased state of this organ. From 
 this erroneous view, a mode of treatment was pursued 
 by him, calculated rather to aggravate than lessen 
 phthisical symptoms. By too great a reliance on the 
 effects of mercury, he unfortunately hastened the ca- 
 tastrophe which he sought to avert ; and gave the 
 sanction of his high authority to a practice, which, for 
 several reasons, could not be attended with other than 
 pernicious effects. It is evident, that he never reflected 
 upon the causes to which this morbid condition of the 
 liver is to be ascribed. 
 
 In consumption, the great venous trunks are always 
 congested in a greater or less degree. The cold stages 
 of the hectic paroxysms, the tuberculous indurations, the 
 
52 MORBID APPEARANCES OF CONSUMPTION. 
 
 partial pleurisies;, peripneumonies, and the contraction 
 of the chest which are constantly diminishing the capa- 
 city of the lungs^ retard the circulation from the right 
 side of the heart through the lungs ; hence a gorged 
 state of the vense cavse, and congestion of the liver, 
 the inseparable consequences of the preternatural ple- 
 nitude of the inferior cava, which receives the blood of 
 this the largest gland in the system. The anatomist, 
 being aware that the vena portse carries the residual 
 blood of the already specified organs through the liver, 
 will readily account for the frequent occurrence of the 
 morbid appearances, that are observable after death in 
 these various parts ; since the derangement of the liver 
 will, it need hardly be said, exercise an injurious in- 
 fluence on the stomach, spleen, pancreas, and the 
 intestinal tube : nay, it is by no means uncommon to 
 meet with the symptoms of subacute inflammation of 
 these parts during life. The frequency, extent, and 
 complication, however, of these lesions on dissection, 
 are chiefly dependent on the treatment that has been 
 pursued. Should depletion have been neglected, these 
 morbid affections will necessarily be considerable ; but 
 should the contrary course have been judiciously re- 
 sorted to, they will be proportionably rarer. I may 
 mention, by way of corollary to these remarks, that 
 
MORBID APPEARANCES OF CONSUMPTION. 53 
 
 serous efFusions take place as a sequence of neglect in 
 recurring to due depletion, and also, in many instances, 
 as the result of debility, and are the proximate cause 
 of death. • These may occur to a quintuple extent; for 
 example — in the brain, the pericardium, the cellular 
 membrane of the lungs, the pleural sacs, and the pe- 
 ritoneal cavity. From repeated observations made by 
 me, and which have never yet been subject to a single 
 exception, I may lay it down as almost an invariable" 
 rule, that an oedematous state of the feet is an index of 
 some internal effusion. Indeed, whenever I observe, 
 after death, and before dissection, that the extremities 
 are swollen, I feel convinced that the presence of ef- 
 fusion will be one of the results of the examination. 
 As one of the complications of phthisis, I may here 
 mention a disposition to fistula, which Bordeu states to 
 be of common occurrence ; but according to my cal- 
 culation, I estimate that the proportion does not exceed 
 one in five hundred cases. Yet anal abscesses are far 
 from being infrequent : on examination, however, they 
 will be found not to deserve the name of true fistulse. 
 Calcareous deposits are occasionally found loose, in some 
 large cavities of the lungs ; and I entertain no doubt 
 from having seen them in imperfect cicatrizations, that 
 they have escaped into these excavations, owing to 
 
54 MORBID APPEARANCES OF CONSUMPTION. 
 
 the destruction of their containing cicatrice by ulcera- 
 tion. The general formation of these deposits, which 
 are chiefly composed of phosphate of lime, and of traces 
 of animal matter, is not a little curious. When the 
 process of healing is imperfectly performed and the 
 constitution of the individual is possibly inclined to a 
 chalky diathesis, a calcareous secretion is substituted 
 for the cicatrization that remains to be finished, and 
 a cure of the part is thus completed : and I am satis- 
 fied that, in such of the bronchial glands as contain 
 similar concretions, they supply the room of tubercu- 
 lous matter, which, it is by no means improbable, is 
 partly removed by absorption. 
 
 Mr. Abernethy has remarked in the heart, which is 
 generally free from disease, with the exception of slight 
 dilatation of the right ventricle, that the foramina the- 
 besii are frequently enlarged. However, I have never 
 yet met with any appearances to verify his assertion. 
 
 There remain many observations which I would 
 gladly make public, on the morbid appearances ob- 
 servable in consumption, a department of enquiry to 
 which I have devoted my entire professional life ; for 
 instance, empyema, resulting from the escape of tuber- 
 culous matter into the cavity of the chest, pneumo- 
 
PROPHYLACTIC TREATMENT OF CONSUMPTION. 55 
 
 thorax, gangrene, &c. : but, as I have already stated, 
 the circumscribed limits and peculiar nature of my 
 work, preclude me from indulging my wishes on this 
 my favourite theme. On a future occasion, however, 
 it is not improbable that I may have to offer a distinct 
 treatise on this interesting subject. 
 
 This opportunity will be presented in the work on 
 " Diseases of the Chest," to which I have already 
 alluded, and which I am now actively engaged in 
 preparing. However, the reader will find, that I have 
 made an addition to the plates illustrative of the mor- 
 bid anatomy of the disease. 
 
 PROPHYLACTIC TREATMENT, 
 
 BY WHICH THE DEVELOPMENT OF TUBERCLES IN THE 
 LUNGS MAY BE PREVENTED IN PERSONS LIABLE 
 THERETO FROM HEREDITARY PREDISPOSITION, OR 
 A CACHECTIC STATE OF THE SYSTEM. 
 
 Early in my practice, when consulted by patients 
 of an hereditary predisposition to consumption, it was 
 usual with me to recommend a generous invigorating 
 mode of living, and daily exercise in the open air, with 
 
56 PROPHYLACTIC TREATMENT OF CONSUMPTION. 
 
 a caution to avoid every thing calculated to impair the 
 general health. If, too, it were in the patient's power 
 to avail himself frequently of change of air, and scene, 
 I generally found it productive of considerable benefit, 
 both in a physical and mental point of view. The ad- 
 vantages, derivable from short excursions, or still bet- 
 ter, voyages by sea, always invited my recommendation 
 when circumstances rendered them available. Im- 
 pregnated as the sea-breezes are with saline particles, 
 they act, I conceive, as stimulants of the lungs to 
 deeper and more frequent inspiration, and thus for- 
 ward the enlargement of the chest, a point to which I 
 have more than once adverted, in the course of this 
 work, as of primary importance. They may also be 
 regarded as possessed of a tonic power, bracing and 
 invigorating the surface of the body, and, by continuous 
 sympathy, exerting a beneficial influence on the vis- 
 cera, especially those connected with the digestive 
 functions. Another strong inducement to recommend 
 a sea-voyage, in the case of persons labouring under 
 incipient consumption, is the probability of the pa- 
 tient's having his chest expanded in the manner de- 
 scribed above, and thus increasing the chances of his 
 contracting some variety of catarrh — hence bidding 
 defiance to phthisis. With reference to a generous 
 
PROPHYLACTIC TREATMENT OF CONSUMPTION. 57 
 
 mode of living, it is obvious that the tendency to weak- 
 ness, exhibited by individuals of consumptive constitu- 
 tion, calls for a method of treatment calculated to 
 counteract the commencing symptoms. Particular rules 
 and limitations, with respect to the dietetic manage- 
 ment, will be specified under the head of diet. As 
 to change of residence, a singular instance of its pre- 
 ventive effects occurred some years ago in the family 
 of a near relative of .mine, formerly Colonel of a dis- 
 tinguished cavalry regiment, who, after the afflicting 
 loss of two grown-up daughters and a son, removed 
 with his remaining children to Tours. Here he re- 
 sided for five years ; at the expiration of which pe- 
 riod, returning to his native country, and to the neigh- 
 bourhood of the place in which the disease had first 
 manifested itself in the children he had lost, — he had 
 the affliction of witnessing the premature deaths of 
 three other members of his family, within the short 
 period of two years. 
 
 Celsus says, that the worst air for the patient is that 
 which has given rise to the disease ; to which we may 
 add, that to consumptive families the worst locahty is 
 that in which the disease has first betrayed itself. 
 
 Whilst preparing these sheets for the press, I have 
 met with a very striking exemplification of the value 
 
 I 
 
58 PROPHYLACTIC TREATMENT OF CONSUMPTION. 
 
 of distant removal, in families consumptively inclined, 
 to those members whom circumstances have called 
 from their native land. Out of a family, consisting at 
 one period of eleven individuals, seven remaining here 
 have fallen victims to consumption ; whilst two, who, 
 as I have been given to understand, displayed the same 
 phthisical constitution as these, having removed to some 
 of our distant settlements, have enjoyed an excellent 
 state of health for many years, and have continued 
 free from any pectoral complaint. 
 
 Of the different kinds of exercise I would particu- 
 larize running, and riding, as the most calculated to 
 forward the purposes of prevention ; indeed, as the 
 best general prophylactics. After a quick and brisk 
 run, the respiration becomes frequent and deep, and 
 the panting that ensues by exercising the muscles of the 
 chest, favours a healthy development of that part, and 
 enlarges the volume of the lungs. It has been my 
 universal practice to recommend a constant attention 
 to this healthy exercise, in those schools I have been 
 in the habit of attending, and to advise the precept- 
 ors to promote it by every inducement within their 
 power ; and I have never been disappointed in the 
 results experienced. Nor are its happy effects confined 
 to the mere expansion of the chest; by the greater 
 
PROPHYLACTIC TREATMENT OF CONSUMPTION. 59 
 
 portion of air thus brought into contact with the venous 
 system;, the blood becomes more effectually decar- 
 bonized, the animal heat increased, the action of the 
 heart more vigorous, and the multifarious secretions 
 are carried on with greater energy. 
 
 Riding, which stood so high in Sydenham's estima- 
 tion, is an exercise of no mean value, for the self-same 
 reasons, with this advantage, that it yields all the good 
 effects of the former, unattended with its fatigue. To 
 those, however, in whom consumption has decidedly 
 appeared, the benefit derivable from this mode of exer- 
 cise may, perhaps, be enhanced by the tendency to an 
 upward motion imparted to the lungs, thus disposing 
 to apposition the diseased surfaces in the upper region 
 of the chest. Dr. Carmichael Smyth has advocated the 
 utility of swinging as an exercise, and has devoted a 
 treatise to its supposed merits. This, although he does 
 not explain its mode of operation, undoubtedly acts 
 in a manner similar to the foregoing, and, notwith- 
 standing I have never recommended it, it may not 
 be unworthy of trial as a prophylactic. A strong 
 proof of the advantages of exercise may not unwar- 
 rantably be sought for in the probable exemption of 
 man, in a savage state, from the ravages of this dis- 
 ease. Although various disorders are mentioned by 
 
60 PROPHYLACTIC TREATMENT OF CONSUMPTION. 
 
 travellers as having fallen under their observation, I 
 do not remember, in the course of my reading, to 
 have met with any notice of consumption, recorded 
 by those who have mingled with the savage tribes 
 of either the old or the new world; at least, amongst 
 the more active races of uncivilized man. Indeed, 
 it would be wonderful were the case otherwise. De- 
 pendant for their subsistence on incessant vigilance 
 and vigorous exertion ; constantly engaged in the toils 
 of the chace, or animated to activity by the animosi- 
 ties ever subsisting between neighbouring tribes, how- 
 ever they may lapse occasionally into habits of sloth 
 and indolence, their life from the cradle to the grave 
 must, generally' speaking, be calculated to call forth 
 -and perfect every bodily energy. Free from the re- 
 straints which are the unavoidable consequence of a 
 state of superior intelligence, — neither confined to the 
 manufactory, nor chained down to the desk of the 
 counting-house, untrammelled by dress, and uncramped 
 by the various devices to which either fashion, or 
 the force of habit, renders us subservient despite the 
 dictates of reason,— the savage possesses at least the 
 uncontrolled use of his limbs ; and the symmetry, 
 usually observed in him, is perhaps the best index of 
 the health he enjoys. If, too, we extend our course of 
 
PROPHYLACTIC TREATMENT OF CONSUMPTION, 61 
 
 reasoning to the inferior race of animals, and observe 
 the differences existing between them in their wild 
 and domestic condition, we shall find a singular ana- 
 logy betwixt them and man. To go no further than 
 the harmless creature, the rabbit, I have found, in the 
 course of my researches in comparative anatomy, that- 
 this animal frequently dies of consumption, in its tame 
 state ; but I never met with an instance of the kind in 
 the wild rabbit. Perhaps the benefit of exercise can- 
 not be better exemplified than by way of contrast. 
 Swine, proverbially the most indolent of animals, are 
 also the most subject to tuberculous disease ; hence the 
 derivation of the word scrofula from the Latin scrofa, 
 a swine ; and consumption and scrofula are identically 
 the same, both resulting from the presence of tu- 
 bercles. To pursue the analogy, another strong in- 
 stance of the force and good effects of exercise is ob^ 
 servable in the race-horse, the hunter, and indeed in 
 all of this class that are subject to frequent and active 
 exertion. These seldom or ever, I believe, are found 
 to have tubercles in the lungs, so long as they are kept 
 constantly employed. Many illustrations of this na- 
 ture might be adduced, but sufficient has been said to 
 enable the reader to extend this comparative enquiry, 
 and to confirm the high value which I set on the eflfects 
 
62 PROPHYLACTIC TREATMENT OF CONSUMPTION. 
 
 of judicious and well-regulated exercise. In additional 
 confirmation of my reliance on mechanical modes of 
 exercise, as prophylactics, I proceed to relate a few out 
 of numerous cases of the kind I find recorded in my 
 note-book. , 
 
 Case I. — Some few years back I was called in to 
 see the eldest son of a family of rank, a boy of twelve 
 years of age, who, when I first saw him, was in the 
 last stage of consumption, to which a younger mem- 
 ber of the same family, whose case I had not the op- 
 portunity of witnessing, had previously fallen a victim. 
 As was expected, the case terminated fatally ; and on 
 examining the body, independently of the diseased 
 state of the lungs which usually occurs in consump- 
 tion, the serous surfaces of the chest, as well as of the 
 abdomen, were studded with innumerable tubercles. 
 Some of these, seated in the peritoneum investing the 
 intestinal tube, were of large size, and in a state of 
 crudity ; and I traced two minute openings in the 
 ileum, (formed, I have reason to believe, by softened 
 tuberculous matter,) through which liquid foecal con- 
 tents were diffused within the abdominal cavity. This 
 part, during life, was of ascitical magnitude, and fluc- 
 tuated on percussion, but was almost devoid of pain. 
 He had vomited, on two or three occasions, considerable 
 
PROPHYLACTIC TREATMENT OF CONSUMPTION. 63 
 
 quantities of liquid matter^ emitting a foecal odour, 
 and similar in appearance to what I afterwards found 
 deposited in the peritoneal sac ; and subsequent to each 
 vomiting, a perceptible reduction in the magnitude of 
 the abdomen took place. This circumstance would in- 
 duce me to suppose, judging from the peculiar smell 
 and appearance of the ejected fluid, that a portion had 
 been returned from the abdominal cavity into the in- 
 testinal canal, whence, by inverted action^ it reached 
 the stomach to be discharged by vomiting. The same 
 appearances, in regard to extensive tuberculous deposit, 
 with the exception of the intestinal perforation, were, 
 I was given to understand, presented in the body of the 
 younger brother, whose death, I have already men- 
 tioned, preceded that of his elder From the delicate 
 health of the remaining members of the family, two 
 especially, joined to the foregoing signs of highly- 
 charged scrofulous habit, it was apprehended by their 
 nearest relatives that the disease would successively 
 pervade the whole family. One, however, I felt as- 
 sured, from her having had for two years a pulmonary 
 catarrh, would be exempt from the dreaded visitation. 
 Following up the plan which I had ever found so emi- 
 nently serviceable, I immediately recommended them 
 to commence a course of inhalation. For this purpose. 
 
64 PROPHYLACTIC TREATMENT OF CONSUMPTION. 
 
 I ordered that tubes^, of diameters varying with the 
 respective ages of the patients, should be prepared, 
 through which they were directed to respire twice a 
 day; and the time for this process was gradually ex- 
 tended, until it occupied half an hour morning and 
 evening. By pursuing this plan of treatment their 
 chests gradually enlarged, their health became sur- 
 prisingly amended, and a regularity of bowels, without 
 the aid of medicine, was soon established. 
 
 It may here be advisable to explain in what manner 
 the simple process of inhalation, whilst it expands the 
 pulmonary apparatus, at the same time regulates the 
 most important of the visceral functions. The mere ex- 
 pansion of the lungs, in the first instance, tends indi- 
 rectly to remove congestion of the liver, and also of the 
 stomach, spleen, pancreas, and intestinal canal, all 
 dependent on the more free circulation of the blood in 
 the former. The biliary, as well as the great salivary 
 secretion is hereby promoted to a healthy activity. 
 Such morbid irritability of the mucous membrane of 
 the stomach, as may be present, productive of indiges- 
 tion, is removed ; the chyliferous absorption belonging 
 to the small intestines, so indispensable to life, is ac- 
 tively carried on; and the injurious retention of ex- 
 crementitious matter, in the larger intestines, is obviated 
 
PROPHYLACTIC TREATMENT OF CONSUMPTION. 65 
 
 by increased mucous moisture, and accelerated peris- 
 taltic motion. It were easy, did I deem it essential, 
 to point out at length the beneficial effects produced 
 on other secretions, and to explain the mode by which 
 inhalation acts upon that of the kidneys ; but sufficient 
 has been stated to enable the medical man to draw his 
 own deductions in these particulars. To bring the 
 history of this family case to a close ; I have the pleasure 
 of saying, that a perfect restoration has attended my 
 endeavours, and that at this moment these, my former 
 patients, are enjoying all the blessings of health. 
 
 Case II. — A young gentleman was brought to my 
 house, by the Secretary of an incorporated Literary In- 
 stitution in Lincoln's Inn Fields, labouring, his friends 
 feared, under incipient consumption. His conforma- 
 tion evidently predisposed him to phthisis ; and his 
 chest in particular was singularly narrow and slightly 
 deformed. I laid down the plan which I conceived it 
 would be most advisable for him to follow, and pointed 
 out the necessity of strict adherence to my directions. 
 Inhalation, of course, formed a prominent feature in 
 the treatment to be observed. It so happened, that I 
 had only this solitary opportunity of prescribing for 
 him, although I could have wished to have seen him 
 from time to time, since there are circumstances which 
 
 K 
 
66 PROPHYLACTIC TREATMENT OF CONSUMPTION. 
 
 occasionally render it expedient to suspend inhalation 
 for a short period, and to have recourse to local and 
 other treatment. Notwithstanding the want of this 
 opportunity might be considered unfavourable, it so 
 occurred, to my great satisfaction, that meeting with 
 the gentleman who had introduced the youth, about 
 eighteen months subsequent to his consulting me, and 
 of course inquiring into the state of his health, I found 
 that he, having punctually adhered to my instructions, 
 had not only overcome all his consumptive symptoms 
 and been restored to robust health, but that his chest, 
 formerly so flat and confined, had altered in shape, 
 was considerably enlarged, and was, to use the expres- 
 sion of his friend, perfect symmetry. 
 
 Case III. — Two young ladies, of adult age, were 
 brought to town by their mother in the middle of the 
 year 1832, for the purpose of taking my advice. Four 
 of her children had, she stated, been attacked by con- 
 sumption, within a short period of time, and had fallen a 
 prey to it. Both, when I first visited them, had a short, 
 hacking cough, with undefined pain in the chest. In 
 the eldest, who was in her nineteenth year, the mur- 
 mur of respiration was imperfect in the top of the 
 right lung ; percussion also, on the centre of the cla- 
 vicle of the same side, yielded a flat sound. My 
 
PROPHYLACTIC TREATMENT OF CONSUMPTION. 67 
 
 impression from these signs was, that a tuberculous 
 deposit had already taken place. Bronchophonism 
 was distinctly heard by the naked ear ; and it was plain 
 from the absence of any variety of pectoriloquy, that 
 no softening of the mass, so as to form a cavity, had 
 occurred. With respect to the other sister — since the 
 sound of her respiration was natural, and no bronchial 
 affection whatever was indicated, yet as she had occa- 
 sional cough, and had had, as I was informed, slight 
 haemoptysis— I conceived that a few solitary tubercles 
 might possibly exist in her lungs, irritating the pul- 
 monary tissue like the thorn of Van Helmont. These 
 symptoms considered, I commenced with local blood- 
 letting, and the exhibition of nitre in doses of a scruple, 
 &c. ; after which, my chief reliance was on inhalation. 
 They persevered in a course of this for some months, 
 inhaling, according to my customary directions, twice 
 a-day, varying the diameter of the tubes employed, 
 since occasionally pain arose from the expansive pro- 
 cess being too powerful. Indeed, the liability to pul- 
 monary engorgement, from using tubes of too small a 
 diameter, points out the necessity for the constant su- 
 perintendence of the practitioner, skilled in the auscul- 
 tative exploration of the chest. One circumstance, 
 perhaps, should not be passed over, as exhibiting an 
 
68 PROPHYLACTIC TREATMENT OF CONSUMPTION. 
 
 additional proof of the good effects of inhalation on 
 the general health. The periodical uterine secretion 
 of the elder of these young ladies having been sup- 
 pressed for some months, she recovered in the course 
 of a few weeks the usual feminine habit, which sub- 
 sequently continued underanged. Nothing of further 
 moment occurred in the course of these cases. Con- 
 tinuing gradually to improve, the younger became per- 
 fectly restored to health ; and the elder, althoXigh the 
 respiration in the upper lobe of the right lung is not 
 so perfect as I could desire, still, from the general ex- 
 pansion which the pulmonary tissue underwent in all 
 other parts, and the probability that in time black pul- 
 monary secretion will form round the existing nodules, 
 so as to isolate them in the manner I have fully de- 
 scribed in the chapter on Morbid Appearances, I con- 
 sider as entirely free from all danger of any new forma- 
 tion of tuberculous matter. 
 
 The value of exercise, m checking and removing 
 symptoms of incipient phthisis, is, in my opinion, so 
 great, that I am induced to dwell at some length upon 
 this part of my subject. Those musicians, whose pro- 
 fession it is to play upon wind instruments, are in ge- 
 neral supposed to be peculiarly subject to pulmonary 
 complaints ; perhaps not inaccurately so : yet, I am 
 
PROPHYLACTIC TREATMENT OF CONSUMPTION. 69 
 
 not aware that any detailed, or circumstantial expla- 
 nation has been given of the mode, through which in- 
 jurious effects arise from the use of such instruments. 
 Whoever will take the trouble to watch attentively a 
 player on the flute, or clarionet, &c., will find, that al- 
 though the performer seemingly inspires and expires 
 irequently and fully, yet that, in point of fact, he often 
 makes several consecutive expirations to one inspira- 
 tion. Thus his breathing, so far from being advanta- 
 geous, and so far from developing the lungs, as I have 
 previously declared well-regulated mechanical exercise 
 will ever do, is indeed so irregular and furtive, that it 
 produces effects entirely the reverse, narrowing the 
 chest, and confining the volume of the lungs : indeed, 
 it favours that diminished size of the respiratory appa- 
 ratus which engenders a tendency to consumption. 
 What I may not inaptly term a wholesale case occur- 
 red some years ago, illustrative of the foregoing re- 
 marks. The leader of an itinerant band of ndusicians 
 applied to me, in behalf of himself and followers, to 
 know what method they should pursue to avert the 
 threatening appearances, which they considered would 
 ultimately lead to confirmed pulmonary affection. I 
 advised, that after their musical entertainment for the 
 time being was concluded, they should always take a 
 
70 PROPHYLACTIC TREATMENT OF CONSUMPTION- 
 
 long and quick run, or else carry walking-sticks, per- 
 forated longitudinally, through which they might re- 
 spire, and thus compensate their previous irregularity 
 in breathing. Ludicrous as the idea may appear of a 
 set of men scampering off, after an exhibition of their 
 scientific powers, these poor fellows had the good sense 
 to perceive the advantage of pursuing my advice ; and 
 I have subsequently learnt that they have experienced 
 its happy influence. It has been my uniform practice 
 indeed, in similar instances, to recommend a similar 
 proceeding, and the benefit has, I trust, been widely 
 diffused. Before proceeding further in this chapter it 
 may not be irrelevant to notice, that protracted indis- 
 position, whether arising from mental or bodily causes, 
 is productive of diminution of the chest; the general 
 debility causing local muscular weakness, and this 
 being more particularly the case in the muscles of 
 inspiration. The lungs thus compressed, are of 
 course favourable to the development of tubercles ; 
 as well as to pleurisies, which, according to a great au- 
 thority, M. Laennec, are the cause of permanent con- 
 traction of the chest in consumption But it should 
 be borne in mind, that this writer is utterly mistaken, 
 when he asserts that the endeavours of nature to cure 
 phthisis originate the same phenomenon. 
 
PROPHYLACTIC TREATMENT OF CONSUMPTION. 71 
 
 The truth is — the contrary is the fact; since, on ex- 
 amination of the lungs of persons who have recovered 
 from consumption, we almost invariably find their 
 lungs voluminous, and their chests of increased capa- 
 city. When individuals labour under chronic, or 
 incurable diseases of any kind, whether medical or 
 surgical, and the constitution is much impaired by 
 the continuance of ill health, consumption is pecu- 
 liarly prone to manifest itself: but should they have 
 been subject for any length of time to catarrhal, 
 asthmatic, or cardiacal affections, I have long ob- 
 served that they enjoy a complete immunity from 
 tuberculous attacks, and hence cannot become con- 
 sumptive. Therefore, in imitation of my own prac- 
 tice, I would earnestly recommend the physician, as 
 well as surgeon, to exercise the chest by means of in- 
 halation ; and the result would be to ward off any 
 secondary complaint, such as consumption, which so 
 commonly supervenes to shorten lives, that otherwise 
 might have been indefinitely prolonged. To strengthen 
 my assertions respecting the beneficial results arising 
 from the manifestation of catarrh, in patients suffering 
 from incurable complaints, I could give from my case- 
 book, and indeed from memory as well, innumerable 
 
72 PROPHYLACTIC TREATMENT OF CONSUMPTION. 
 
 cases confirmatory of my views : but a few will suffice 
 to shew that I do not exaggerate its happy influence. 
 
 Case IV — Sarah Jackson, aged forty-eight, appHed 
 four years ago to the Infirmary for Asthma, Consump- 
 tion, &c., in consequence of consumptive symptoms ; 
 such as hectic fever, frequent pulse, violent cough, 
 with copious puriform and sometimes sanguineous ex- 
 pectoration, profuse nocturnal perspirations, and, aa 
 might be expected, great emaciation and debility. Her 
 habit had long been feeble : this had been in the first 
 place induced by a cancerous affection of the womb, 
 destructive of the cervix and a portion of its body, and 
 which had produced malignant ulceration of the upper 
 part of the vagina, accompanied with racking pain, fetid 
 sanies, and other exhausting discharges attendant on 
 schirrous uterine disease. It was not till she had been 
 an out-patient at the infirmary for some time, that I was 
 made acquainted with the above alarming cancerous 
 state. This of course appeared a fearful complication 
 of disease, and, in fact, made me regard the case as 
 almost hopeless. However, by means of small local 
 bleedings, at times from the chest, and occasionally 
 from the neighbourhood of the uterus, together with 
 the exhibition of saline medicines, conjoined with tar- 
 
PROPHYLACTIC TREATMENT OF CONSUMPTION. 73 
 
 tar emetic in small quantity, and aluminous and other 
 injections for the womb, I succeeded in entirely re- 
 moving her constitutional disorder, and in greatly mi- 
 tigating the disease of the chest, as well as that of the 
 uterus. Now, whether it was owing to her own im- 
 prudence in improperly using the injections too cold, 
 or from incautious exposure to the weather during the 
 prevalence of easterly winds, a severe bronchial affec- 
 tion took place, in which was well-marked sonorous, 
 and sibilant rattle. Excepting mucilaginous and de-^ 
 mulcent drinks, with small doses of nitre, she had very 
 little medicine administered to her. Indeed, I hailed 
 this adscititious complaint, notwithstanding her much 
 embarrassed breathing and distressing cough, as the 
 most fortunate circumstance that could have befallen 
 her ; and was therefore inclined to let nature work, 
 carefully watching every indication, and desirous to 
 assist, rather than to interfere, with her operations. It 
 is superfluous to enter into all the minutiae of this pa- 
 tient's • treatment ; suffice it to say, that a permanent 
 catarrh was established, thus at once arresting the pro- 
 gress of consumption, and daily adding to her security 
 from all danger of relapse. Nor was this the sole ad- 
 vantage resulting from the supervention of a bronchial 
 complaint. By the improvement which the patient's 
 
74 PROPHYLACTIC TREATMENT OF CONSUMPTION. 
 
 general health experienced^ from the successful ter- 
 mination given to the consumptive symptoms, the 
 uterine malady has increased but little, which, aggra- 
 vated by the supervening phthisis, would, without the 
 ingression of the last of this ternary complication, 
 most probably have long since proved fatal. Thus, in 
 this instance, as well as in many others of no dissimilar 
 nature, which it were easy to adduce, we have proof 
 corroborative of the fact, that the supervening catarrh, 
 occurring spontaneously, will not only give a favourable 
 turn to the course of consumption but be instrumental 
 in delaying the advance of an incurable disease. So 
 well defined is this case, and so strong a proof does it 
 afford of the efficacy of the practical treatment which 
 it is my chief object to point out, that I deem it neces- 
 sary to demonstrate beyond doubt the consumptive 
 condition of this patient ; and I therefore am anxious 
 to add, that my opinion was not grounded merely upon 
 the common symptoms of phthisis, but upon the more 
 certain indices aiForded by physical phenomena. This 
 female, whose employment is that of a nurse, has, I 
 understand, communicated her improved health to 
 Mr. White, surgeon to the Westminster Hospital, and 
 also to Dr. Borett, a Polish physician, and others, 
 who, in conjunction with myself, carefully ascertained 
 
PROPHYLACTIC TREATMENT OF CONSUMPTION. 75 
 
 the nature of hei* pectoral as well as uterine disorders, 
 and can bear testimony to the order in which they 
 occurred. 
 
 Case V — Mr. C. W.;, from the neighbourhood of 
 Rumfordj, applied to me in February, 1828, for a com- 
 plaint of the chest. He had been for some months 
 expectorating muco-purulent matter in considerable 
 quantities ; through this, as well as profuse perspira- 
 tionSj and an occasional febrile state, he had become 
 excessively debilitated and attenuated. After pursuing 
 my advice for a short time, he lost his more formidable 
 symptoms ; and there were merely left slight cough, 
 and an oppressive wheezing, which, at times, would 
 compel him to leave his bed about two hours after mid- 
 night. Though he considered himself well for nearly 
 five years after this, I have nevertheless grounds for 
 belief, as this was a cured consumptive case, and as he 
 exhibited slight symptoms of emphysema, that his 
 lungs must have been more or less affected, through- 
 out this space of time, with some bronchial irritation, 
 though he had but little cough. Being called in to 
 this gentleman about three years ago, as apprehen- 
 sions were entertained, from certain pulmonary indi- 
 cations, of his relapsing into the state from which I 
 had formerly relieved him, I ascertained by the ear 
 
76 PROPHYLACTIC TREATMENT OF CONSUMPTION. 
 
 that a bronchial afifection had been established, which, 
 from my recollection of the peculiarities of his ailments, 
 and my having regarded his case as one of cured con- 
 sumption;, I felt satisfied, previous to auscultation, vi^ould 
 prove to be the fact. Pointing out this condition 
 of his patient to that most intelligent practitioner, 
 Mr. Sewell, I assured him that he need not have con- 
 templated a recurrence of consumption, though such 
 might not unreasonably be apprehended from a malig- 
 nant schirrous affection, which had made its appear- 
 ance a year previously, and had committed extensive 
 ravages on the rectum, perineum, and adjoining parts, 
 for which the most celebrated surgical advice was 
 taken. From the ill-health induced by the foregoing 
 d.estructive malady, the chances of his having con- 
 sumption were considerably augmented ; but owing to 
 the protection afforded by chronic catarrh, as I have 
 often reiterated, the patient is placed beyond the reach 
 of that most common and fatal of human diseases — 
 pulmonary consumption. 
 
 Case VI. — However Anti-Mai thusian the doctrine 
 may be, yet as it is in accordance with the law, and 
 may likewise be regarded as a special dispensation of 
 nature, I do not scruple to advance it as my opinion, 
 that many cases of threatened, or indeed actual con- 
 
PROPHYLACTIC TREATMENT OF CONSUMPTION. 77 
 
 sumption, in the female^ may be warded off by a timely 
 compliance with the first benignant ordination given to 
 our first parents — marriage. In order fully to explain 
 how the benefit arises, and in what manner the bless- 
 ings of matrimony, — for such I believe, despite the 
 late talented professor just alluded to^ they are still 
 called, — operate, I shall cite one from a variety of si- 
 milar cases. Mrs. E. S., aged thirty-eight, made appli- 
 cation to me, in the winter of 1827, for a painful 
 state of the chest, with oppressed breathing and severe 
 cough, with expectoration of blood, mixed with frothy, 
 yellow matter. She likewise complained of profuse 
 perspirations, followed by emaciation and extreme de- 
 bility. Among other physical signs, pectoriloquism 
 was distinctly heard by the naked ear, underneath the 
 second and third ribs of the right side. When she 
 first came to me, she laboured under much depression 
 and anxiety with respect to her state, not only from 
 her having lost two sisters by the same disease, but 
 from her husband's having inadvertently communicated 
 to her the opinion of a respectable medical practitioner 
 of Great Ormond Street, who, to use her own words, 
 had unreservedly stated to him, " that no power on 
 earth could save her life." My opinion, at first, was 
 also of an unfavourable kind. The experience of a 
 
78 PROPHYLACTIC TREATMENT OF CONSUMPTION. 
 
 few days, however, since the most distressing symp- 
 toms of the case yielded to remedial treatment, in- 
 duced me to entertain hopes. These hopes became 
 certainty when I discovered that she was in a state of 
 pregnancy, for I had long noticed that the constantly 
 increasing magnitude of the womb exerts a powerful 
 influence in suspending, and still further in curing, 
 tubercular phthisis. This circumstance is not brought 
 forward as any novelty to the profession, but simply as 
 affording an opportunity of explaining the process, by 
 which the gravid uterus accomplishes so favourable an 
 end. The hitherto received opinion is, that a diversion 
 of morbid action from the lungs takes place, through 
 the necessary afflux of sanguineous fluid to the womb 
 and its embryo, thus arresting disease ; but I conceive 
 that this mode of accounting for the cures effected 
 is utterly vague and unsatisfactory. In such cases, 
 the suspension of existing disease in the lungs, and 
 indeed the permanent removal of the constitutional 
 symptoms of phthisis, are no doubt effected by the en- 
 croachment made on the chest from below upwards by 
 the pressure beneath the diaphragm, which has the 
 effect of bringing in apposition the inferior and su- 
 perior surfaces of the pulmonary cavities, so as to 
 unite them. This view of mine is borne out by the 
 
PROPHYLACTIC TREATMENT OF CONSUMPTION. W 
 
 post mortem appearances, which I have witnessed 
 in those who had recovered from consumption while 
 in a pregnant state. In not a few examinations of 
 this kind;, I have noticed that the internal cicatriza- 
 tions of the healed lungs were transverse or horizontal, 
 thus proving that the progressive pressure upwards, 
 in the direction of the diseased summit, had been 
 the sole cause of that union to which the disease has, 
 in great measure, owed its cure. This mode of ex- 
 plaining the cure appears to me much less hypothe- 
 tical than the generally received doctrine, since it is 
 based on proofs derived equally from anatomical and pa- 
 thological research; yet I do not wholly dissent from 
 the customary view of the subject, the cure being in- 
 disputably, in many instances, consequent on the de- 
 termination of blood to the uterus, thus diminishing to 
 a certain extent a local disease, and allowing, by this 
 diminution, the supervention of subacute bronchial 
 irritation. This last accident is, in no slight degree, 
 perhaps, favoured by the horizontal enlargement of the 
 lungs, especially of the lower lobes. Though instances 
 of recovery, attendant on pregnancy supervening to 
 consumption, are numerous, yet as cases notwithstand- 
 ing happen in which a cure has not been effected, 
 I think it essential to indicate one or two reasons for 
 such occurrence. 
 
80 PROPHYLACTIC TREATMENT OF CONSUMPTION - 
 
 First, we cannot be surprised, when pregnancy takes 
 place in an advanced stage of the disease, at not meet- 
 ing with the usual effects, and a second reason that 
 may be assigned for death following, what might other- 
 wise be regarded as a case of cured consumption, may 
 be found in the absence of chronic catarrh ; or in the 
 production of a fresh crop of tubercles by ill health, 
 after cicatrization has taken place. Having thus pur- 
 posely digressed, in order to explain my views of the 
 sanatory influence of pregnancy, I hasten to the con- 
 clusion of the present case. Since Mrs. E. S. first 
 became my patient she has had four children, now 
 alive ; and with the exception of a discharge of blood 
 and muco-purulent matter, that continued for a week 
 about five years ago, possibly expectorated from some 
 imperfectly-healed cavity of long date, she has had no 
 recurrence of her former formidable complaint. Du- 
 ring the last two years she has been free from cough ; 
 and, with the exception of slight catarrh, for a time 
 attended with abundant pituitous discharge, she is 
 in the enjoyment of better health than she has been 
 in for the last ten years. At present, I consider 
 her as perfectly secured against a relapse into her 
 former state, for two reasons — the partial cicatriza- 
 tions which evidently took place during pregnancy, 
 and the existence of emphysematous, and voluminous 
 
PiiOPHYLACTiC TREATMENT OF CONSUMPTION. 81 
 
 lungs — the first discoverable by respiration denoting that 
 State, and the second being its certain consequence. 
 ft cannot, I think, be wondered at, that having re- 
 peatedly witnessed the fortunate results arising from the 
 pregnant state, I should have some years ago occasion- 
 ally ventured to suggest to the unmarried consumptive 
 female the propriety or necessity of matrimony, where 
 from the circumstance of existing reciprocal attachment. 
 Such an engagement could be happily entered into. 
 
 I have previously mentioned that asthmatic, catarrh- 
 al, and cardiacal individuals are exempt from all 
 danger of pulmonary consumption ; and to these I 
 may subjoin persons affected with diseases of the con- 
 vulsive kind, such as hysteria, epilepsy, or, in truth, 
 all in which a prolonged, forcible retention of the 
 breath is frequently seen. This circumstance, in pa- 
 tients of this description, must be accounted for in the 
 manner already explained, when dwelling upon the 
 benefits arising from the mechanical extensibility of 
 the air cells by inhalation. 
 
 Before bringing these remarks on the prophylactic 
 treatment of phthisis to a close, there remain a few 
 general observations, which spring as much, or nearly 
 so, from experience in my own person, as from my 
 attention to the cases of others. In the foregoing 
 
 M 
 
82 PROPHYLACTIC TREATMENT OF CONSUMPTION. 
 
 portion of my work, I have advised a generous mode 
 of living as among the preventives of this disease ; 
 and in peculiar circumstances I would even recom- 
 mend the use — of course the cautious use — of wine, 
 sound home-brewed malt liquors, and occasionally of 
 other stimulants. I now allude to a failure of health, 
 the forerunner of consumptive attack, induced by 
 trouble of mind, to which I lament to say numbers 
 fall lingering victims. It has been my misfortune to 
 witness, in the course of my practice, but too many 
 instances of the maladies engendered by " a mind 
 diseased." Well has the poet of nature remarked 
 this, amongst his aggregate of human ills, when he 
 mentions ^'^the law's delay," than which I know not 
 a greater destroyer of peace of mind, and, with it, of 
 the body's health. We are accustomed to look back 
 with horror on the proceedings, recorded by historians, 
 as having taken place in that iniquitous court which 
 went under the name of the Star Chamber : how then, 
 judging by analogy, will our posterity execrate the 
 records left them of the practice of the Court of 
 Chancery ! They will there read a piteous tale of 
 justice withheld,— of hope, the brightest boon of heaven, 
 extended and protracted, until to look forward is to 
 exclaim, with Lear, " Oh ! that way madness lies." 
 
PROPHYLACTIC TREATMENT OF CONSUMPTION. 83 
 
 The ghastly train of diseases^, — coiiwSumption, cancer;, 
 and other fell destroyers of the human race^ — whit>h 
 I have seen brought on the wretched victnns of the 
 procrastination, until recently the characteristic of this 
 court, leads me, in common with the general voice, to 
 reflect with gratitude on the change that has been 
 eifected by the wise energy of one master-spirit. 
 Had the reforms, introduced by him, been adopted 
 even a few years sooner, how many a fair fabric of 
 human happiness would have been spared, that now 
 lies dismantled and overthrown ! To return from this 
 digression. On occasions when the mind is kept con- 
 stantly on the rack, I consider it not unadvisable to 
 allow a comparative freedom in point of living ; but 
 I must add a caution, with respect to patients of the 
 weaker sex, to whom this freedom, limited as I have 
 stated it should be, must be still more sparingly 
 granted. The difference in strength, both mental and 
 physical, calls for strict attention to this distinction. 
 
THE TREATMENT 
 
 OF 
 
 CONSUMPTION. 
 
 There are but two modes by which we can hope 
 to cure this disease : the one is by rendering it chronic, 
 and the other by artificially enlarging those portions 
 of the lungs which are pervious to air. In the first 
 we endeavour to effect an absence of constitutional dis- 
 order ; but, after this change is effected, there may 
 still remain for an indefinite period one or more 
 cavities uncicatrized, with lining membrane, partly 
 semi-^cartilaginous, or of such condensed and insensible 
 structure as to be productive of little inconvenience, 
 if we except occasional cough and some haemorrhage 
 which last occurs at long intervals, and rarely to a great 
 extent. In the second, there is produced what is inva- 
 riably seen when nature or art has effected a cure — 
 an enlargement of the vesicular structure of the lungs. 
 
TREATMENT OF CONSUMPTION. 85 
 
 and subsequently a gradual healing of the tuberculous 
 excavations. 
 
 It has always been my great aim to put an end, as 
 early as possible, to the symptoms of hectic fever. 
 This I have successfully accomplished, in many in- 
 stances, by employing moderate anti-phlogistic means ; 
 among which, I may first mention general and local 
 blood-letting. It is astonishing how great is the relief 
 afforded by even six or eight leeches, applied to the 
 chest whilst the patient is labouring under the hectic 
 paroxysm. It was early my practice to bleed two or 
 three times from the arm, as we thus interrupt the 
 noonday chills, evening fever, and the nightly perspira- 
 tions : and when the abstraction of blood by the lancet 
 is employed early (acute inflammation being absent,) 
 and in a quantity rarely exceeding five or six ounces 
 at a time, weakness is seldom complained of; on the 
 contrary, the greatest relief is experienced. The weight 
 and erratic pains of the chest, distressing cough, short- 
 ness of breath, and irritability of the stomach, are greatly 
 lessened. It has long appeared to me that the necessity 
 for the abstraction of blood has not been judiciously 
 considered ; otherwise, I should not be consulted by so 
 many consumptive individuals, in whom the disease has 
 gone on unpalliated by any sanguineous depletion. 
 
86 TREATMENT OF CONSUMPTION. 
 
 This consideration becomes the more important when 
 we reflect how liable to produce a certain degree of 
 venous congestion are the chilly iits, which are of daily 
 occurrence, — as well as tubercular deposits and engorge- 
 ments in the lungs themselves, the bulk of which is gra- 
 dually undergoing a diminution by the contraction of 
 the chest. The blood of the right ventricle of the heart 
 not finding a ready passage through the lungs, afflicted 
 as above-mentioned, causes a preternatural quantity of 
 the same fluid in the adjoining auricle, and especially in 
 the two great veins opening into it. The consequences 
 of this state are head-ache, owing to intei-ruption of 
 the free return of blood from the head ; pulmonary 
 engorgement, through the difficulty the bronchial veins 
 experience in transmitting their blood, by either its 
 direct or circuitous course, into the vena azygos ; and 
 serious derangement, or actual disease, of the most im- 
 portant viscera of the abdomen. The superior cava, 
 prenaturally full of blood, will, by retarding that fluid 
 in the jugular veins, produce pain in the head ; and, by 
 a similar interruption to the circulation of the vena 
 azygos, besides interfering with the free return of the 
 blood into the bronchial veins, it will in some degree 
 impair the activity of the kidneys ; the due return of 
 the eflete blood of which organs depends on the free- 
 
TREATMENT OF CONSUMPTION. 87 
 
 dom with which it is conveyed from the vena azygos, 
 into the vena cava superior. 
 
 The moderate abstraction of blood, occasionally^ pre- 
 vents that congestion in the floating viscera of the ab- 
 domen which gives rise to diarrhoea, irritability of 
 stomach, and effusion from the serous membrane in- 
 vesting them, which at times occurs. It has, indeed, 
 an excellent effect in securing freedom to the hepatic 
 circulation ; and thus all the parts, whose venous cir- 
 culation passes through the liver by the vena portse, 
 are long preserved in a state of integrity. Besides 
 the great exemption from diarrhoea which this prac- 
 tice affords, the colliquative perspirations likewise are 
 either greatly lessened, or for no inconsiderable pe- 
 riod wholly removed. Where the disease is not of 
 such long duration as to be attended by much ema- 
 ciation and debility, I would advise general bloods 
 letting, to the extent of four or six ounces, to be per- 
 formed three or four times during the presence of 
 hectic fever ; allowing of course, the patient being bet- 
 ter, a reasonable time to elapse before he be again 
 subjected to this operation. In consumption, particu- 
 larly in its early stage, I find patients generally say 
 they are strengthened, rather than weakened, when 
 four or five ounces of blood are taken at intervals of a 
 
88 TREATMENT OF CONSUMPTION. 
 
 few days. After the constitutional fever has been in 
 this manner interrupted, if it seems shortly after dis- 
 posed to return, we may again ward it off by apply- 
 ing six or eight leeches on the summit of the chest 
 just beneath the clavicles. In my opinion, they are 
 best applied on the upper part of the chest, since it 
 is there that the tubercular aifection first commences. 
 By thus alternating the general and local bleedings, 
 we husband the patient's strength, while at the same 
 time we mitigate the most distressing symptoms of his 
 disorder. Cases are at times met with, in which the 
 lancet may be used with some degree of freedom. For 
 example : when signs of pleuritic or pneumonic in- 
 flammation are present, and when hsemoptical dis- 
 charges are attended with much oppression, pain, and 
 heat in the chest. I have not seen it noticed, that, in 
 the absence of acute inflammation, the blood taken 
 from the arm of consumptive persons is peculiar in its 
 crassamentum ; it is never cupped, and its upper sur- 
 face has a somewhat greenish, semi-transparent, ge- 
 latinous appearance, with yellow filaments here and 
 there interspersed. This extraordinary and characteris- 
 tic state of the blood has been for years noticed by the 
 attentive apothecary, so long attached to the Infirm- 
 ary for Diseases of the Chest. It is indicative of an 
 
TREATMENT OF CONSUMPTION- 89 
 
 actual, and inappreciable change in the circulatory 
 fluid- When the muscular parts and integuments 
 about the chest are greatly attenuated, local bleedings 
 are best accomplished by leeches, rather than cupping 
 — the tediousness of the former may be obviated by 
 picking them off when they are tolerably full. In- 
 stead of fomenting the bites as is customary, which 
 practice exposes the patient unnecessarily to cold, I 
 advise some lint or old linen to be immediately ap- 
 plied, and not removed for at least half an hour ; by 
 this means, the blood absorbed acts as a fomentation 
 to encourage a sufficient effusion. 
 
 I have ascertained, by auscultative examination, that 
 when sanguineous sputa make their appearance in 
 chronic or latent phthisis, they not unfrequently result 
 from inflammation of the lower lobe of one or both 
 lungs, causing an unusual degree of congestion in parts 
 remaining unhealed ; my advice is, therefore, that a 
 careful exploration of the chest be made, both by the 
 ear and percussion, in all cases, however unequivocal 
 be the common symptoms of inflammation of the sub- 
 stance of the lungs. When we have fully satisfied 
 ourselves that the spitting of blood is not the result of 
 any primary change in the vessels coasting tuberculous 
 excavations in the summit of the lungs, but that it is 
 
 N 
 
< 
 
 K 
 
 90 TREATMENT OF CONSUMPTION. 
 
 owing almost wholly to some engorgement, or sym- 
 pathy with portions of the lung beneath in a state of 
 actual inflammation;, it will be found that an effective 
 abstraction of blood, to the amount of fourteen or six- 
 teen ounces, will assist in bringing the patient in a 
 short time to his wonted state of health. Should this 
 be insufficient, the bleeding may be advantageously' 
 repeated after a couple of days. But it must be 
 premised that any active treatment of this kind employ- 
 ed without discrimination, particularly when much tu- 
 berculous disease is disseminated through the lungs, and 
 has formed numerous cavities which have seriously 
 and manifestly impaired the general health, would in 
 most cases be productive of the greatest evil, and 
 possibly soon give rise to oedema of the lungs, or 
 . some other watery effusion elsewhere. Few consump- 
 tive cases terminate fatally, without being preceded 
 by some dropsical state of the lungs. This generally 
 occurs when the feet and legs begin to swell, and is 
 a period too when leeches even are rarely admissible. 
 I shall now close my observations on bleeding with 
 mentioning, that blood drawn from the arm, in any 
 inflammatory affection of the chest co-existing with 
 phthisis, appears with a cupped and huffy coat, and 
 not with the peculiar appearance already noticed by 
 
TREATMENT OF CONSUMPTION- 91 
 
 me, as attending the latter disease in its unmasketi 
 state. Not unfrequently the close of existence in the 
 consumptive individual, already reduced to the lowest 
 condition of weakness and emaciation, is preceded by 
 some pneumonic and pleuritic affection which admits 
 of no permanent relief by bloodletting. 
 
 Inhalation. — I am well aware that many objections 
 may be started to this practice from prejudice, or in- 
 efficient observation. Strange to say, the principle on 
 which this mode of treatment operates beneficially, 
 appears to me .quite unknown to medical men. It is 
 supposed, that the inspiration of medicated vapours has 
 in many instances proved useful by allaying cough, 
 and by producing some healthy and unexplained 
 change in diseased parts of the lungs, as well as on 
 such adventitious surfaces as are formed after the 
 softening, or discharge, of tuberculous matter : but the 
 permanent advantages which inhaling is capable of 
 affording, are for several reasons unsuspected by the 
 generality of practitioners. First, because the period, 
 during which persons are directed to inhale, is gene- 
 rally too short to produce either a catarrhal or an 
 enlarged state of the lungs, one of which conditions 
 is absolutely necessary in order to suspend, or cure 
 consumption : and, secondly, the apparatuses employed 
 
 1 
 
 / 
 
92 TREATMENT OF CONSUMPTION. 
 
 for this purpose are not constructed scientifically, so 
 as to facilitate those physical changes which it is de- 
 sirable the chest should undergo. Proper inhalers 
 ought to be so arranged, as to offer some slight im-r 
 pediment to free expiration ; which can be effected by 
 having the vessels which are to contain the materials 
 to be inhaled, large enough to hold about two quarts 
 of liquid, and with covers perforated by two apertures ; 
 one of very small size, serving as an air-vent, the 
 other furnished with a flexible or straight tube of nar- 
 row diameter, and at least five feet long. For the end 
 of the tube destined to be received between the lips, 
 we may have mouth-pieces formed of ivory or bone, 
 each of them having an aperture of a different size. 
 The length of the tube will save the patient's counte- 
 nance from being heated by too close an approximation 
 to the body of the apparatus, when filled with warm 
 water ; besides, it contributes, together with the small 
 air-vent, to retard the free egress of air from the lungs, 
 which, I shall presently show, constitutes in no small 
 degree the great virtue of inhalation. 
 
 An' extraordinary, but* most undeserved reputation 
 is bestowed on various substances, mechanically re- 
 ceived into the lungs in a state of vapour. Among 
 these I may mention tar, iodine, chlorine, hemlock. 
 
TREATMENT OF CONSUMPTION. 93 
 
 turpentine, and many other articles of a stimulating, 
 or sedative nature. I attach little or no importance 
 to any of them. If benefit is derived, it is, in almost 
 every instance, in consequence of some such eifects as 
 the following : — Pulmonary expansion, to a degree 
 sufficient to exert an influence in bringing into contact 
 the surfaces of those early cavities, which are almost 
 invariably formed in the summit of the lungs ; — pul- 
 monary catarrh, or its common consequence, a vesicu 
 lar emphysema, in both of which the lungs acquire an 
 unusual magnitude ; in the latter more especially. 
 
 Neither perfect recovery, nor indeed exemption 
 from the danger of relapse into a consumptive state, is 
 found to occur, except in very rare instances, unless 
 the pulmonary organs become naturally, or artificially, 
 voluminous ; which not unfrequently happens by the 
 supervention of some catarrhal state of the larynx, 
 trachea, or bronchial tubes. It is a most fortunate 
 circumstance for some affection of this kind to occur 
 early, as it never fails permanently to arrest this most 
 fatal disorder. When the lower lobes of the lungs are 
 entirely free from tuberculous matter (which is often 
 indisputably the case for a considerable period, unless 
 there be strong hereditary predisposition), and though 
 there exist, at the same time, cavities in the superior 
 
 } 
 
 
94 TREATMENT OF CONSUMPTION. 
 
 part of one or both lungs, clearly indicated by perfect 
 pectoriloquism, there is almost a never-failing hope of 
 recovery to be entertained;, provided an emphysema- 
 tous sound can be heard. In fact;, I never knew a 
 consumptive person vs^ho did not lose all his formidable 
 symptoms and regain health, w^hen an emphysematous, 
 or a semi-asthmatic change had early taken place ; 
 and, likewise, I never knew an individual to become 
 consumptive who was subject to chronic catarrh, or to 
 any species of asthma. It is from long consideration 
 of these facts, that I interfere but little with any ca- 
 tarrhal inflainmation which may show itself in the 
 midst of consumptive symptoms, for I well know that 
 it will gradually supersede all these. 
 
 I may here remark, that cavities in the upper part 
 of the chest are never healed, unless the pulmonary 
 tissue be expanded in their neighbourhood, or in the 
 other lobes of the lungs. In such case, I have re- 
 peatedly listened to some bronchial inflammation which 
 has fortunately taken place near to those, cysts, which 
 are left when tuberculous matter has been removed by 
 absorption or expectoration. I have been truly gra- 
 tified to hear the well-marked pectoriloquy gradually 
 become less distinct, till, together with the constitu- 
 tional symptoms of phthisis, it has been at last entirely 
 
TREATMENT OF CONSUMPTION. 95 
 
 lost, and nothing has remained but the dry rale of en- 
 larged air-cells, slight catarrh, and a little absence 
 of respiratory murmur in the place before occupied by 
 tubercles. 
 
 Should there be catarrh in the superior bronchial 
 tubes, of a duration sufficiently long only to heal ul- 
 cerations and cure the patient, he may be again 
 attacked by consumption, months or years afterwards, 
 if there be any cause assisting to impair the general 
 health; but never can this relapse happen, if the bron^ 
 chial tubes be subacutely inflamed for a period sufficient 
 to produce chronic dyspnoea, or habitual asthma, more 
 or less severe. Half of those, which are commonly 
 regarded as cases of catarrhal asthma, originate in 
 consumptive disease whose progress has been arrested 
 by the supervention of that affection ; but in which 
 neither fresh crops of tubercles, nor hectic fever, are to 
 be apprehended. Any individual indeed having asthma, 
 from whatever cause, is as perfectly exempt from con- 
 sumption as he who had been consumptive, but has 
 afterwards had his disease merged into asthma. In a 
 word, it may be confidently affirmed, that no asthmatic 
 person need ever fear becoming consumptive. 
 
 In order to promote expansion of the aerial tissue of 
 the lungs, it is my usual practice, in the absence of 
 
96 TREATMENT OF CONSUMPTION. 
 
 catarrh, and when congestion in the chest and the 
 symptoms of hectic fever have been diminished by 
 small general bleedings, repeated at proper intervals, 
 or by the application of leeches over the second and 
 third ribs anteriorly, to advise inhalation as soon as 
 possible. A drawing of a suitable apparatus will be 
 found at the end of this work. There are few cases of 
 incipient consumption but what will be rapidly improved 
 by this treatment, steadily pursued. The disease being 
 thus checked, the same changes will follow which are 
 attendant on catarrh. The nodules of unripe tuber- 
 cles will become innoxious in consequence of being 
 surrounded by black secretion, or what has been called 
 black pulmonary matter ; and small cavities, already 
 formed, will have their surfaces soon brought in con- 
 tact, so as to heal by what surgeons term the first in- 
 tention. It is, we must own, preferable to effect pul- 
 monary expansion by sure artificial means, rather than 
 to depend upon the uncertain production of catarrh. 
 And there is another point gained, inasmuch as re- 
 covery takes place unaccompanied by the cough, or 
 difficulty of breathing, generally attendant on those 
 cures which Nature herself now and then accomplishes, 
 by introducing this less fatal, yet distressing complaint. 
 Inhaling, performed two or three times daily, for half 
 
TREATMENT OF CONSUMPTION. - 97 
 
 an hour each time, will in the space of a few weeks 
 work a wonderful change on the chest ; externally the 
 muscles concerned in respiration will be manifestly en- 
 larged, and the bony compages of the chest, both be- 
 fore and laterally, visibly increased ; whilst, at the 
 same time, the natural respiratory murmur will be 
 heard internally, far more distinct than ever. Such 
 has been the increase of size which the chest, in young 
 persons especially, has undergone through the exercise 
 of inhalation, that I have known individuals, after in- 
 haling little more than a month, require their waistcoats 
 to 1)6 let out. It is in fact incredible to one who has 
 never been at the pains to measure the chest, or exa- 
 mine its shape, what an enlargement it acquires by 
 the simple action of breathing for the time above- 
 stated, backwards and forwards, through a narrow tube 
 of a few feet in length. I have several times found, 
 on measurement of the chest, that its circumference 
 has increased, within the first month after inhaling, 
 to the extent of an inch. I here speak of patients 
 not arrived at adult age. Though I attach but little 
 virtue to the substances that are inhaled, still, as we 
 find patients prefer receiving into their lungs some- 
 thing having sensible properties to pure atmospheric 
 air, I recommend a handful of hops, ether, a little 
 
 o 
 
 1 
 
98 TREATMENT OF CONSUMPTION. 
 
 vinegar, or a table-spoonful of spirits of turpentine, 
 to be added to the warm water in the inhaler. 
 Every impediment to the free action of the ribs is to 
 be guarded against by loosening whatever, in the way 
 of dress, is at all likely to confine them ; and it would 
 be advisable too for the patient, if strength allows, to 
 inhale at times in a standing position, as the diaphragm 
 will then descend more easily and deeply, and of 
 course allow the lungs more room to expand. 
 
 There are cases in which inhalation is contra-indi- 
 cated ; for instance, in dilatation, or hypertrophy of 
 the heart, severe mucous catarrh, general emphysema 
 of the lungs, pleuritic or pneumonic inflammation, 
 haemoptysis, or latent consumption of long standing. 
 
 It is to be discontinued, at least for a time, should 
 there arise distressing head-ache, or much internal 
 thoracic soreness. When it agrees well, it can be 
 safely and most beneficially used for six months, or 
 even longer. By this time, besides a removal of every 
 consumptive symptom, a permanent enlargement of 
 the chest will have taken place, proving a perfect 
 safeguard against the recurrence of any future attack. 
 
 No permanent benefit is to be expected from this 
 remedy, when the inferior lobes of the lungs contain 
 cavities, or are studded with tubercles : yet, even in 
 
TREATMENT OF CONSUMPTION. 99 
 
 this unfavourable state, I have known relief arise, and 
 surprising prolongation of life ensue, from its employ- 
 ment. I have individuals under my care, at this 
 moment, in whom one lung is almost useless from 
 extensive tuberculous disease, and with even well- 
 marked pectoriloquy on the top of the opposite lung ; 
 still, from having the rest of the lung on this side in 
 a satisfactory state, and thus being partially susceptible 
 of the influence of inhalation, the progress of con- 
 sumption has been arrested ; and, in more than one 
 instance, the relief afforded by inhaling has enabled 
 the individual to attend to the duties of his calling — of 
 course, no very onerous ones. Indeed, I shall feel 
 happy to introduce any of my readers, who may enter- 
 tain a desire to see such remarkable instances of the 
 virtues of inhalation, to these patients of mine. 
 
 I must direct especial attention to the circumstance, 
 that restoration, by means of inhaling, is only to be 
 looked for when the cavities are confined to the sum- 
 mit of one, or of each lung. When they extend 
 into the lower lobes, relief, as I have just shown, will 
 often be given, but it would be unreasonable to ex- 
 pect perfect recovery. The experience of the medical 
 world, from the days of Hippocrates down to our own 
 time, has proved, that medicine is utterly powerless 
 
100 TREATMENT OF CONSUMPTION. 
 
 over the excavations formed in the lungs by tubercular 
 phthisis. It cannot bring into contact, and unite the 
 opposite surfaces of the cavities : it cannot enlarge the 
 pulmonary tissue ; — mechanical agency will. I have 
 never known inhalation fail, when resorted to in the 
 incipient stage of consumption ; and am firmly of opi- 
 nion, that when pursued under the eye of a skilful 
 practitioner, who knows how to apply according to 
 circumstances the other inferior but still accessary 
 powers of art, it never will. 
 
 As tubercles are rarely formed in the muscles of 
 voluntary motion, we have hence reason to believe that 
 the same additional exercise of the pulmonary organs, 
 by more frequent expansions and contractions, will act 
 as a preventive. 
 
 Before I was aware how materially the lungs can be 
 enlarged by simply respiring through a long tube, of 
 small diameter, I was induced some years ago to try 
 various means for producing pulmonary catarrh, or 
 some corresponding affection, in the great air-passage 
 vulgarly called the windpipe ; knowing well what an 
 excellent agent such an affection is for expanding the 
 chest, removing speedily well-marked symptoms of 
 consumption, and, in a word, destroying altogether 
 the tuberculous tendency. For this purpose, as in the 
 
TREATMENT OF CONSUMPTION. 101 
 
 heat of summer and the early part of autumn we 
 rarely meet with cases attended with a catarrhal com- 
 plaint^ one of my expedients was to oblige the patient to 
 breathe twice orthric&a day atmospheric air, made cold 
 by artificial means. In more than one case I succeeded 
 in producing a catarrh, which led to the recovery of 
 the consumptive patient. I have, on several occasions, 
 dismissed those in-patients of the Infirmary for Dis- 
 eases of the Chest, — the wards of which are heated in 
 winter so as to imitate a moderate summer temperature, 
 — whose consumptive state seemed to be but little 
 relieved ; but, owing to their going at once from the 
 warm atmosphere to their own abodes, where perhaps 
 some of them were badly secured against cold, or in- 
 deed owing perhaps to their imprudent and thoughtless 
 exposure to the open air, they have caught a severe 
 cold of a catarrhal nature ; and this, I can assure the 
 reader, has alone effected a cure in some who have had 
 tuberculous excavations of ancient, as well as recent 
 date. I subjoin a case, in which will be seen the value 
 of a catarrhal affection in removing, or affording per- 
 fect security against consumption. 
 
 Case VII. A young man, a cutler by trade, having 
 lost three brothers by consumption, came to my house 
 in the summer of 1827, seeking to be relieved from 
 
102 TREATMENT OF CONSUMPTION. 
 
 symptoms similar to those which he had observed in 
 them during their illness. He stated, that the first in- 
 dication of his complaint appeared after he had had a 
 severe attack of rheumatism;, which was with difficulty 
 removed, and which left him much debilitated. When 
 I first saw him, he computed that his cough, which 
 was soon followed by a discharge of blood from the 
 chest, had existed four months. He stated, too, that 
 he had early placed himself under medical advice ; 
 but that, in spite of various medicines administered 
 for his cough, the spitting of blood, periodic fever, 
 profuse perspirations at night, and occasional diar- 
 rhoea, in short all the unfavourable symptoms seem- 
 ed daily to increase. The moment I saw him, his 
 countenance bespoke the nature of his malady ; and a 
 few questions put to him soon confirmed my supposi- 
 tion,— that he had all the common symptoms of con- 
 sumption. On exploration of the chest by the naked 
 ear, and by the stethoscope, I ascertained the exist- 
 ence of a cavity in the summit of the right lung, which 
 afforded, when he spoke, a perfect pectoriloquy, and 
 there was a gurgling when he coughed. The respiratory 
 sound was indistinct on the left side, anteriorly, beneath 
 the clavicle and over the second and third Tibs : in all 
 other parts the chest seemed healthy, save a state of 
 
TREATMENT OF CONSUMPTION. 103 
 
 respiration approaching the puerile which was heard in 
 the lower lobes. In order to subdue the constitutional 
 fever and painful cough, I directed some blood to be 
 taken from the arm ; and this not affording the ex- 
 pected relief, several leeches were applied a few hours 
 after to the anterior and upper part of the chest ; 
 and, scruple doses of nitre, with a quarter of a grain of 
 tartar emetic, and a drachm and a half of syrup of 
 poppies were taken in an ounces of some demulcent 
 vehicle, at intervals of four or six hours during the 
 day. This compound acted freely on the kidneys, 
 and, together with pills taken at bed-time, contain- 
 ing extract of lettuce, ipecacuanha, and precipitated 
 sulphuret of antimony, gave, in the course of four 
 or five days, great relief to his pectoral disorder. 
 Though I succeeded two or three times, by means 
 of leeches again and again applied, and medicine 
 varied to meet new symptoms as they appeared, in re- 
 gaining for him what, comparatively speaking, he con- 
 sidered a return of tolerable health; still, with a view 
 to effect a perfect cure, it occurred to me, that as 
 my patient was a man of no small ingenuity I might 
 possibly get him to make a steel instrument shaped 
 like a collar, deep behind, and so contrived, whilst it 
 produced no inconvenience on the neck laterally, as to 
 
104 TREATMENT OF CONSUMPTION. 
 
 make a gentle pressure on the small part of the trachea, 
 immediately above the sternum, and between the ster- 
 no-cleido mastoid muscles. This new agent was soon 
 ready for use, and was worn at intervals for the 
 space of two months. In front, a small piece of dry 
 sponge was placed between the converging points of 
 this imperfect collar and the wind-pipe ; most happily 
 for the patient, the pressure on the wind-pipe caused a 
 slight mucous inflammation within it, and this was 
 succeeded throughout the lungs by bronchial irritation, 
 with a slight wheezing denoting an enlargement of the 
 air-vesicles. None of these symptoms were interfered 
 with ; and they continued for some months, after every 
 apprehension of consumption was removed. It was 
 really wonderful how much he increased in flesh, and 
 to what bodily vigour he arrived, especially when the 
 catarrhal complaint had established itself in the neigh- 
 bourhood of the tuberculous disease in the superior 
 lobes. At the expiration of a fortnight from this time, 
 a loud mucous rattle began to appear near to the seat 
 of the pectoriloquy in the top of the right lung; all 
 trace of a cavity was nearly lost, and the respiration 
 there daily became more audible. The same improve- 
 ment took place in the respiration of the upper portion 
 of the other lung, which, I have already mentioned. 
 
TREATMENT OF CONSUMPTION. I05 
 
 seemed to be diseased. With the exception of periodic 
 shortness of breathing, sometimes preceding and at 
 other times following fits of coughing, the patient 
 might be said, were he judged only from his looks and 
 his feelings, to be perfectly well. After tracheal rattle 
 had been distinctly heard in the larynx for a month, 
 and appeared to be extending itself along the trachea 
 to the larger bronchial tubes, he was directed to dis- 
 continue altogether the further use of that simple ap- 
 paratus, the steel collar. On one occasion only was it 
 necessary to moderate, by the application of leeches, 
 the mucous excitement of the lungs, when it ran so 
 high as to cause suffocative breathing, incessant cough, 
 superabundant expectoration, and general febrile dis- 
 order. With the exception of five grains of compound 
 ipecacuanha powder, and double that quantity of ex- 
 tract of hops, made into pills to be taken at bed-time, 
 and the occasional use of a mild aperient, there was 
 little else done for the supervening catarrh ; for I felt 
 exceedingly reluctant to interfere much, well knowing 
 the value of the new disorder, and that it would long 
 prove a successful antagonist to any future, as well as 
 present, liability of sinking under consumption. In 
 the month of August, 1830, which was three years 
 from the time he became my patient, I had an oppor- 
 
 p 
 / 
 
106 TREATMENT OF CONSUMPTION. 
 
 tunity of seeing him in the enjoyment of excellent 
 health ; if I except a little asthmatic respiration, which 
 I detected by the naked ear^, whenever he made a 
 forcible expiration. The expirations were of an emphy- 
 sematous character, in the upper part of the chest, 
 both before and behind ; the air, in fact, was heard es- 
 caping from the enlarged air-cells with a prolonged 
 murmur in which dry cracklings were audible, per- 
 haps arising from some air-cells being united into one. 
 Having ascertained what I have just described, and 
 how much the shape of the chest had been altered, 
 which, from being narrow in its antero-posterior dia- 
 meter and flat, was become cylindrical and enlarged, I 
 assured him that he never would relapse into his for- 
 mer consumptive state ; and that with some care, on 
 his part, in attending to the directions which I gave 
 him, his present asthmatic symptoms would have 
 little effect in abbreviating the duration of his life. 
 
 This case is highly instructive. It is one by which 
 mechanical aid produced, m the midst of summer, 
 such a degree of general catarrhal affection of the air 
 passages of the lungs, that complete recovery took 
 place. Nor was this all; for, through the emphy- 
 sematous state of the lungs, a perfect security existed 
 against any liability hereafter to tuberculous produc- 
 
TREATMENT OF CONSUMPTION. 107 
 
 tions. In a word, he escaped all danger of pulmonary 
 consumption. 
 
 It may not be uninteresting to mention the particular 
 circumstance, which led me to imagine and adopt the 
 above invention. A gentleman of the name of Willis, 
 who a few years ago resided in the neighbourhood of 
 Kennington, and was under my care, happened to 
 have a small oblong tumour in front of the neck, with 
 its inferior portion lying between the sternum and the 
 trachea, from which resulted a slight obstruction to 
 his respiration. This tumour, which had existed for 
 some years, had induced a perfectly asthmatic state. 
 By preventing free expiration, and likewise by exciting 
 a slight continuous inflammation of the mucous mem- 
 brane from the point of pressure into the numerous 
 ramifications of the bronchi, the air had become im- 
 prisoned within the air-cells, and in this manner was 
 produced a general emphysematous state of the lungs. 
 Besides the diflficulty of breathing, usually attendant on 
 this condition of the pulmonary organs, the obstruction 
 from the tumour naturally caused him to breathe with a 
 loud, wheezing, and somewhat croupy sound. Obser- 
 ving this, I concluded that if a slight mechanical 
 resistance to the free egress of air from the lungs could 
 be produced, so as to impart the prophylactic benefits 
 
108 TREATMENT OF CONSUMPTION. 
 
 of the asthmatic state, without the distressing and ag- 
 gravated accompaniments noticed in the case just des- 
 cribed, it would be a remedial agent of no small ef- 
 ficacy. " On this hint I spake" ; and, seconded by 
 the ingenious contrivance of the artizan whose case I 
 have particularized, I was fortunate enough to bring 
 the contrivance to bear, and to find that I had not 
 miscalculated its advantages. I have entered into 
 this detail, as it serves, by analogy, to throw addi- 
 tional light on the position I have advanced respecting 
 the non-liability of the asthmatic, or catarrhal, patient 
 to phthisis; although, from the superior benefits to be 
 obtained by a duly extended course of inhalation, and 
 having satisfied my curiosity by the experiment, I have 
 never since employed the preceding mechanical con- 
 trivance. 
 
 Having noticed the effects arising from a small tu- 
 mour on the neck of my patient, Mr. Willis, I may 
 observe, that that enlargement of the thyroid gland, 
 technically called bronchocele, but more familiarly 
 known by the name of Derbyshire neck, induces, 
 when considerable, similar symptoms and results by 
 the pressure it occasions on the trachea. Nor are 
 the consequences of aggravated hysteria to be over- 
 looked in this place ; since a frequent communication 
 
TREATMENT OF CONSUMPTION. 109 
 
 of spasm to the posterior membrane of the trachea, 
 will, by imparting to the person so affected a slight 
 asthmatic tendency, and thus enlarging the volume 
 of the lungs, preserve the female from all liability to 
 pulmonary consumption. 
 
 A positive proof of the advantage accruing to the 
 consumptive patient through mechanical development 
 of the lungs, is to be inferred from the general immunity 
 from phthisis enjoyed by those families in which a well- 
 formed chest is common to all the members. I may 
 cite as, what the lawyers call, a case in point, the nu- 
 merous offspring of the venerable George the Third, 
 himself the model of a manly form. Heaven knows, 
 nature must have done more for them than medicine. 
 
 A negative proof of the benefits of inhalation, and 
 a positive one of the inefRcacy of medicine, has unfor- 
 tunately occurred, of late years, in the family of a 
 noble lord, to whose illustrious kinsman this country 
 is indebted for one of the greatest boons ever conferred 
 upon it by legislation. It is impossible to look upon 
 the frank, artless, but pensive features of the lovely 
 boy, whose lineaments are recorded by the imperish- 
 able pencil of Lawrence, and not to regret that me- 
 dicine could effect nothing. 
 
 How long will it be before this truth will lead the 
 
110 
 
 TREATMENT OF CONSUMPTION. 
 
 scientific to adopt its fellow truths — that, so surely as 
 medicine alone will ever fail;, the mechanical means I 
 have pointed out will succeed ? 
 
 Whilst preparing this edition for the press, I have 
 met with two very singular cases, confirmatory of my 
 views ; the one in Hippocrates, and the other in a 
 curious treatise, entitled " Phthisiologia," written by 
 Dr. Richard Morton, a man of considerable eminence 
 in our early English medical school. I term them 
 singular, inasmuch as written at two such distant 
 periods, they present accounts which elucidate and 
 strengthen my opinions as strongly as any case taken 
 from my own memoranda. The father of medicine 
 relates that the daughter of Agasias, when a girl, la- 
 boured under tubercular consumption; that becoming 
 pregnant after marriage, she expectorated an unusual 
 quantity of puriform matter ; and that, subsequently 
 to this, she became asthmatic. Here the process 
 of cure, as laid down by me in the preceding pages, 
 IS distinctly traced. I have already noticed the ad- 
 vantages of pregnancy in consumption ; and have 
 proved, what the above early record so surprisingly 
 confirms, that if asthma supervene on consumption, 
 the latter is cured. 
 
 The case, I am now about to quote, bears witness to 
 
TREATMENT OF CONSUMPTION. Ill 
 
 the solidity of my practice no less triumphantly than 
 the former. I quote Dr. Morton's own words.' — "My 
 only son, before he was eight years old, whilst I was 
 out of town, was taken with a most severe bloody flux, 
 by which he seemed to be brought into a consumption, 
 even to a marasmus, before I returned : but after the 
 bloody flux was plainly overcome by the diligent use 
 of all sorts of convenient remedies, and his body, with 
 respect to his stools, was reduced to its natural state, 
 there still remained a hectical heat, a dryness of his 
 skin, a quick pulse, with other signs of a hectical heat. 
 Moreover, his appetite failed him very much ; a dry 
 cough came upon him, and a thickness of hearing, 
 with a dulness of his brain : but yet, with the choice 
 of a wholesome air, the use of a milk diet, and after- 
 wards of the Peruvian bark, and of a plentiful nou- 
 rishment, which afforded a good juice, he recovered a 
 good colour, and his flesh, within the space of three or 
 four months, without any other inconvenience, but 
 only that he has been ever since very subject to an 
 asthm,atical cough upon the least occasion" 
 
 My remaining observations on the treatment of con- 
 sumption will be brief, for two reasons , first, since I 
 have fully detailed the two most important branches of 
 the curative process ; and, secondly, because the ge- 
 
112 TREATMENT OF CONSUMPTION. 
 
 neral uses of medicine are to palliate, or, by inducing 
 a chronic state, to favour the supervention of catarrh. 
 Again, by removing the constitutional symptoms, the 
 local affection may terminate in an insensible excava- 
 tion, hardly interfering with the general health. 
 
 Amongst the innumerable medicaments that have been, 
 and are still tried, I shall specify a few, the advantages 
 of which are capable of proof, not depending on the 
 caprice of fashion — there being a fashion even in me- 
 dicine — or upon any imaginary virtues. Our dispen- 
 satories are full of such drugs, and so unfortunately is 
 practice ; yet the number applicable under any form 
 to phthisis, is of a limited extent. 
 
 Cathartics. — Recourse must he had to purgatives 
 very sparingly, in the commencement of consumptive 
 symptoms, as the general health is usually deranged. 
 From an erroneous view of the causes of consumption 
 great mischief has arisen in the employment of aperi- 
 ent medicines ; and this injudicious treatment has been 
 propagated by the sanction of names of no mean 
 authority. Instead of increasing debility by the exhi- 
 bition of cathartics, it is infinitely preferable to remove 
 congestion by the moderate abstraction of blood, as 
 previously noticed. Great caution should be observed, 
 as to the kind of medicine employed for purgative pur- 
 
TREATMENT OF CONSUMPTION. 113 
 
 poses. Saline aperients ought in general to be avoided, 
 from the debility they induce by carrying off the serum 
 of the blood, and by too rapidly accelerating the pas- 
 sage of the chyliferous matter, before due absorption 
 takes place. It should be borne in mind, that a re- 
 laxed state of the bowels is a very frequent accompani- 
 ment of consumption ; and that any undue administra- 
 tion of laxative medicines will, in most cases, super- 
 induce abdominal gripings and diarrhoea;, events which 
 cannot be too sedulously guarded against. In the in- 
 flammatory complication of phthisis, a powder, com- 
 posed of from ten to fifteen grains of jalap, combined 
 with two or three grains of calomel, may be adminis- 
 tered as an auxiliary to venous depletion. Indigestion 
 is of no uncommon occurrence in consumptive com- 
 plaints, yet, as it usually arises from vascularity, and 
 morbid sensibility of the stomach and of the intestines, 
 the most rational method of proceeding is to equalize 
 the circulation by moderate venesection. Occasionally, 
 a few leeches, applied to the pit of the stomach, will 
 be equally successful in removing dyspepsia. As an 
 ordinary laxative, a few grains of dried subcar- 
 bonate of soda, calcined magnesia, and rhubarb, 
 taken in some liquid vehicle, will be found highly 
 
 useful. 
 
 Q 
 
114 TREATMENT OF CONSUMPTION. 
 
 Since I am on the subject of dyspepsia, I cannot 
 help adverting to the strange tissue of absurdities, 
 gravely put forth by a Dr. James Johnson in a treatise 
 on Indigestion. So far as I can make out the meaning 
 of a series of passages, which contain a number of 
 scientific words, serving only to show a remarkable 
 ignorance of morbid anatomy, this person seeks to es- 
 tablish a distinction betwixt the symptoms of phthisis, 
 when it " supervenes on derangement of the liver and 
 digestive organs ;" and when it " commences originally 
 in the chest." What he would have his reader under- 
 stand by this word '^'^ originally" is somewhat difficult 
 to make out. I never before heard of pulmonic affec- 
 tion commencing in any other part than the lungs. 
 Does he wish to have it inferred that consumption, at 
 times originates in the stomach, or the head, or the 
 feet ? Again, it is by no means clear what he intends 
 to convey by pulmonic affection supervening on "de- 
 rangement of the liver," &c. If the literal interpre- 
 tation of these words be taken, he states what is by no 
 means the fact. Phthisis supervenes on impaired ge- 
 neral health, and this may be occasioned by dyspeptic 
 ailments ; but to say that it supervenes on dyspepsia, is 
 nonsense. But when he begins to draw his distinc- 
 tions, he sinks still deeper into " confusion worse con- 
 
TREATMENT OF CONSUMPTION. 115 
 
 founded." He talks of phthisis advancing in conse- 
 quence of "a previously tuberculated state of the 
 lungs." As Parson Evans says, " These be phrases 
 and tropeS:, look you." Advancing ! — If phthisis be 
 not established, and too surely established, vs^hen the 
 lungs are tuberculated, then '^'^ there's nothing serious 
 in mortality." We shall hear next, that when an 
 individual has got a v70oden leg, he is in a fair way 
 of losing his fleshly one. Perhaps Dr. Johnson 
 makes use here of the figure Hysteron, Anglice, 
 ^^ putting the cart before the horse." He then, pursu- 
 ing his nice distinctions, winds up his medical budget 
 by stating it as a pathological fact, that ^'^ phthisis, of 
 the common and fatal kind, will soon be developed" — 
 after what — " after hepatization of the parenchymatous 
 tissue of the lungs." Better and better still ! In plain 
 English, the doctor expressly affirms, that, instead of 
 consumption inducing hepatization — for this is the natu- 
 ral order — the latter, which every anatomist knows is 
 the consequence, will be the cause of the former. 
 vTo attempt to unravel still further this Gordian knot 
 of technical terms, which, like Mrs. Malaprop's, are 
 " so ingeniously misapplied," would be* waste of time : 
 nor should I have thought it worth while to have taken 
 this slight notice, but for the parade of superior know- 
 
116 TREATMENT OF CONSUMPTION, 
 
 ledge^ the " flourish of drums and trumpets," with 
 which this nautical surgeon ushers in his dicta. They 
 may suit the cock - pit, but not the temple of 
 science. 
 
 Another individual^ Dr. W. Philip, who has likewise 
 written on Indigestion, with more, although not much, 
 success, has stated that the pulmonic affection is merely 
 sympathetic ; and again, that the sympathetic produces 
 actual disease in the lungs, indicated by some degree of 
 inflammation in the bronchia, &c. Now, had his ex- 
 perience been at all of an extended nature, or his ob- 
 servation been keenly applied to even limited oppor- 
 tunities, he could hardly, one would imagine, have 
 failed of perceiving that such a disease as dyspeptic 
 phthisis does not exist. Indigestion is a very common 
 disorder ; but the dyspeptic patient never becomes con- 
 sumptive, until his. general health has been seriously 
 impaired by the derangement of the digestive func- 
 tions. Dyspepsia, it may be as well for him to know, 
 often follows pulmonic affections, but is never their 
 proximate cause. Were Dr. P. in the habit of em- 
 ploying auscultative exploration of the chest, he would 
 discover that the presence of blood in the expectoration 
 is not, as he seems to imagine, the forerunner of tu- 
 bercles ; but that, in three-fourths of the cases, it arises 
 
TREATMENT OF CONSUMPTION. 117 
 
 from the existence of cavities already formed by the 
 softening down of tubercles. As to inflammation of 
 the bronchia occurring at the time he speaks of, if it 
 doeS:, it is of a very fugacious description indeed. 
 
 The singular opportunities I have enjoyed^ for ob- 
 serving every variety of disease connected with the 
 chest;, have led me to entertain views not a little at 
 variance with those of this writer. Ten years ago I 
 have had the opportunity of seeing a hundred patients, 
 at the Infirmary alone, in a single day ; and, since that 
 time, my field for observation has been very consi- 
 derable : yet I have never found the daily use of mer- 
 cury, as advocated by Dr. P,., of advantage, even in a 
 soHtary instance. I have had, on the contrary, pa- 
 tients who have been under his care, and who have 
 derived no benefit whatever from his undue estimate 
 of the virtues of this mineral. It is by no means im- 
 probable, judging from his opinions as expressed by 
 himself, and from his non-employment of auscultation, 
 that he has been mistaken in the nature of those cases 
 which have yielded to his treatment ; that he has sup- 
 posed them to have been connected with phthisis, when 
 no such complication had existed. 
 
 Emetics. — At one period emetics were held in no 
 slight repute ; and much useless torture, or I should 
 
118 TREATMENT OF CONSUMPTION. 
 
 rather say injurious pain^ was the consequence to the 
 consumptive sufferer. It has ahvays been a principal 
 object with me to avoid every thing calculated to dis- 
 tresSj, or annoy, without imparting benefits equivalent 
 to the uneasiness undergone. That this is not the case 
 with the administration of emetics is proved con- 
 vincingly by the fact, that when vomiting is brought 
 on in a natural way by violent coughing, the patient 
 experiences no relief. Whatever faith medical men 
 may be inclined to place in the remedial powers of 
 emetics, I have none ; although I candidly confess, 
 that I am in the daily habit of prescribing small doses 
 of the tartarized antimony, and of ipecacuanha ; yet in 
 so minute a degree, that they are within the limit of 
 actual nausea. 
 
 SuDORiFics. — Twenty or thirty years ago, it was the 
 general practice, in all diseases, to determine to the 
 surface of the body ; and some practitioners, ena- 
 moured of the wisdom of their youthful days, still ad- 
 here to it. Great injury undoubtedly resulted from 
 this indiscriminate course, and more particularly would 
 this be the case in phthisical complaints. Although 
 employed with the view of diverting morbid action 
 from the lungs to the surface of the skin, yet the con- 
 sequence of the stimulus thus imparted is not unfre- 
 
TREATMENT OF CONSUMPTION. 119 
 
 quently increase of hectic fever, terminating in pul- 
 monary engorgement, or other visceral excitement. 
 
 No relief indeed is afforded by sudorifics ; on the 
 contrary, when perspirations occur spontaneously, they 
 are found sensibly to reduce the patient's strength. In 
 the hot stage of hectic fever, I endeavour to reduce 
 the tenseness and aridity of the cuticular surface, by 
 having the hands and upper part of the body sponged 
 with tepid water and vinegar ; . and I order this to be 
 continued, until a reduction of temperature takes 
 place. The same treatment is to be pursued on every 
 return of the hectic paroxysm. It being of infinite 
 importance to preserve an equable temperature of the 
 body, I uniformly attempt the removal of whatever 
 state is unduly predominant : therefore, in the cold 
 stage, I direct the immersion of the feet in warm 
 water, and advise the patient to take some warm beve- 
 rage, as tea, &g. ; and, when perspiration is profuse, I 
 lessen it by administering either an infusion of eolumba 
 or of camomile, in preference to the acidulated infu- 
 sion of roses, in such general, but, in my opinion, in- 
 judicious use. Except in the very last stage of the dis- 
 ease, the application of leeches to the chest, in periodi- 
 cally recurring perspiration, will be found far superior 
 to any tonic whatever. 
 
120 TREATMENT OF CONSUMPTION. 
 
 Expectorants. — The use of this class of medicines 
 seems founded on no valid reasons ; nor are the benefits 
 produced very visible or satisfactory. Could they 
 stimulate the mucous membrane of the lungs to a ca-' 
 tarrhal state, they would be beneficial indeed : col- 
 chicum, I have reason to believe, occasionally operates 
 in this manner : but its effects are uncertain. 
 
 In many consumptive cases there exists a super- 
 abundance of expectoration ; and, consequently, in 
 these all expectorants are supererogatory. Above all, 
 that anxiety which is frequently displayed to avert, or 
 palliate cough, is unnecessary, since it often occurs 
 that to this an emphysematous state of the lungs is 
 owing ; which protective is thus lost, by the injudicious 
 attempt to allay the cough. The chief good resulting 
 from expectorants is not owing to any specific action 
 exerted, in particular, on the pulmonary organs : but 
 rather, as is the case with ipecacuanha and tartar 
 emetic, it is due to a variety of influences. Thus the 
 former of these medicines seems to act as an astringent 
 where expectoration is superabundant ; and, generally 
 speaking, both these substances, in addition to their 
 value as expectorants, aid all the secretions. Other 
 expectorants, as squill, ammoniacum, myrrh, &c., are 
 to be cautiously employed when phthisis is accompanied 
 
TREATMENT OF CONSUMPTION- 121 
 
 by hectic fever; but ipecacuanha, and preparations of 
 antimony, possess the great advantage of being of safe 
 administration during every stage. Mercurial agents 
 exert a powerful influence in promoting expectoration, 
 as they likewise do on every other secretion ; and 
 this property has led to most injurious consequences. 
 Some years ago, I had opportunities . of seeing, in the 
 practice of a deceased physician at the London Hos- 
 pital, a woful example of the evils arising from the 
 exhibition of mercury in cases of phthisis. The faci- 
 lity given to expectoration seemed to delight this 
 practitioner ; but it was so rapidly increased^ and ac- 
 companied by such extreme perspirations, wasting away, 
 and diarrhoea, that the patients soon went into what 
 is vulgarly, but not inappropriately, denominated — gal- 
 loping consumption. 
 
 Narcotics and Demulcents. — The latter, as reme- 
 dies, are out of the question ; but, as palliatives, are 
 highly serviceable. Being mostly of a nutritious na- 
 ture they tend to keep up the patient's strength, while 
 they soothe the irritability of the chest. The former 
 are occasionally useful, but they are liable to great 
 abuse. Given with a view to promote sleep at night, 
 much nicety is required in their regulation. When 
 the hectic state and excitement obstructive of sleep 
 
 R 
 
122 TREATMENT OF CONSUMPTION. 
 
 have been removed, recourse may for one night be had 
 to an opiate ; but should it be repeated on the succeed- 
 ing evening, it too often happens that its effect will be 
 lost. Digitalis and hydrocyanic acid have both been 
 extolled as of infinite efficacy ; but they are unde- 
 serving of the high reputation bestowed upon them. 
 Dr. Ferriar imagined, that by combining the former 
 with myrrh and sulphate of iron, he increased its 
 utility in consumptive disease ; yet, how its union with 
 two stimulants could be productive of benefit, I do not 
 exactly see. As to hydrocyanic acid, I concur with 
 Laennec in regarding it, although it may sometimes 
 relieve cough and dyspnoea, as of far inferior value to 
 many preparations of opium. In particular idiosyn- 
 crasies, in which opium under any form is found to 
 disagree, the extract of liyoscyamus, and the feebler 
 narcotics, as extract of lettuce or hops, will singly, or 
 combined, lull cough and afford rest. I should regard 
 it unfair were I not to state, that Battley's Liquor Opii 
 Sedativus is the preparation I in general prefer. I 
 m9.y here note, that the pharmacopoeia of this country 
 exhibits an unsatisfactory catalogue of opiates. It is 
 to be hoped that these, with other omissions, will 
 shortly be rectified. The expected admission of the 
 numerous and intelligent physicians, termed licentiates. 
 
TREATMENT OF CONSUMPTION- . 123 
 
 to the privileges due to their learning and science^ will 
 indisputably operate a most beneficial change and form 
 a new era in medicine. 
 
 Astringents and Tonics — The first of these are 
 employed for a threefold purpose — to check discharges 
 of blood from the lungs, to restrain colliquative per- 
 spirations, and also diarrhoea. Sulphuric acid, with 
 infusion of roses, has acquired much notoriety as an 
 astringent ; but I seldom employ it, since I find its use 
 not unfrequently followed by distressing tension of the 
 chest. Although, I own, it may be advantageous for a 
 time, yet its continuance is apt to exercise an effect the 
 reverse of what is intended. It seems to me, in such 
 cases, to increase rather than diminish haemoptysis. 
 The acetate of lead in small doses, combined with 
 opium, is far superior not only to the acid but to every 
 other astringent. All danger of its producing an un- 
 pleasant action upon the bowels, apprehended by some, 
 may be obviated by occasionally intermitting it, and re- 
 gulating the evacuations. I have already pointed out 
 the most salutary mode of checking perspiration, by 
 the application of leeches to the chest, and it remains 
 for me to notice the best remedial agents for diarrhoea. 
 These are chalk, kino, catechu, pomegranate bark, 
 and Armenian bole. Chalk, with a few minims of 
 
124 ^ TREATMENT OF CONSUMPTION. 
 
 Battley's preparation of opium, administered in barley 
 water J gruel, &c., will be found to equal in efficacy 
 more compound admixtures. Of tonics, the simplest 
 are the best. Bark I rarely, or ever, prescribe ; but 
 under particular circumstances infusion of columba, of 
 camomile, or occasionally of cascarilla, may for a 
 short period be not disadvantage ously employed. 
 While the Brunonian theory was held as the guide of 
 practice, preparations of iron were in high repute ; and 
 one of these, the antihectic mixture of Dr. Griffith, so 
 termed it would seem like " lucus a non lucendo," 
 from its possessing properties the reverse of its name, 
 is still, I am sorry to say, in estimation with some 
 practitioners. The use of such medicines, in a com- 
 plaint that calls for every effort to abate and moderate 
 excitement, cannot be too highly reprobated. 
 
 It is not a little curious, that the only medical work 
 which has, I believe, issued from the University of Oxford 
 for the last century and a half, should have been written 
 to divulge the virtues of an insignificant astringent. 
 Dr. Bourne, the Aldrickian Professor of the Practice 
 of Physic, published in the year 1805 an octavo vo- 
 lume, wholly dedicated to the recommendation of the 
 uva ursi, or whortleberry, as a specific in phthisis pul- 
 rnoiialis. The poor gentleman even apologizes in his 
 
TREATMENT OF CONSUMPTION. 125 
 
 preface, for having delayed divulging this astounding 
 discovery to the world so soon as he might have done. 
 I honour his sense of humanity, but cannot help being 
 amused at the simplicity of the professor. The little 
 good he did effect was obviously due to the medicines 
 combined with the aforesaid whortleberry. As for 
 any pathological views, they were out of the question. 
 He does not even enter into any consistent rationale of 
 his own practice. However, he did manage to write 
 a book, and attempt, in his small way, to promote 
 science : which is more than many of his brother pro- 
 fessors have done. The medical world should not be 
 severe upon them, seeing that, from their situation as 
 heads of the art, they have enough to do in conferring 
 degrees, without the additional trouble of acquiring 
 knowledge. What can be expected from a place where 
 there is no regular school of anatomy ; and no lectures 
 on half the useful branches of medical science ? In- 
 deed, professors in all places, in this country, seem to 
 be alike ;— witness the elder Duncan's anomalous trea- 
 tise on the same complaint. Both appear to have been 
 exempt from the sin of having ever opened a human 
 body. May the reign of such teachers be quickly at 
 an end ! To think, too, of the last having been forty 
 years a medical lecturer at Edinburgli, and of having 
 
126 TREATMENT OF CONSUMPTION. 
 
 written fifty volumes^ — such is his own boast : it is to 
 be hoped, at least, that he never published them. ^ 
 
 Balsams. — I hold it totally unworthy time, or pa- 
 per, to waste many words on this very futile descrip- 
 tion of medicine, at least as applied in consumptive 
 cases. It was supposed, in the days of Dr. Morton, 
 and of Van Swieten as well, that balsams exerted a 
 vulnerary power ; but to use such medicines at present> 
 or to suppose that any medicine whatever can heal ul- 
 cers of the lungs, betrays an extraordinary ignorance 
 of the peculiar nature of phthisis. There can be no 
 other possible method of healing them, than by 
 bringing their surfaces in apposition, since, unlike 
 other ulcers, they never granulate. 
 
 Blisters — When expectoration is superabundant, 
 or an oedematous state of the lungs is supervening, 
 these may be applied with success ; and when abstrac- 
 tion of blood generally, as well as locally, fails in 
 removing fixed pain of the chest, I find them very 
 useful. In general, however, they are too indiscrimi- 
 nately employed; since their use at an improper pe- 
 riod tends to bring on, and accelerate, the hot stages 
 of hectic paroxysms. Thus they superinduce a con- 
 tinued febrile state, not unfrequently terminating in 
 some variety of thoracic inflammation. One fact, pe- 
 
TREATMENT OF CONSUMPTION. 127 
 
 culiar to the application of epispastics in consumptive 
 cases, seems almost unknown to the medical profes- 
 sion. I have never known a patient suffer from gan- 
 grene through their use, although such cases are of no 
 uncommon occurrence in other disorders. How little 
 susceptible individuals labouring under phthisis are to 
 mortification, has been noticed by that great authority, 
 Laennec ; he explicitly states, that even protracted 
 confinement is inapt to produce gangrenous eschars, 
 anil the whole course of my experience corroborates 
 his assertion. 
 
 Diet.— This should ever be varied according to the 
 digestive powers of the patient. Van Swieten has 
 given a homely, but very sensible, illustration of what 
 ought to form the general guide in all dietetic advice. 
 He compares the physician, who pronounces such or 
 such food to be wholesome without reference to the 
 state of the patient, to the sailor who shouts out that 
 the wind is fair without considering to what port the 
 vessel is bound. As a general rule, the system of over- 
 feeding, or, to use a common phrase, of keeping up 
 the strength of the consumptive individual, cannot be 
 too strongly deprecated. It is, indeed, strange to find 
 any one so imbecile as to recommend in a disease in 
 which, even under the most judicious treatment, fe- 
 
128 TREATMENT OF CONSUMPTION. 
 
 brile action will be of almost daily occurrence, a course 
 of diet suitable only to the healthy and vigorous : yet, 
 in the absence of gastric irritation, and on the abate- 
 ment of hectic fever, the food may be of a nutritive 
 and invigorating description. This caution, however, 
 is to be borne in mind, that whatever is followed by 
 increased heat of body should be abstained from. The 
 best index of food's agreeing with a patient, is the ab- 
 sence after meals of constitutional disturbance. Ex- 
 cept during the presence of inflammation and of hae- 
 moptysis, I am in the habit of allowing the moderate 
 use of meat once a day, with an egg occasionally at 
 breakfast or by way of lunch, according to the patient's 
 fancy ; nutritive broths, taken lukewarm (indeed, ex- 
 cept the patient feels chilly, whatever liquid is drunk 
 should be of very moderate temperature) ; and, as to 
 a milk diet;> so commonly ordered, I reject it altoge- 
 ther. It excites expectoration in an unusual degree, 
 without however leading to a catarrhal state. When 
 consumption is decidedly manifested, wine is for the 
 most part inadmissible. A small glass of ale at dinner 
 may at times be permitted ; and occasionally at night, 
 with the view of inducing sleep. 
 
 I subjoin a few leading observations on the common 
 articles of diet. To begin with fish, an important 
 
TREATMENT OF CONSUMPTION. 129 
 
 item in the cuisine of the invalid. It forms a mode- 
 rately nutritious food ; and is so far of advantageous 
 use, that it does not stimulate the body and raise the 
 pulse, in the same degree as flesh. The chief con- 
 siderations, in selecting fish for the patient, are, in the 
 first place, its exemption from oiliness and viscidity ; 
 in the second, its firmness of texture ; and, lastly, 
 the colour of its muscle, which should be a clear 
 white. Such being the most desirable qualities, had- 
 dock, whiting, sole, cod, and turbot, all, in different 
 degrees, answer to these requisites. The whiting and 
 haddock are the easiest of digestion, — the cod, per- 
 haps, the least so of all. Salmon is too heating, and 
 too oily, to be indulged in. 
 
 As to shell-fish, the claws of crabs, lobsters, and 
 craw-fish, are usually palatable, and agree well with 
 the patient. Nor are shrimps and prawns to be for- 
 bidden : of course, they should not be indulged in to 
 any extent ; but, in moderation, they may be safely 
 eaten. Indeed, I have often observed, that the petty 
 delay and trouble that there is in unshelling this tiny 
 fry seem to excite the salivary glands, and, by sup- 
 plying the food in small quantities and in slow succes- 
 sion, to stimulate the secretion of the gastric juice. In 
 cases, too, of extreme debility, the preparation and pro- 
 
130 TREATMENT OF CONSUMPTION. 
 
 cess of the repast serve to interest and amuse a mind 
 weakened by long indisposition. Oysters I generally 
 leave to the discretion of the patient. If there is any 
 desire expressed for them, I see no reasons for their 
 refusal ; but I have observed that patients, whose ex- 
 pectoration is heavy, generally turn from them with 
 loathing. I do not deny, that many of these articles 
 are commonly and justly considered as indigestible ; 
 but this can only hold good when they are taken in 
 any quantity. When their use is moderated by pru- 
 dence, I have never found them more liable to disagree 
 than the ordinary edibles of the table. I may men- 
 tion, that I had a patient, a very frequent article of 
 whose food was turtle. He took it, of course, dressed 
 in a less stimulating manner than the usual form. 
 
 So much does the agreement or disagreement of 
 food depend upon the constitution and habit, that, in 
 laying down dietetic rules, we must always bear in 
 mind the old axiom, " Quid nocet alteri, alterijuvat." 
 I have found it a very ordinary custom among my 
 poorer patients to indulge, in eels, when first permitted 
 after illness to take anything of a more solid nature 
 than gruels, &c. Judging n priori, one would con- 
 clude from their oleaginous nature, that they would 
 prove a most indigestible article of diet : yet nothing 
 
TREATMENT OF CONSUMPTION. 131 
 
 can be more common than for them to be chosen by 
 the lower orders, on these occasions^, as a delicacy ; and 
 nothing can be more certain than that they agree. 
 
 So long as hectic fever, or any febrile symptoms 
 continue to any extent, the living of consumptive in- 
 dividuals should indisputably be low ; but otherwise a 
 generous diet, in the absence of fever^ so far from 
 being deprecated, may be safely left to the option of 
 the patient. Mutton is the lightest, most digestible, 
 and most nutritious meat for the invalid ; and broiling 
 one of the most advisable modes of cookery : at the 
 same time that few things are more palatable, nothing 
 can be more wholesome than a mutton chop. Beef is 
 of a denser fibre, requires a longer space to perfect its 
 chymification, and is consequently less easy of diges- 
 tion. Although it is equally as nutritious as mutton 
 to the healthy, it can hardly be pronounced to be so to 
 the invalid, since it requires a tone and vigour in the 
 digestive organs which the latter seldom possesses. 
 Veal and pork are the meats which follow next in the 
 order of digestion. I need scarcely enter my veto 
 against eating much of the fat, whether of mutton or 
 any other meat; for the delicate state of the stomach 
 in illness will, in general, cause a repugnance to it. 
 
 The meat should always be plainly cooked ; and. 
 
132 TREATMENT OF CONSUMPTION. 
 
 when it does not contravene all the laws of cookery, I 
 would say, let it be roasted : next to this, broiling is 
 the most wholesome form. Spallanzani has demon- 
 strated satisfactorily, that meat should be neither over 
 nor under-done ; and, since he has established this 
 point by numerous well-conducted experiments, the 
 general order to the cook, on this head, should be to 
 observe the '"juste milieu." A few words, as to the 
 reasons of the preference given to roasting over the 
 other modes of cookery, may not be unacceptable to 
 the patient. The loss in roasting arises from the di- 
 minution of the fat, which is melted out, and the eva- 
 poration of the water ; in boiling, the loss is caused 
 chiefly by the solution of the gelatine and osmazone ; 
 therefore, the nutritious matter, as the gelatine, is 
 considerably lessened in boiled meat, but remains 
 condensed in roasted. Its superiority over broiling 
 consists in its retaining, from its size — we are of course 
 supposing that a joint is put down — more of the juices 
 of the meat. Broiling, from the quickness with which 
 the outside of the meat is hardened, suffers it to retain 
 a much greater portion of its juices than boiling or 
 baking; but even the celerity with which a chop or 
 steak is thus cooked, cannot enable it to compete, in 
 this respect, with the advantage roasting possesses 
 
TREATMENT OF CONSUMPTION. 133 
 
 from the size of the portion^ usually submitted in this 
 mode, to the action of the fire. Baking, from its pe- 
 culiar process, not only prevents the evaporation of the 
 oils of the meat, but renders them additionally indi- 
 gestible by presenting them in an empyreumatic form. 
 On the whole, however, I prefer it to boiling. Before 
 quitting the subject of meats, I may mention that 
 venison or hare will prove a very nutritious food, to 
 those whose stomach is debilitated. They are easily 
 digested ; but, as they furnish a quantity of highly 
 stimulating chyle, they must be avoided by those whose 
 state of body requires the absence of all stimuli. 
 
 As to the bird kind^, the wild are more digestible, 
 but at the same time more stimulating, than the do- 
 mesticated ; and the darker the colour, and the greater 
 the proportion of fibrin, the more stimulant the chyle 
 produced. There is this advantage presented by the 
 bird kind, that they all differ in flavour from each 
 other, and are consequently well adapted to tempt the 
 invalid. The appetite, in ill health, is often in abey- 
 ance — not so much from weakness of the digestive 
 functions, as from the want of a little management in 
 varying the food. Persuasion is no less requisite in 
 leading the animal, than in conciliating the rational 
 powers. An argument, pleasingly addressed to the 
 
134 TREATMENT OF CONSUMPTION. 
 
 palate^ is often no less conducive to bodily than— when 
 directed to the judgment — it is to the mental health. 
 Nothing is to be deemed trivial which can soothe ; no- 
 thing should be neglected which may, with due limi- 
 tation, contribute to invigorate the sufferer. 
 
 Climate. — It has been seen from the preceding 
 pages, how much I am at variance with the common 
 opinions entertained of phthisis, and to none am I 
 more diametrically opposed than to those which respect 
 climate. So far from sending a consumptive patient 
 to the south of France or Italy, I should, if change be 
 requisite, deem the climate of St. Petersburgh a thou- 
 sand times more beneficial. In the latter case he has 
 a chance of contracting catarrh, and of thus staying 
 consumption : in the former, any catarrhal state which 
 might exist would assuredly be fatally removed. When 
 I hear of consumptive individuals being recommended 
 to try the genial climes, as they are absurdly termed 
 in these instances, of Lisbon, Madeira, or other sunny 
 lands : and when I reflect on the evidence given by 
 medical statistics of their deadly influence on phthisis, 
 I long to suggest the fitting answer to such advisers,-— 
 *'Jfe vestigia terrent omnia adversum spectantia, 
 nulla retrorsum." My experience on this point is full 
 and explicit ; and I could substantiate it, were it re- 
 
TREATMENT OF CONSUMPTION. 135 
 
 quisite at the close of a treatise the scope of which has 
 been to prove the true nature of this little understood 
 malady, by numerous cases. Two, however, which 
 have come to my knowledge since the publication of 
 the last edition of this work, are on several accounts 
 so interesting, that I am unwillmg to withhold them. 
 The first of these, which I extract from the letter of 
 an eminent solicitor in the west of England, who had 
 occasion to consult me, bears ample and irresistible 
 evidence to the soundness of my conclusions. It 
 comes with the full weight of authority, for it is a true 
 tale told by the most unexceptionable witness. The 
 writer commences by stating that the death of three 
 sisters, a brother, and his mother of consumption had 
 naturally induced some anxiety on his part, and led 
 him to consult me for symptoms it is here unneces- 
 sary to detail ; he then proceeds as follows : ^^ I am 
 unacquainted with medical science, but I presume 
 that what you call 'a. permanent catarrh,' I vulgarly 
 designate a constitutional cough,— if this be so, my 
 own father affords a striking illustration of the correct- 
 ness of your views. He, when young, was considered 
 very consumptive, and to use his own words was 
 'sent home from abroad twice to die among his 
 friends,' the foreign doctors pronouncing his case to 
 
136 TREATMENT OF CONSUMPTION. 
 
 be incurable decline. The first time he rallied, pro- 
 bably in consequence of the voyage &c., but relapsed 
 after his return to Italy, where he was when first 
 attacked — (a further corroboration of your opinions). 
 Business then called him to Newfoundland, where he 
 was exposed to the severest weather. He returned 
 to England, apparently without a chance of living 
 many weeks ; he, however, soon exhibited indications 
 of amendment, and although a strong cough and expec- 
 toration continued and never left him for sixty years, 
 he attained the age of 8.4, and never from the establish- 
 ment of his catarrh (if such it was) knew a day's ill- 
 ness of consequence, with the exception of occasional 
 attacks of the gout. — There are other circumstances," 
 the writer continues, "which I have not space to 
 mention. My eldest sister has escaped hitherto, and 
 she has a similar cough, and has had it for years ****** 
 the other members of my family who have died in de- 
 cline, had no such constitutional cough." The above 
 is surely to use the language of Shakespeare, " con- 
 firmation strong as proof of holy writ." The other 
 case to which I have alluded is not equally valuable 
 in point of conclusive testimony with the preceding, 
 yet is far from foreign to the purpose. It is, indeed, 
 rather curious, that as I had originally instanced the 
 
TREATMENT OF CONSUMPTION. 137 
 
 climate of St. Petersburgh as preferable to more 
 southern latitudes^, selecting it by chance as the repre- 
 sentative of cold climes in general^ the following should 
 have been sent me as a piece of gratifying news by 
 a lady of high rank;, a patient of mine. — " I have 
 now before me a confirmation of your views of the 
 beneficial effects of a cold climate in pulmonary cases, 
 in a letter from Mr. Canning, (the Premier's son) who 
 has spent the last winter in St. Petersburgh, though 
 many of his friends in consequence of his extreme 
 delicacy and liability to attacks on the chest dreaded 
 the effects of that climate, and urged him to visit the 
 South of Europe in preference. He says '''I have 
 never felt so well, or been so free from cough and 
 every ailment as since I have been in Russia." 
 
 The author of the article on" Climate" in the "Cyclo- 
 paedia of Practical Medicine," a work based on a 
 foreign prototype but far inferior in original views, 
 has obtruded some crude notions on the subject which, 
 being calculated to mislead the young practitioner, I 
 shall briefly notice. He writes as follows— "the great 
 desideratum in this country is to find a mild climate 
 and sheltered residence for our pulmonary and other 
 delicate invalids during the winter and spring"— and 
 then proceeds to specify the various advantages of our 
 
138 TREATMENT OF CONSUMPTION, 
 
 different watering-places. Now it is lamentable to find 
 in a work of so much pretensions^ a writer who, at 
 this time of day, is so obtuse as to advocate opinions 
 which have become the opprobria of the science. If 
 instead of repeating platitudes which have been hand- 
 ed down from father to son, he had taken the trouble 
 to repair to some of the spots whose salubrity he 
 vaunts, and examine the tomb-stones in their respective 
 burying grounds, he would have discovered from the 
 excessive proportion of deaths occurring in the spring 
 of life, particularly among females, that consumption, 
 here if anywhere, "shadowed the portals of the tomb." 
 As a friend once observed to me — a walk in Clifton 
 church yard read a finer homily on the vanity of 
 life than any sermon which he knew. He mentions 
 to prove the beneficial effects of the climate of Madeira, 
 that out of 52 patients who went thither in a given 
 number of years, 23 recovered ; which, if it proves 
 anything, would indisputably establish — were the cases 
 accurately reported — the efficacy of a sea voyage, since 
 those who died, succumbed for the most part it would 
 seem from too prolonged a stay on the island. The truth 
 is, this person is contented with writing in the usual 
 vogue manner on the efficacy of a warm climate, 
 without condescending to explain how warmth can 
 
TREATMENT OF CONSUMPTION- 139 
 
 heal up a cavity in the lungs, as if indeed there were 
 a charm in the phrase — warm climate. I have had 
 numerous patients who have returned from these lands 
 of ''^the myrtle and vine" with excavations in the 
 pulmonary organs, but never knew a solitary instance 
 in which a cure has been the result, except by the 
 fortunate supervention of a catarrh or bronchial affec- 
 tion. Facts are the best, and most stubborn argu- 
 ments. 
 
 So decided am I on this head, that I never admit 
 into the infirmary a phthisical patient with recent ca- 
 tarrh, because its wards are heated in winter time 
 so as to resemble a moderate summer temperature. 
 The cases of consumption, that come under my notice 
 in summer, are nearly double the number of those I 
 see in winter. The reason is evident : — the augment- 
 ed temperature of the weather increases the intensity 
 of two of the most important stages of the hectic pa- 
 roxysm — the hot, and the sweating. To subdue these 
 then becomes peculiarly difficult : how likely they are 
 to be aggravated by going abroad, any well-constructed 
 thermometrical table will tell. Again, if the disease 
 be latent, removal to a warm climate is the most pro- 
 bable means of making the case one of manifest phthisis. 
 In uniformity with these opinions, I feel no anxiety 
 
140 TREATMENT OF CONSUMPTION. 
 
 respecting consumptive patients being kept scrupulously 
 within doors. Wlienever the weather permits, they 
 should be allowed to take an airing daily ; but be by no 
 means suffered to remain so long as to be sensible of 
 chilliness or cold. 
 
 From every inquiry I have made with respect to the 
 influence of climate, I conceive that, all things duly 
 considered, the patient cannot have a more suitable 
 residence in winter, than in some of the spacious, 
 well-ventilated streets of our own metropolis. Another 
 consideration — a great one to the invalid — is that of 
 comfort, a word indigenous among ourselves. Many 
 of those, who had been led by blind guides to roam 
 abroad in a vain search after that health which, under 
 judicious treatment, they might have preserved here, 
 have assured me, to use the language of Sterne, that 
 they had done better to '^'^have remained dry shod at 
 home ; " and I am convinced that the greater number 
 thus sent on a useless errand, make — when hundreds 
 of miles from their own comfortable fireside — the re- 
 flection that occurred to honest Touchstone, " -^J, 
 now am I in Arden — the more fool I; when I was at 
 home, I was in a better place." 
 
A PPENDIX. 
 
 CASE I. 
 
 Supposed Consumption cured by Paracentesis. 
 
 ExuPERius V. Parker, aged 32, of the merchant 
 service, but formerly a petty officer in the royal navy, 
 was admitted into the Infirmary for Diseases of the Chest 
 in November, 1831. He was at this time suffering under 
 frequent and painful cough, attended with expectoration 
 of opaque yellow sputa, singularly fetid, and so abundant 
 in its discharge as to amount in the course of the day, to 
 three quarts; it was occasionally tinged with blood. 
 Along with violent pain in the inferior part of the left 
 side, his respiration was obstructed and difficult; and 
 his sleep was unrefreshing and broken by constant suf- 
 fering, and accessions of high fever on the approach of 
 night. He likewise laboured under profuse perspirations, 
 was excessively emaciated, and his complexion of asiukly 
 yellow hue. It appeared, on inquiring the causes which 
 had led to this state, that whilst on his passage, in 1829, 
 from Kingston to Morant Bay, in Jamaica, he had been 
 frequently drenched to the skin, and that he had suflered 
 
142 APPENDIX. 
 
 his clothes to be dried on him by the heat of the sun. 
 In consequence of this^, as he supposed, he was seized 
 with the yellow fever, and, on a relapse occurring^ after 
 his return to Kingston, he was admitted into the hospi- 
 tal. The fever was so violent as to produce delirium, 
 during which he repeatedly rose from his bed to commit 
 suicide, and being then under a course of mercury, he 
 concluded that he must, in these paroxysms, have 
 caught cold ; since, when convalescent, he experienced 
 severe pains in the left breast, accompanied by violent 
 cough. The latter continued unabated; and on his re- 
 turn to England he consulted a medical man at Lime- 
 house, after a violent seizure, in which he experienced a 
 sense of strangulation, followed by a copious discharge 
 of matter. Being regarded by this gentleman as in the 
 last stage of Consumption, he was induced to apply to 
 the Infirmary. Here he derived such relief, notwith- 
 standing the existence of a large abscess, occupying the 
 inferior lobe of the left lung, which I detected on the 
 first examination of the chest, that I recommended him 
 to go to sea again. I was induced to give this advice 
 from having met with two or three similar cases, in which 
 the abscess had remained stationary for some years. He 
 again made a voyage to the West Indies : on his return 
 from which to this country it was that he presented him- 
 self to me, affected with the formidable symptoms I have 
 detailed at the commencement of the case. 
 
 Having satisfied myself by auscultation with the naked 
 ear (which I invariably prefer to the stethoscope) of the 
 extent of the disease, and after various topical applica- 
 
APPENDIX. 143 
 
 tionS;, combined with constitutional treatment, had failed 
 to mitigate the intense pain in his side or to relieve the 
 suffocative respiration, I determined to introduce a small 
 trochar into an intercostal space immediately over the 
 seat of the abscess. I had resolved to perform this ope- 
 ration when I was first called in to this patient, two years 
 previous to the period of which I am now .speaking, had 
 no improvement taken place ; but finding his health so 
 amended on the very day I had fixed for the paracen- 
 tesis thoracis, as to preclude its necessity, I deemed it 
 expedient to trust to time and palliative treatment. The 
 result proved I had not judged incorrectly. But to re- 
 turn to the operation. Having observed a slight tume- 
 faction about two inches beneath the left nipple, I direct- 
 ed Mr. Herring, in the presence of Mr. Hudson, navy 
 surgeon, to open it ; having first carefully ascertained, 
 that the pressure of the accumulated matter had occa- 
 sioned a sensible inclination of the heart towards the 
 right side. From the intensely acute pain felt in this 
 spot by the patient, for which the abstraction of blood 
 afforded no relief, it appeared to me that nature was on 
 the point of endeavouring to work a cure by gangrene of 
 the pleura; and that by fixing on this as the spot of 
 election, a ready escape would be given to the contents 
 of the pulmonary abscess. After the division of the in- 
 teguments by the lancet, the same instrument was 
 used to open the intercostal space ; and no sooner was 
 this effected than a quantity of air issued from the orifice 
 with a hissing noise, followed by a discharge of opaque 
 yellow matter similar to his expectoration, with the ex- 
 
144 APPENDIX. 
 
 ception of its containing particles of a friable substance. 
 The opening thus made continued to discharge -matter, 
 mixed with air, for the space of ten days, with surprising 
 mitigation of his previous suffering. Having about this 
 period imprudently sat for a considerable time in an un- 
 aired apartment, he was seized with so violent an inflam- 
 mation of the bowels, as to demand vigorous and decided 
 antiphlogistic treatment. This attack produced a sud- 
 den and entire suspension of the thoracic secretion ; but 
 on the abatement of the inflammatory symptoms, his 
 convalescence was slowly though permanently effected. 
 It should be mentioned, that on examining his chest, I 
 ascertained thait the portion of the lung which had pre- 
 viously been the seat of matter and air, and from which 
 a clear, gurgling sound as well as pectoriloquism emana- 
 ted, began almost immediately after the operation to 
 be occupied by the dilated pulmonary tissue; a pro- 
 cess indicated by respiratory murmur. Before the ope- 
 ration, and indeed for three years previously, the respi- 
 ration of the whole of the right lung, and of the upper 
 portion of the left, as far as a line drawn horizontally 
 from the outside of the nipple of the left breast to the 
 spine, had been distinct, and somewhat puerile. In the 
 inferior part of the left side of the chest, pectoriloquism 
 was clearly marked ; and nearly the whole of the lower 
 lobe of the left lung was, as far as I could judge, the 
 seat of an immense abscess, from which he could dis- 
 charge matter at will, even to the amount of a tea-cup 
 full. At times, during the action of coughing, I could per- 
 ceive the intercostal spaces over the vomica apparently 
 
APPENDIX. 145 
 
 distended. Mensuration of the chest gave no perceptible 
 difference between the capacity of the two sides; but 
 that enlargement of the ends of the fingers, especially of 
 the thumbs, which I have already noticed as indicative 
 of the existence of large excavations, was in this case 
 particularly observable. On his recovery, this unnatural 
 tumefaction entirely subsided. I have been thus minute 
 in detailing this case, from my conviction of its rarity and 
 importance. It was, as has been seen, a case of pulmo- 
 nary abscess, which had existed for three years, resulting 
 from the combined effects of yellow fever and severe 
 cold, and terminating in pneumonia. During the greater 
 part of this time I was called upon to observe, and con- 
 sequently felt a strong interest in, its progress. As Ihad 
 early intimated to my pupils my judgment on this case, 
 and was sanguine in my belief of the patient's recovery, 
 I derived great satisfaction from haying the precision of 
 my diagnosis verified. 
 
 CASE II. 
 
 Consumption cured by Paracentesis. 
 
 David Scott, aged 17, admitted as an in-patient of 
 the Infirmary, Nov. 1827, had been indisposed eleven 
 years ; his illness originated in his having taken arsenic 
 by mistake. For several years previous to my seeing 
 him, he had been afflicted with cough, and other symp- 
 toms of Consumption. On entering the Infirmary he 
 showed none of the usual signs of emaciation in his 
 person, but there was an unhealthy fulness and flushing 
 
146 APPENDIX. 
 
 in his face ; he expectorated abundantly viscid, frothy 
 sputa, of a greenish colour, and semi-opaque. This 
 matter, amounting to about two pints daily, was of an 
 odour so intolerably offensive as to require the almost 
 instant removal of the vessel which received it, in order 
 to spare the feelings of the patients of the same ward. 
 Conceiving that a well-regulated atmosphere, such as 
 that of the Infirmary, (which is kept of a uniform tempe- 
 rature by means of German stoves,) would, conjoined 
 with sedatives, lessen the copiousness of the discharge, I 
 deemed it advisable to try their influence for a time. 
 After a month's sojourn in the Infirmary, and the failure 
 of remedial agents, finding his feet oedematous and con- 
 siderable dyspnoea present, and that there was, in fact, 
 a decided change for the worse, I resolved to have re- 
 course to an operation. His condition, at this period, 
 was as follows. On the right side anteriorly, from the 
 clavicle to the fourth rib, there was a strong gurgling 
 rattle, indicating the passage of air through cavities con- 
 taining matter. The character of the sound induced the 
 belief, that the fluid was in immediate contact with the 
 walls of the chest. Pectoriloquism was well-marked, 
 posteriorly, as well as anteriorly ; his respiration caver- 
 nous, but there was an entire absence of the souffle voile 
 (the veiled puff). Hence, I became certain, that the 
 surface of the lung adhered firmly to the costal pleura. 
 Percussion on the same side, as well as the naked ear, 
 showed that some portion of the inferior lobe of the lung, 
 a little below the excavations, still admitted the passage 
 of air. On the left side the chest sounded well, and the 
 
APPENDIX, 147 
 
 respiration was distinctly audible over the whole of it, 
 except below the clavicle^, where I at once detected im- 
 perfect pectoriloquism. The operation was performed 
 with a small trochar, in the presence of Mr. Herrings the 
 apothecary, and of more than twenty of my pupils, by a 
 surgeon, a fellow-lecturer of mine. The place of elec- 
 tion was in the intercostal space, a little anterior to the 
 digitations of the greater serratus muscle. It was my 
 desire that the puncture should have been made between 
 the third and fourth ribs ; however, it so happened that 
 the instrument was introduced between the fourth and 
 fifth, upon which there immediately issued a quantity of 
 air, with a hissing noise, without any discharge of mat- 
 ter. The point of the trochar, indeed, exhibited traces 
 of pus, and although it had been fairly introduced, yet 
 the place of election was too low to suffer the escape of 
 the matter. Observing that the patient was lapsing into 
 syncope during the rushing out of the air, I stopped its 
 further escape by placing my finger over the orifice, 
 until this could be properly secured by bandages. On 
 his recovering from this disposition to faint, and scarcely 
 complaining of pain, I explored his chest with my naked 
 ear, and in the region of the spot operated upon, I dis- 
 tinguished a dry, crepitous rattle, accompanied by a con- 
 tinued sound as of a rent, or as of something being torn 
 within the chest. This particular noise lasted, and even 
 increased, for some days. Subsequent to the operation, 
 he slept well, with the aid of a composing draught ; his 
 expectoration, as well as the nedema of his legs, gradu- 
 ally diminished, and for a short period he exhibited 
 
148 APPENDIX. 
 
 every sign of returning health. However, confinement 
 to the house appearing to operate injuriously, it was re- 
 solved he should return to his place of abode in the 
 country, a short distance from town. Here I saw him 
 two or three times, and at first he displayed symptoms of 
 amendment ; but subsequently his breathing became 
 troublesome, in consequence of an Emphysematous state 
 of his left lung, and of the other's being from cicatriza- 
 tion of its several cavities, and from compression also, 
 impermeable to air. So great was this compression pro- 
 ceeding from contraction of the chest, that he became 
 what is termed pigeon-breasted, the thorax being altered 
 to the condition represented in figure 1, plate 4. As a 
 consequence of the hepatized state of the one lung, which 
 occurred a few months afterwards, the circulatory func- 
 tions were disturbed, and venous congestion gave rise to 
 general dropsy. I recommended abstraction of blood to 
 equalize the circulation, diuretics, and other hydropical 
 remedies, but fruitlessly, he having been, I apprehend, 
 prejudiced against my advice by some neighbouring 
 practitioner. After much suffering he succumbed to this 
 complication of disease, about eleven months from the 
 time of his leaving the Infirmary. I was sent for to ex- 
 amine the body, which I did about twenty four hours 
 after decease. Notwithstanding the deformity which 
 the chest had undergone, there was no perceptible con- 
 traction of the affected side, which, subsequent to the 
 operation, had yielded the fleshy sound on percussion. 
 The right lung was one-fourth less than the left, and ad- 
 hered intimately to the costal pleura by well organized 
 
APPENDIX. 149 
 
 cellular tissue^ and likewise to the middle mediastinum, 
 which, with the heart, was forced considerably into the 
 right side of the chest, by enlargement of the left lung. 
 This lung was altogether emphysematous, remained un- 
 collapsed, and occupied the entire cavity of the left side 
 of the chest. The anterior edge was rounded, and dis- 
 played vesicles which were of great size, owing to the 
 union of several air-cells into one. The summit of the 
 lung adhered to the chest, developing in its centre the 
 indurated trace of cicatrization ; and it presented several 
 nodules of tubercles, surrounded by a copious deposit of 
 black pulmonary matter. In the cavity of the pleura, 
 there were above two pints of reddish serosity. On 
 making a longitudinal section of the right lung, its inte- 
 rior, which was flaccid, somewhat fleshy, and of a 
 marbled blue and brown colour, presented cellular lines 
 running in different directions, being the remains of ob- 
 literated excavations ; but there was not the slightest 
 vestige of tuberculous formation. The pericardium con- 
 tained about a tea-cup full of serum, and the apex of the 
 left ventricle was unusually prolonged ; a considerable 
 quantity of fluid existed in the peritoneal cavity ; the 
 chyiopoietic viscera were much congested ; the kid- 
 neys were of remarkable magnitude, and their cortical 
 substance underwent fatty degeneracy. 
 
 From a general view of the case I feel satisfied that 
 this patient might have lived some years, had he submit- 
 ted to the treatment I proposed to him on his change 
 for the worse. 
 
150 APPENDIX. 
 
 CASE in. 
 
 Consumption, in its very Advanced Stage, 
 Singularly Arrested. 
 
 W., clerk in a counting house in the city, aged 
 
 25, — for whom my advice was solicited by Dr. Tuke, 
 the humane and talented proprietor of Sidney House, 
 Homerton, the best regulated private establishment for the 
 insane I have ever visited, — when first seen by me, had 
 been for some months affected with cough, and expecto- 
 ration of thick, yellow sputa. He was extremely pallid, 
 and much emaciated, perspired profusely at night, and 
 had occasionally been subject to heemoptysis. It ap- 
 peared that he had recently lost a brother by the same 
 complaint : this circumstance, as was natural, seemed to 
 prey upon his mind, and depress his spirits ; and to so 
 low a condition was he reduced, that he was given over 
 by a respectable surgeon-apothecary, who had attended 
 him. I detected distinct pectoriloquism on the anterior 
 and upper part of both sides of the chest ; and this phe- 
 nomenon, together with a strong gurgling sound, most 
 audible in the left side, was clearly perceptible, over the 
 whole space, from the top of the shoulders to the third 
 rib. From partial indistinctness of the respiratory mur- 
 mer, without the rale of pneumonia in the lower part of 
 the right side, I apprehended that nodules of tubercles 
 were disseminated throughout its lung. I ordered the 
 application of leeches to his chest, with a view to lessen 
 perspiration, and remove congestion and morbid sensi- 
 bility of the chest ; and having described to him the 
 
APPENDIX. 151 
 
 species of apparatus for inhalation I wished him to use, 
 he procured for himself a tube of half an inch.in diame- 
 ter, and furnished with a stop-cock, by turning which 
 he was enabled to increase, or diminish, the resistance 
 to the egress of air from the chest. With very little 
 medicine, and that merely to regulate his stomach and 
 bowels, a striking amendment was soon visible, through 
 the beneficial effects of the above mechanical exercise. 
 His progress to recovery being now rapid and decided, 
 I recommended him to repair to the country for a short 
 time, and to continue the plan from which he had al- 
 ready derived such benefit. After some weeks' resi- 
 dence, he returned to town well enough to resume his 
 employment, and exhibited every appearance of health. 
 He had gained flesh in a surprising degree, his muscles 
 were firm and developed, his cough and expectoration 
 had almost left him, and he was — comparatively speak- 
 ing — a vigorous man. The only time I saw him after 
 his return, I examined his chest, and the result was, on 
 the whole, satisfactory. Pectoriloquism, indeed, could 
 still be detected in both sides of the chest ; but in the 
 right it was imperfect : in the left, however, it was 
 extensively manifested, though in a less degree than 
 before, and had a metallic sound. From this last cir- 
 cumstance, I inferred that the lining membrane was 
 acquiring a semi-cartilaginous structure ; which I have 
 found in many individuals will remain insensible, and be 
 productive of but trifling inconvenience for a series of 
 years. It unfortunately happened, that at no long pe- 
 riod after his convalescence, he was attacked with pleu- 
 
152 APPENDIX. . 
 
 risy, probably from neglecting himself; and although he 
 survived this latter affection, as I was given to under- 
 stand, for two months, yet not applying for advice, he 
 ultimately sunk beneath its effects. 
 
 CASE IV. 
 
 Pulmonary Excavation, Discharging its Contents 
 By an Opening made in the Right Side of 
 
 • The Neck. 
 
 In 1822, a child, nearly two years old, whose father 
 was an out-door patient of the Infirmary, was brought 
 for my advice, labouring under cougli, as well as a rare 
 disease, known under the name of pemphigus, which 
 commenced behind the right ear, with the eruption of 
 vesicles, about the size of almonds ; and these succes- 
 sively extended themselves" some way down the back, 
 and the same side of the neck, discharging acrimonious 
 yellow serum, and forming deep pits in the skin. This 
 almost intractable disease yielded, at last, to varied 
 treatment, and the application of an ointment composed 
 of the scrofularia nodosa. The part that had been af- 
 fected with the disease, healed up like a burned surface, 
 but with several depressions. The delicacy, brought on 
 by this disorder, terminated in tubercular formations in 
 the summit of the right lung, which finally softened and 
 made a way for themselves by forcing a passage under 
 the clavicle — the matter approaching the middle of the 
 neck, in the direction of the cicatrized integuments. 
 Observing that every time the child coughed, a puffing 
 
APPENDIX. 
 
 153 
 
 up of this part took place, and that there was air within 
 it, I directed Mr. Sturkey, the intelligent surgeon-apo- 
 thecary of the establishment at that time, to make an 
 opening here, when there immediately issued a consi- 
 derable quantity of air and matter, with great relief to 
 the little sufferer. This discharge ceased after some 
 days ; but in consequence of the extreme debility, in- 
 duced by two diseases occurring in a short space of 
 time, the child, originally of delicate constitution, did 
 not survive beyond two weeks. Its death, indeed, was 
 absolutely owing to a complete prostration of vital 
 power, not to be restored either by nourishing diet, or 
 tonic remedies. On examination there were several tu- 
 bercles in both lungs, but the surfaces of the large 
 cavity were found to be in apposition, and in more than 
 one point slightly adherent ; affording a proof, evi- 
 denced likewise by the voluminous state of the lungs, 
 that had the child lived, it would have triumphed over 
 every consumptive tendency. I must not omit to men- 
 tion, that the mesenteric glands were so enlarged, as to 
 present a decided obstruction to proper nutrition of the 
 body. 
 
 CASE V. 
 Consumption Cured by Paracentesis. 
 
 Mr. G. S., aged 30, residing in Norfolk-street, Strand, 
 having experienced several severe losses in trade, fell 
 into a declining state, which ultimately led to confirmed 
 consumptive symptoms. It appeared that about three 
 
 X 
 
154 APPENDIX. 
 
 years previous to my attending him he had laboured 
 under phthisis, from which it would seem that he reco- 
 vered ; and his recovery took place, as I have reason to 
 believe, from the occurrence of bronchial affection, 
 which after a time deserted him. However, meeting 
 with new calamities, he relapsed into his former phthisi- 
 cal condition. At the time he first sought my advice, 
 every sign indicated that his malady had made consider- 
 able progress. From the history of his case, I con- 
 cluded that a secondary eruption of tubercles must have 
 taken place at least eighteen months before ; and that 
 the softening of a tuberculous mass of large size had led 
 to the formation of a vomica. At times he was sensible 
 of fulness in the upper region of the left side of the 
 chest, as if produced by accumulation of matter in the 
 cavity, unable to find an exit ; and he would suddenly 
 be relieved by expectorating a quantity of p'urulent se- 
 cretion, sufficient to fill a small tea-cup. He could him- 
 self distinguish the agitation of the fluid in his chest, 
 when he coughed. On examination with the ear, ex- 
 tensive pectoriloquism was audible, extending from be- 
 neath the clavicle to below the third rib, and I distinctly 
 recognized the gurgling of the fluid over the whole of 
 the upper part of the left side of the chest. I succeeded 
 in removing for a time, in a great measure, well-marked 
 hectic fever, and the abundant expectoration was some- 
 what lessened. The fluctuations from amendment to 
 relapse were frequent ; and, among other remedial mea- 
 sures, I advised him to go to the north of England by 
 sea, conceiving that he might derive benefit from the 
 
APPENDIX. 
 
 155 
 
 bracing qualities of the air. Remaining there a brief 
 period, he returned to London but slightly improved in 
 health. Convinced that medicine could only afford tem- 
 porary relief, and being satisfied that his right lung, with 
 the exception of old cicatrization, was sound, and that 
 the inferior lobe of the left lung was in a very satis- 
 factory state, I ventured to propose an operation to him. 
 In spite of the ridicule thrown upon the proposal by a 
 medical acquaintance of his, he reposed such entire con- 
 fidence in me, that he unhesitatingly agreed to it. In- 
 d<eed, no accident ever attended the operation as per- 
 formed by me, except in a case of empyema, occurring 
 in my early practice ; the particulars of which extraor- 
 dinary case I unreservedly stated to a medical society of 
 this city. Laennec gives an instance not dissimilar from 
 that which happened to me, since both arose from an 
 unnatural position, in my case an unheard-of one, of an 
 important viscus. 
 
 Attended by one of my pupils, I operated with entire 
 success. The trochar was introduced by me between 
 the second and third ribs, in a line nearly perpendicular 
 with the left nipple : very little matter escaped, as I had 
 expected ; for ray chief object in performing this opera- 
 tion was to ensure the emission of the air, and thus effect 
 a diminution of the cavity by the expansion of the inferior 
 lobe of the left lung. I kept the punctured place open 
 for about ten days by the introduction of a small piece 
 of catgut, properly secured externally ; when, finding 
 that the cavity became so contracted, through the en- 
 croachment made on it l)y general pulmonary expansion 
 
156 
 
 APPENDIX. 
 
 as to preclude all further escape of air, I withdrew it. 
 About this time, a catarrhal affection of the inferior lobe 
 of the punctured side supervened ; and I could tell by 
 the ear, that the pulmonary tissue in the summit of the 
 same side, was undergoing expansion. In less than two 
 months, my patient was able to go out, and had com- 
 pletely lost all his phthisical symptoms. In less than 
 two years after the operation, he was in the enjoyment 
 of excellent health, the only drawback being the exist- 
 ence of catarrh, to which he more immediately owes his 
 recovery. • 
 
 CASE VI. 
 
 Consumption Cured by suddenly Supervening 
 Emphysema. 
 
 A young lady, daughter of a highly respectable 
 tradesman in Little Britain, long subject to a nervous 
 disorder for which various advice had been taken with- 
 out permanent effect, became consumptive. Her decline 
 was, in my opinion, brought on by an ill regulated use of 
 medicine. After long manifestation of the various symp- 
 toms of phthisis, it was proposed to me to meet in consul- 
 tation a physician, belonging to one of the metropolitan 
 hospitals. The view of the case taken by this gentleman 
 was so unfav^ourable, he unhesitatingly gave it as his 
 opinion to her parents — that she could not survive six 
 weeks. Careful exploration, however, of the summit of 
 the left lung, where I suspected the presence of a cavity, 
 convinced me of the probable error of his conclusion. 
 
APPENDIX. 157 
 
 This belief, on my part, originated in detecting decided 
 indications of emphysema from a dry crepitous rattle, 
 with large bubbles, manifested by auscultation. This 
 emphysematous state, I conceive, arose from a spasmodic 
 attack of the throat, so violent as almost to produce suffo- 
 cation. From this circumstance, combined with the 
 suddenness of the emphysema, I inferred that a rupture 
 of several air-cells had taken place, and that in time cic- 
 atrization would be effected through the consequent 
 pulmonary dilatation. Nor did my conjecture prove 
 erroneous ; since, though five years have elapsed from 
 the period of which I am speaking, I am most happy to 
 state, that this young lady is not only living, but is in the 
 enjoyment of excellent health. 
 
 CASE VII. 
 
 Consumption Cured by Neglect. 
 
 A Silversmith, when in good health and circum- 
 stances, and nearly fifty years of age, was exposed to one 
 of the most terrible of all paternal inflictions — the mis- 
 conduct and subsequent legal punishment of his son. 
 The young man, having formed dissolute connections, 
 had been persuaded to pass a forged note ; and, on the 
 fact being proved against him, was sentenced to trans- 
 portation. The disgrace, thus brought on their hitherto 
 unimpeachable family, operated so powerfully on the feel- 
 ings both of the father, and of a daughter just entering 
 into life, that their distress and agony of mind at last 
 entirely undermined their health. The debility, thus in- 
 
158 APPENDIX. 
 
 duced;, terminated in each of them in Consumption. 
 After a few months' illness, the daughter died ; and the 
 father, after extreme suffering both of body and mind, 
 having apparently reached the verge of the grave, and 
 being indeed so utterly reckless of life, which he regarded 
 only as a burden, as to neglect not -only recourse to 
 medical advice but even common care of himself, yet re- 
 covered, and survived for many years. It was fully seven- 
 teen years subsequent to this seemingly miraculous reco- 
 very, that I attended him on the occasion of his being 
 seized with an apoplectic fit, resulting, as I afterwards had 
 reason to believe, from valvular disease of the heart. 
 During his convalescence from this attack, he was un- 
 feelingly taunted by some brute in human shape with his 
 son's disgrace ; and so wounded and humiliated did he 
 feel by this unworthy allusion, and so deeply did it sink 
 into his mind, that I entertain no doubt it accelerated his 
 death. It was during my attendance on him, that learn- 
 ing from his wife his previous consumptive state and re- 
 covery, and perceiving that he laboured under a bron- 
 chial affection of long standing, I at once attributed the 
 return to health which she regarded as so strange, to 
 the ingresssion of catarrh on phthisis. The post-mortem 
 examination verified my conclusions ; it presented well- 
 defined cicatrizations, especially on the summit of the 
 right lung ; nodules of tubercles, yellow and opaque in 
 the centre, and rendered inert by the secretion of black 
 pulmonary matter in the surrounding tissue ; and the 
 lungs were exceedingly voluminous. I will venture 
 one observation on the case, and although it may 
 
APPENDIX. 159 
 
 appear harsh^ regard for truth and the advancement 
 of medical science compel me to make it ; namely, that 
 had this person when reduced to a phthisical state re- 
 curred to medical advice, the probability is, that the 
 bronchial affection, which was his safeguard, would, have 
 been interfered with, its value being unknown to the 
 profession, and his life, consequently, shortened for 
 years. 
 
 CASE VIII. 
 Consumption spontaneously Cured. 
 
 Miss M , about 23 years of age, a lady of great 
 
 personal attractions, and highly-cultivated mind, con- 
 sulted me in the summer of 1826, for symptoms of con- 
 firmed Consumption ; for which she had already enjoyed 
 the benefit of Mr. Howship's advice. It was arranged 
 that I should visit her in conjunction with this talented 
 surgeon ; and we continued to attend her for several 
 weeks. In all the cases I have witnessed, I never met 
 with such distressing, racking, and perpetual cough. 
 We tried every method of rehef we could possibly de- 
 vise, and administered sedatives of every description, 
 but without effect. Her disorder, instead of receiving 
 mitigation, evidently increased ; and not only were the 
 fears of her friends awakened, but we ourselves began to 
 despond. At this crisis, through the importunity of 
 some near connexions, her mother was persuaded to try 
 the advice of an individual, who, although I am not 
 aware that he had received a regular medical education, 
 enjoyed some notoriety. On receiving a delicate inti- 
 
160 APPENDIX. 
 
 mation to this effect, and being of course inclined to hu- 
 mour the natural anxiety of a parent, we agreed that it 
 might not be totally infra dignitatem of us, the more 
 legalized authorities, to hear what this person might 
 suggest, although a formal consultation was out of the 
 question. To do him justice we found his opinions 
 sensible, and much to the purpose ; but he considered 
 the condition of the patient as so hopeless, that he de- 
 clined interfering with the case. Yet, notwithstanding 
 these grave prognostics, the young lady, to our great 
 satisfaction, soon after this began to exhibit signs of 
 amendment. Her health was gradually restored, and 
 continues, I believe, unimpaired up to the present time. 
 From my further experience, and from cases which have 
 subsequently come under my notice, I entertain no 
 doubt that the cough I have already alluded to, and 
 which was of a convulsive character like that of the 
 hooping-cough, must have produced a rupture of the 
 air-cells, which, caused infiltration of air within their 
 partitions. This variety of emphysema, similarly to the 
 vesicular, renders, while it lasts, the lungs voluminous ; 
 and when happening in the neighbourhood of the dis- 
 eased summit of the lung, would naturally bring the 
 surfaces of any excavation into contact. Indeed al- 
 though from my reluctance to put the patient to incon- 
 venience by examining the chest in the latter part of 
 her illness, I could not positively affirm the existence 
 of emphysema, still all my reflections on the case lead 
 me to the belief, that she is in no small degree indebted 
 for her cure to a cough, which in general would be con- 
 
APPENDIX. 161 
 
 sidered highly injurious;, and in fact appeared so to me at 
 the time. 
 
 CASE IX. 
 
 Rkmarkable Influence of the Protective Power 
 OF A Bronchial Affection. 
 
 I offer this case as one instance out of many^ equally 
 as decisive which I could adduce^, of the value of 
 catarrh in preventing Pulmonary Consumption. An emi- 
 nent publisher of Paternoster-row, all of whose brothers 
 and sisters have been the prey of Consumption, is him- 
 self subject to asthma, induced by a catarrhal affection 
 of the chest contracted in childhood. The gentleman 
 to whom I allude, is at present about fifty years of age, 
 of a ruddy, healthy complexion, expanded chest, and 
 excepting occasional inconvenience experienced from 
 the above constitutional complaint, he enjoys life in 
 every respect. It is but fair then to infer that since, out 
 of a numerous family, he is the sole member who has 
 escaped phthisis, this singular exemption has been owing 
 to what might to a superficial observer appear an in- 
 fliction, but which is really in this instance a provi- 
 dential dispensation ; namely, catarrhal asthma. 
 
 Being thus naturally led to the subject, I take the 
 opportunity of explaining a very remarkable phenome- 
 non, exhibited in the offspring of consumptive, and asth- 
 matic individuals. That Consumption is hereditary, I 
 have already noticed ; but an additional confirmation 
 not only of this fact, but of the truth of the opinions I 
 
 Y 
 
162 APPENDIX- 
 
 have given on the preventive nature of catarrh, may be 
 found in a circumstance often noted by me ; — that when 
 a consumptive individual becomes asthmatic, the children 
 born prior to the supervention of asthma exhibit a 
 phthisical diathesis, whilst those who are born subse- 
 quently are entirely free from any consumptive tendency. 
 Exceptions may undoubtedly be met with, the result of 
 some strong exciting cause ; but, generally speaking, the 
 rule will be found to hold good : the exception, indeed, 
 will substantiate the rule from the resistance, in such 
 cases, offered by nature to the inroads of Consumption. 
 
 CASE X. 
 
 Complication of Disease ending in Phthisis. 
 
 C. L., aged 50, the matron of a medical institution, 
 and who consequently had the best advice within her 
 reach, and was visited by several eminent medical men, 
 was for some months subject to distressing uneasiness 
 and irritability of stomach, which prevented the due re- 
 tention of food. It being supposed that she laboured 
 under a cancerous affection of this organ, various palli- 
 ative expedients were resorted to. Her health, however, 
 declined, and she became subject to frequent cough 
 from which she had hitherto been free, — to shortness of 
 breath, purulent expectoration, much emaciation, hectic 
 fever, and night sweats. After great suffering for a 
 lengthened period, she sank under this seemingly 
 double affection of the stomach and chest. On examina- 
 tion, however, of the body, the cause of this train of dis- 
 
APPENDIX. ' 163 
 
 ease was discovered to be a polypus of the womb, which 
 had considerably enlarged it, and had undoubtedly ex- 
 cited that morbid sensibility of the stomach which de- 
 ranging the general health, induced phthisis. The only 
 remarkable appearances presented by the stomach, 
 were several small opaque glands in the mucous surface, 
 near the pylorus. The lungs were excavated, and tuber- 
 culous ; and exhibited marks of inflammation in various 
 places. I have introduced this case to prove the just- 
 ness of the views I have taken in the preceding portion 
 of this work, with respect to the fatal supervention of 
 phthisis on general debility, when unchecked by catarrh, 
 or mechanical expansion of the chest. Had inhalation 
 been early employed, the disease would have been at 
 once arrested ; and the patient might have lived until the 
 appearance of the polypus through the external opening 
 of the womb would have attracted notice ; when means 
 might have been adopted for its removal. 
 
 I have by me numerous cases, in which Consumption 
 has fatally supervened on diseases both of a curable and 
 incurable kind ; but their description could only confirm 
 what I have already, I trust, established. 
 
 CASE XI. 
 
 The Pkotecting Influence of Catarrh, 
 Supervening on Consumption, Exemplified. 
 
 Mrs. Hawkes, the wife of a gentleman attached to the 
 Bank of England, who had been under the care of a re- 
 tired lecturer on midwifery at our largest hospital, with- 
 
164 APPENDIX. 
 
 out relief of her consumptive symptomS;, applied to me 
 about twelve years ago. She suffered from hectic fever, 
 spitting of bloody and, in short, exhibited all the w^ell- 
 known symptoms of phthisis. At this time, my views of the 
 treatment of Consumption were not matured. However, 
 I succeeded in rendering her disease chronic : and soon 
 after this change was effected, a bronchial affection su- 
 pervened. Until the pulmonary cavity was perfectly 
 healed, she was liable at long intervals to sanguineous 
 expectoration ; and her health consequently exhibited 
 occasional fluctuation. During one of these temporary 
 relapses, she consented in order to oblige a friend 
 whose importunities were unceasing, although at the 
 same time her confidence in me continued unshaken, to 
 apply to Dr. Maton, the late physician to their Royal High- 
 nesses, the Duchess of Kent and the Princess Victoria. 
 Like other physicians of the same standing he possessed 
 no very accurate knowledge of the modern improve- 
 ments in the art, and from the defective education which 
 prevailed when he commenced his studies had, probably 
 never turned his attention to pathological researches. 
 At least, I cannot otherwise account for his mistaken 
 views of the present case. I do not intend reflecting on 
 Dr. Maton in particular, more especially as he is now no 
 more. He was quite equal to any of the practitioners of 
 his day, and having had the honour to prescribe for two 
 successive Queens, was known, like most of those who 
 have enjoyed similar posts, by his preferment chiefly. 
 The duties of the station, doubtless, preclude the posses- 
 sors from making contributions to medical science, or, at 
 
APPENDIX. 165 
 
 least, from extending their fame to foreign countries. A 
 rather singular exception;, indeed, to what occurs else- 
 where, since we find that abroad those medical men who 
 hold similar posts, are the most distinguished by their 
 professional attainments. To return to the case. Dr. 
 Maton, gave it as his opinion that recovery was impos- 
 sible. This was^ accordingly reported by my patient 
 to me, with apologies for the apparent want of con- 
 fidence in my skill. I soon reasoned her out of her 
 fears, and carefully putting by the prescription, she pro- 
 ceeded in better spirits from my assurances to order mine 
 to be made up. The usual results, attendant upon ca- 
 tarrh in Pulmonary Consumption, were not belied in her 
 case. She is at this moment ever ready to join in the laugh 
 with me at her former trepidation ; and is one, out of 
 hundreds of instances that have passed under my obser- 
 vation, of the cures effected by the interposition of 
 Nature herself. 
 
 CASE XII. 
 
 Consumption Cured notwitpistanding Exposure to 
 Cold and Neglect of Medicine. 
 
 Mr. D , aged 24, had so materially impaired his 
 
 constitution through irregular habits, as to fall in conse- 
 quence into a decline. He of course availed himself of 
 the benefit of medical advice, which produced no very 
 visible amelioration of his state of health. Being natu- 
 rally of active habits, he grew impatient of the confine- 
 
166 APPENDIX. 
 
 ment to which he was subjected, and;, tempted by the 
 return of spring, he suddenly deserted his heated apart- 
 ment and determined, since he concluded he must die, 
 to die in the manner most agreeable to himself. Ac- 
 cordingly he betook himself to his favourite sport of fish- 
 ing. This was in the month of March, a period at 
 which easterly winds are most prevalent. The worst 
 consequence of this apparently rash exposure was, that 
 after a time he caught a cold, which, as it would appear, 
 was confined to the trachea. His respiration was sensibly 
 affected, and he laboured under a distressing fulness of 
 the chest. He continued subject to this affection, with an 
 apparent increase of the violence of his disorder ; but he 
 still rejected all care and medicine, and persevered in 
 going out. After some period, he began to exhibit signs 
 of amendment ; he gradually lost his emaciated appear- 
 ance, and acquired flesh and bodily vigour ; but was 
 much annoyed by wheezing of the chest, and loud rattle 
 in the throat. He had remained in this state for some 
 months, when he applied to me. On examination of the 
 chest, and hearing a detail of his complaints, not only 
 from himself, but from the gentleman under whose care 
 he had previously been, I at once perceived that he was 
 indebted for his recovery from Consumption to this ca- 
 tarrhal state of the trachea. I may here observe, that re- 
 coveries of this kind are more frequent among the lower, 
 than the other classes of the community ; owing, doubt- 
 less, to what may at first appear a misfortune, but is to 
 the consumptive patient, in numerous instances, a bless- 
 ing—exposure to cold ! 
 
APPENDIX. 167 
 
 CASE XIII. 
 
 Case of Consumption, Exemplifying the Great 
 Value of Inhalation. 
 
 A Gentleman, aged 50, whose house of business 
 is in Hatton-garden, began to exhibit decided symp- 
 toms of Consumption about three years ago. Originally 
 of delicate constitution, and inclined by his make to 
 phthisical disorder, his health was undermined by fa- 
 mily afflictions. Within a very brief period^ he lost his 
 wife and two grown-up daughters ; the two latter 
 through the same destructive complaint, which, super- 
 vening on the decay of health occasioned by grief for 
 their loss, has since endangered his own life. At the 
 time I was called in he exhibited the physical signs, as 
 well as constitutional symptoms of the disease. He had 
 inflammation of the inferior and middle lobe of the right 
 lung, and expectorated no inconsiderable quantity of 
 blood. This circumstance, indeed, is no infrequent con- 
 comitant of the above inflammatory state, when it coex- 
 ists with tuberculous excavations of the lungs. He had 
 been under the care of two able practitioners, his brother- 
 in-law, Mr. Wallace, and Mr. Christie, a surgeon in the 
 neighbourhood of his country-residence- Both these 
 gentlemen considered their patient in a most alarming 
 state ; and on seeing him, I fully shared their apprehen- 
 sions. The first consideration was to subdue the inflam- 
 matory state ; and for this purpose blood was taken from 
 the arm, and medicines were likewise exhibited to fur- 
 ther the end proposed. The pneumonia continuing, it 
 
168 APPENDIX. 
 
 became necessary to repeat the general abstraction of 
 blood, and to follow this up by the application of leeches 
 near the seat of the inflammatory action. By these de- 
 pletory measures, the pneumonic disease lost its more 
 violent symptoms ; but, after displaying a temporary 
 amendment, the active determination of blood to the 
 chest recurred with its former severity. At this juncture, 
 his brother-in-law, Mr. Wallace, who watched the case 
 with great anxiety, considered himself fully justified in 
 bleeding him in my absence, and that to some extent. 
 Leeches were also repeated, and medicines given, whose 
 chief action was determined to the kidneys. Under this 
 plan of treatment, he gradually got rid of the formidable 
 pneumonic complication, and it remained to counteract 
 the phthisical disease alone ; which, after a time, began 
 to exhibit graver and more pressing symptoms. In fact, 
 the patient was at this period in so lamentable a condition, 
 and so utterly hopeless of recovery — being rendered addi- 
 tionally uneasy by the discharges of blood again appear- 
 ing—that he arranged his affairs, and made every prepa- 
 ration which a conscientious man deems it imperative to 
 do, when looking forward to the awful summons. Having 
 first reduced the spitting of blood, and removed some of 
 the more formidable external symptoms connected with 
 phthisis, I pressed the necessity of recurring to inhalation. 
 The practice was novel to the other medical gentlemen, 
 but I pointed out its rationale, and illustrated my 
 opinions by the convincing support of cases. They 
 yielded to my arguments, inasmuch as their reason was 
 convinced; yet so unwillingly, that they could not enlist 
 
APPENDIX. 
 
 169 
 
 their hopes on my side. The utmost they at first expect- 
 ed was palliation ; but they could not^^bring^themselves, 
 as they have since owned to me, to believe that inhala- 
 tion could effect the healing of internal ulcers, and pre- 
 vent the fresh formation of tubercles. The trial was, 
 however, made ; and its result up to the present date, 
 has been attended with marked success. In less than 
 two months from the period of the patient's commenc- 
 ing to inhale, his chest was so much enlarged as to 
 render it necessary for him to have his waistcoats let out ; 
 and his general health was proportionably amended. It 
 is now two years and a half since he began this process, 
 and for the last two, he has been enabled to attend con- 
 stantly to his business in town. He inhaled for many 
 months twice a-day, except at such times as slight spitting 
 of blood, arising from the cavities not being yet entirely 
 closed, has called for an interruption. This is a circum- 
 stance, which, although it is apt to occasion alarm in the 
 patient, is to be expected in many instances, so long as 
 the excavation remains. I have already adverted in 
 Case XI. to a similar instance of sanguineous expector- 
 ation, which likewise proved perfectly innocuous. The 
 cure was in the case of this lady complete ; and in that 
 now under consideration, I am happy to be able to say 
 ''finis coronat opus.^^ 
 
170 APPENDIX. 
 
 CASE XV. 
 
 Another Case Corroborative of the Efficacy of 
 
 Inhalation, Written by the Father of the 
 
 Patient. 
 
 " Dinah Marks, of the Jewish persuasion, aged 19, 
 was suddenly seized with spitting of blood, in the begin- 
 ning of September, 1833. On application to a medical 
 gentleman, he treated the case as of no importance, but 
 prescribed for her ; and she continued under his care, 
 without experiencing any relief, until the end of Decem- 
 ber. She was seized at this juncture with sanguineous 
 expectoration, similarly to the first attack; and this was 
 followed by a violent cough. Nocturnal sweats ensued, 
 accompanied by loss of appetite, dejection of spirits, and 
 other common symptoms of decline. She drooped visibly ; 
 and her appearance awakened all the fears of her mother 
 and myself. At this critical period, I made the acquaint- 
 ance of a person who had been indebted to you for 
 restoration from a state, even more alarming than my 
 daughter's ; and I immediately sought the benefit of 
 your advice for her. The state of weakness to which 
 she had been reduced, and consequent inability to in- 
 hale, prevented her firom deriving, or rather, perhaps, 
 from exhibiting outwardly, much immediate benefit from 
 your prescriptions; ^nd she remained, apparently, in a 
 very precarious condition. The spitting of blood came 
 on again in the beginning of March ; and, on its re- 
 moval by your treatment, you advised her at once to 
 commence inhaling. From this moment, her progress 
 
APPENDIX. 
 
 171 
 
 to convalescence has been rapid. With her amended 
 healthy her spirits also have revived. She has been en- 
 abled to resume her business ; and no doubt can pos- 
 sibly be entertained of her ultimate recovery. Her 
 mother and myself" — 
 
 I cut short the thanks of the worthy couple, as they 
 have nothing to do with the understanding of the case. 
 Since the above was written, the amendment of my 
 youthful patient has been still more decisive. 
 
 CASE XVI. 
 
 Case of a Medical Gentleman, who has Reco- 
 vered BY Inhalation. 
 
 Mr. Clements, aged 25, member of the Royal Col- 
 lege of Surgeons, did me the honour to solicit my advice 
 more than two years ago. I found that he laboured under 
 well-marked symptoms of Consumption. Since, however, 
 they presented no peculiar features, it is unnecessary to 
 recapitulate the long list of constitutional and physical 
 phenomena, which have been so often described in the 
 preceding pages as concomitants of the disease : suffice 
 it to say, that I have enjoyed the satisfaction of seeing 
 him recover ; and that he chiefly owes his restored 
 health to inhalation. 
 
 CASE XVII. 
 
 Protecting Influence of Partial Emphysema, 
 
 Exemplified in the Long Life of a 
 
 Consumptive Patient. 
 
 Martha Henderson, of Cherry Garden-street, Ber- 
 
172 
 
 APPENDIX. 
 
 mondsey, first came under my care about thirteen years 
 ago. She was at that time fifteen years of age. It appeared 
 that phthisical symptoms first supervened after an attack 
 of the small poX;, which had seized her naturally the year 
 preceding. The ill health engendered by this^ it is pro- 
 bable^ gave rise to the formation of tubercles in the 
 lungs. She exhibited no signs of consumption in her 
 person. Her countenance was florid^ not flushed ; and 
 the emaciation usually witnessed in consumptive pa- 
 tients, was not observable. The hectic symptoms were 
 very irregular and undefined, recurring at uncertain 
 intervals, and those far distant. She was subject to 
 cough, and shortness of breath, influenced by changes 
 of weather ; but the most remarkable symptom was the 
 quantity and the fetor of her expectoration. It resem- 
 bled the matter discharged by a phlegmonous abscess, 
 and she could bring it up at will. She imagined from 
 the peculiar sensation she felt there, that it proceeded 
 from the right side of the chest ; and, in point of fact, a 
 great sympathy was discernible betwixt the external and 
 internal parts on this side. A swelling, and induration 
 of the mamma, invariably took place whenever the mat- 
 ter collected to any great extent within. I have alluded 
 to the fetid odour of the expectorated matter ; it was of 
 so rank and sickening a nature, that her parents, al- 
 though she was their favourite child, needed every ex- 
 citement that a sense of parental duty could give, to en- 
 able them to live with her. It is no exaggeration to say 
 that it contaminated the whole house, and was percepti- 
 ble as soon as the street-door was opened. I have seen 
 
APPENDIX. 173 
 
 my own pupils ready to vomit at the disgust it occa- 
 sioned;, and have, used as I am to such scenes, been 
 affected by it myself. When I first examined her, she 
 exhibited the following symptoms. The sound of respir- 
 ation was barely audible over the right side of the chest, 
 with the exception of a space, about two inches square, 
 between the clavicle and the third rib, where a loud 
 gurgling rattle was heard, caused by the intromission of 
 air into a cavity containing a quantity of puriform sputa. 
 A mucous and sometimes sibilous sound was occasion- 
 ally heard in some of the bronchial tubes, in the inferior 
 region of the same lung. The opposite side of the chest 
 gave out an asthmatic wheezing, from the clavicle down- 
 wards, as far as the fourth rib. The inferior part of the 
 same side, both before and behind, yielded a dull sound 
 on percussion ; and the respiration was nearly inaudible 
 over the same region. When she spoke, I could dis- 
 cover on the same side distinct pectoriloquism in the 
 midst of this imperfect respiration. After examination, 
 I recorded the following diagnosis : — Large excavation 
 in the superior lobe of the right lung, containing a 
 quantity of liquid mtttter ; the rest of the lung, on 
 the same side, tuberculated; cavity in the middle of 
 the inferior lobe of the left lung, the remainder of the 
 lobe in a state similar to the opposite ; the iipper lobe 
 of the same lung emphysematous throughout. 
 
 I augured no long period after this, that she was 
 likely to live many years ; feeling assured that the asth- 
 matic condition of the one lobe of the lung would coun- 
 terl)alaii(;e the defects, alarming as tliey were, of the rest 
 
174 APPENDIX. 
 
 of the pulmonary apparatus. I caused her to attend on 
 several occasions^ when lecturing on Diseases of the 
 Chest, to point out the phenomenon of a person's existing 
 so long under such ravages from consumptive disease. 
 She was seen several times at the Central Infirmary, as 
 well as the Infirmary for Diseases of the Chest ; was well- 
 known to the two apothecaries of those establishments ; 
 and must have come under the notice of above one hun- 
 dred professional individuals. I was not aware for some 
 short time after her first attendance on me, of the value 
 of that emphysematous state, which I now recognize as 
 the preserver of her life for so long a period. Hers was 
 at first considered by me as a remarkable case, from the 
 circumstance of her displaying most of the external signs 
 of health in spite of her really distressing condition. Of 
 late years, however, I have learnt to estimate properly 
 this strong corroboration of the truth of those views, 
 which I have at last systematized, and reduced to proof. 
 
 A singular peculiarity, connected with the history of 
 the patient, is, that from the age of fifteen to twenty-two 
 her personal appearance exhibited no change. She dis- 
 played the same girlish look throughout these years ; and 
 it was not, indeed, until she had turned her twenty-second 
 year that she underwent the catemenial crisis. After 
 this, it was astonishing how quickly she acquired the las- 
 pect and proportions of womanhood. She was an occa- 
 sional patient of mine, as I have already stated, for the 
 space of ten years ; applying to me from time to time, 
 whenever she was in London, In the course of these years 
 she experienced several severe inflammatory attacks. 
 
APPENDIX. 175 
 
 The immediate cause of her death was, in fact, a violent 
 pleurisy, which seized her when on a visit to some 
 friends about forty miles from town. She endured this 
 as long as she could hold up, without taking any medical 
 advice ; and at last hastened home, and sent for me. 
 But she had delayed till too late. Hertongue was thickly 
 covered with aphthae, her lips livid, her respiration so 
 impeded as to prevent her from lying down, and accom- 
 panied with extreme pain in the side : her extremities 
 were cold, and she had occasional hiccough. I saw that 
 she was beyond the reach of medical aid ; and the poor 
 girl expired within thirty hours after reaching home. 
 
 Dissection, thirty -six hours after death. — The right 
 lung was adherent throughout, by ancient attachments, 
 to those parts with which (though without adhesion) it is 
 naturally in contact. The summit was indented, indu- 
 rated, and covered, or capped as it were, by a fibro-car- 
 tilaginous mass- Highly condensed cellular substance, 
 of irregular thickness, and about an inch and a half in 
 length, extended itself into the lung, and gave off seve- 
 ral bands, of the same structure, which ran in nearly a 
 horizontal direction, and gradually lost themselves in the 
 cellular membrane of the viscus. The structure just 
 described, was probably formed from the cicatrization of 
 ancient vomicae. In the same summit there was a num- 
 ber of tubercles, in different stages, several of them sur- 
 rounded by black pulmonary matter. There was a large 
 cavity, nearly opposite the third and fourth intercostal 
 spaces, containing a calcareous secretion of the size of a 
 peach stone ; and instead of being lined by semi-cartilagi- 
 
176 APPENDIX. 
 
 nous membrane, its lining was composed of laminae of the 
 colour, and consistence, of old yellow wax. The rest of 
 lung contained a multitude of greyish tubercles, of un- 
 usually firm consistence, and of various sizes : on cutting 
 it, a quantity of frothy serum flowed out. The upper 
 lobe of the left lung completely filled the cavity of the 
 chest, on that side ; and, when handled, imparted a sen- 
 sation different from the natural crepitation, and some- 
 what similar to that caused by the displacement of some 
 elastic fluid. Its surface exhibited several transparent 
 vesicles, some of the size of an almond, evidently dilated 
 air-cells. The dilatation of the cells over the rest of this 
 lung, was likewise remarkable. On making a longitudi- 
 nal section of this lobe, a slight trace of cellular cicatrix 
 was perceptible ; and two of the bronchial tubes were 
 considerably dilated from their cartilaginous termination. 
 The mucous membrane of all the tubes, without appear- 
 ing highly vascular, was considerably thickened, and 
 contained much yellow opaque matter. The inferior 
 lobe, on the same side, on its anterior and lateral surface, 
 was adherent through the medium of a false membrane 
 a quarter of an inch in thickness, containing beneath it a 
 gelatinous substance, transparent and almost colourless. 
 There was a large cavity, with tubercles, similar to those 
 presented in the superior lobe of the opposite lung, but 
 not so numerous ; and marks of inflammation were ex- 
 hibited in various places. The above cavity, which oc- 
 cupied the centre of the lobe, and communicated by a 
 large opening with another of less size, had a mem- 
 branous lining exactly resembling in structure that which 
 
APPENDIX. 177 
 
 I have described as appearing in the excavation of the 
 right side. 
 
 I entertain no doubt that there existed originally a 
 cavity in the summit of the left lung, along with tubercles 
 in a state' of semi-transparency ; the latter of which had 
 been absorbed, and the former healed by the first inten- 
 tion. 
 
 CASE. XVIII. 
 
 Consumption Warded off by the Pre-existence 
 OF Asthma, WHICH had lasted upwards of twenty 
 years IN A Female, who subsequently died 
 through Cancer in the Womb- 
 
 Mr. Morgan, a general practitioner of Great New- 
 port street, has, on various occasions, invited me to ac- 
 company him to post mortem examinations. I have 
 had the pleasure of pointing out to him, in sonie of these 
 associated labours, the cicatrices of cured Consumption 
 arising from enlargement of the volume of the lungs. 
 In the case now under consideration, extensive cancerous 
 disease had destroyed a great portion of the uterus and 
 the bladder ; had produced considerable induration of 
 the rectum, as well as obturation of the external iliac, 
 with a portion of the adjoining hypogastric vein on the 
 right side ; and had affected the whole of the right leg 
 and thigh in a manner similar to what is witnessed in 
 phlegmasia dolens. Notwithstanding the ill-health in- 
 duced by the continuance of cancer of the womb, with 
 the deplorable accompaniments just detailed, as well as 
 
 a a 
 
178 APPENDIX. 
 
 exhausting discharges for upwards of two years, no 
 symptom of Consumption appeared ; but the patient, at 
 last, succumbed under general effusion, the result of 
 protracted debility. On opening the body, I pointed 
 out to Mr. Morgan the asthmatic state of the lungSj (with 
 cicatrices on their summits), which had acted as a pre- 
 servative against the ingress of that phthisical condition 
 which, without this state, would in such a case have in- 
 disputably supervened. I have had opportunities of 
 showing similar cases to several respectable practition- 
 ers, and, amongst others, to my worthy friend. Dr. Hel- 
 sham. My chief inducement for mentioning this case, 
 is to impress upon the medical world the high advan- 
 tage of recurring, in all instances of debility occasioned 
 by long continued chronic ailment, to mechanical means 
 for preventing the sure inroads of Consumption, the 
 consequence of such state. Mr. Carmichael of Dublin, 
 has indeed affirmed in the second edition of his excel- 
 lent work on Cancer, that he never examined the body 
 of a patient who died with any variety of that disease, 
 without finding the lungs tuberculated. This, in the 
 first instance, strongly corroborates the correctness of 
 my opinion, that Consumption is a very common result 
 of ill-health produced by any ailments of long continu- 
 ance ; and, in the second, it shows by negative testi- 
 mony the value of those means which will prevent such 
 supervention. I have no doubt that this gentleman, in 
 the prosecution of his pathological studies, will meet 
 with cases in which the utility of catarrhal and asthmatic 
 affiections in anticipating, or arresting Phthisis, will be 
 
APPENDIX. 179 
 
 well-marked : and I feel pleasure in adding, that from 
 his high character, and zeal for the true interests of his 
 profession, he will, in such case, I am confident, be for- 
 ward to acknowledge the accuracy of these observations, 
 already verified by me in numerous examinations after 
 death. 
 
 CASE. XIX. 
 
 Cure of Hereditary Consumption. 
 
 Mr. S , a gentleman of middle age, attached to 
 
 one of the government dock-yards, applied to me more 
 than twelve months ago, after having been under the 
 care of a physician in large practice in the west end of 
 the town. He presented all the usual symptoms of Con- 
 sumptive disease, and had a cavity in the summit of his 
 right lung, where was well-marked pectoriloquy. He 
 was considerably emaciated, expectorated abundantly 
 matter streaked with blood, was harassed by incessant 
 cough, and perspired profusely. His cough, which had 
 made its appearance simultaneously with the first symp- 
 toms of illness, had constantly remained unrelieved. 
 Having ascertained by auscultation that the entire of the 
 left lung, and the lower part of the right from the third 
 rib downwards, were perfectly healthy, I felt no doubt, 
 notwithstanding his reduced state and the time he had been 
 seriously ill, which was five or six months, that there were 
 firm grounds for hope- In conformity with my usual plan 
 I advised the application of leeches in order to lessen the 
 hectic syinploms, and niitifjale tlje violence of the cough: 
 
180 APPENDIX. 
 
 they were applied at times beneath the clavicle, at others 
 between the right scapula and the spine. The medicines 
 ordered were chiefly diuretic and sedative. After the 
 leeches had been employed a few times and the hectic 
 symptoms reduced, I recommended him to begin inhaling, 
 which he accordingly commenced at the rate of eight or 
 ten minutes, three times a day, and extended the period 
 by a minute daily till he reached the term of half an hour. 
 After continuing at this increased rate for a short time, 
 he complained of a feeling of soreness in his chest,- possi- 
 bly created by it, and I advised him to lessen his term of 
 inhaling in the same manner as he had increased it, by 
 a minute each time, until he gradually dropped down to 
 the ten minutes with which he had originally begun. I 
 may observe that this course of alternate increase and 
 decrease is often advised by me, with the best results. 
 In about four months after consulting me, he had become 
 quite an altered man. During this time, his health had 
 occasionally fluctuated, the hectic and other unfavourable 
 symptoms recurring : being, however, always promptly 
 met, they produced only slight interruptions to the steady 
 course of his amendment. These alternations, indeed, 
 must generally be expected ; and the occasional returns 
 of hectic fever are sometimes owing, I conceive, to the 
 softening of tubercles which have reached, or are nearly 
 arrived at a state of maturity when the patient commen- 
 ces inhaling, and which, forcing their way into some of 
 the bronchial branches, produce an irritation with which 
 the constitution sympathizes. 
 
 It is now a year since I first prescribed for this patient. 
 
APPENDIX. 181 
 
 On last exploring his chest, I could not discover the 
 slightest sign indicative of the presence of the cavity I 
 have spoken of above : there was a slight indistinctness 
 of the respiratory murmur perceptible in the summit of 
 the right lung, but no remains vi^hatever of pectorilo- 
 quism. 
 
 The above is a case of Hereditary Consumption ; and 
 several of this patient's brothers and sisters have fallen 
 victims to the disease. He is now actually in the enjoy- 
 ment of better health than he remembers his ever pos- 
 sessing ; and is perfectly competent to the active dis- 
 charge of business. 
 
 I may conveniently place under the same head seve- 
 ral other cases of the cure of Hereditary Consumption ; 
 and I adduce them as so many proofs that the possibility 
 of the cure of Consumption in this, its worst form, does 
 not depend upon an isolated, or fortuitous instance, but 
 has been effected in various patients of both sexes and of 
 different ages. I do not propose entering into any par- 
 ticular detail of the progress of the complaint in the re- 
 spective cases, but shall cite them as facts that may easily 
 be ascertained by any of my readers. 
 
 A young gentleman, grandson of a late celebrated 
 financier and member of parliament, whose theory of 
 rent is well known to the political economist, was 
 brought to consult me about a year and a half since. 
 His family were in the greatest alarm respecting him, as 
 a sister of his had died not long before, who had pre- 
 sented symptoms precisely similar to those he was then 
 labouring under. Such was their alarm, and llieir ner- 
 
182 APPENDIX. 
 
 vous apprehension of having his fears excited;, that they 
 begged me, if possible, to examine his chest in an appa- 
 rently unconscious manner, as if going through a mere 
 matter of form, so as to avoid awakening suspicion in his 
 mind of his real state. This youth, who is now about 
 eighteen years of age, is quite well. 
 
 Miss G , whose father is a fashionable ladies' shoe- 
 maker, in Soho-square, had been deprived of her mother 
 by Consumptive disease, and had likewise lost a brother 
 and a sister by the same scourge, all three within the two 
 years previous to her consulting me. When she applied 
 to me, this young lady was in a most enfeebled state, and 
 could hardly walk a dozen yards. Passing over other 
 symptoms, it is sufficient to say that I ascertained the ex- 
 istence of a cavity in the summit of the right lung. Miss 
 G. is, at the time I now write, in the enjoyment of excel- 
 lent health. 
 
 Mr. M., a gentleman well known in one of our large 
 manufacturing districts, came to town to consult me, 
 about a year ago. His case had been pronounced despe- 
 rate by the most eminent medical man of the city in which 
 he resides ; and indeed, there was a cavity in his left lung 
 so extensive as almost to preclude hope. He was daily 
 visited by me, for about two months, and remained in 
 town until the constitutional symptoms were removed. 
 Returning to the country, he continued a regular course 
 of inhalation. Five months afterwards he revisited Lon- 
 don and I begged him to have the kindness to call on 
 Dr. Waller, Lecturer on Midwifery, who had then a deep 
 interest in whatever related to Consumptive disease, in 
 
APPENDIX. 183 
 
 order to let him hear the history and examine into the 
 state of the case. The cavity was not then entirely 
 healed up ; but its size had been reduced by one-half, 
 and Mr. M. was so far restored as to be able to attend to 
 the business of his factory. My last accounts from him 
 are of the most favourable nature. 
 
 This gentleman, I must state, has lost a mother and 
 sister through Consumption. 
 
 Some short time since Messrs. Maw, the celebrated 
 surgical instrument makers, put a domestic of theirs 
 under my care, who was labouring under far advanced 
 Phthisis. I received the subjoined letter from them the 
 other day, in which her present state of health is satis- 
 factorily alluded to. 
 
 "Sir, 
 
 "The bearer of this, W. B , a young man 
 
 in our employ, seems much in the same state as the 
 female servant of ours whom you kindly attended a few 
 months since, and who we have the pleasure to inform you 
 is now enjoying a good state of health. As he is not able 
 to pay for medical advice we enclose a fee, and shall feel 
 obliged by your kind attention to him. 
 
 "We remain, 
 " Your obedient Servants, 
 
 "J. & S. MAW. 
 
 "11, Aldersgate Street, 
 "May 26th, 1836. 
 
 "To Dr. Ramadge, 24, Ely Place." 
 
1S4 APPENDIX. 
 
 CASE XX. 
 
 Consumptive Disease Supervening on Dyspepsia. 
 
 Mr. C , a highly respectable tradesman, r-esident 
 
 at Brighton;, naturally of delicate constitution, fell into a 
 most distressing state of health through long protracted 
 dyspeptic disease. The consequences of this debilitated 
 condition manifested themselves in the expectoration of 
 muco-purulent matter, often streaked with blood; in 
 harassing cough ; in night-sweats ; in gradual and almost 
 complete prostration of bodily strength ; and in fine — 
 in confirmed Consumption. To so alarming a state was 
 he reduced that the prayers of the congregation had been 
 publicly requested in his behalf, in the church which he 
 attended. When he had himself conveyed to town to 
 consult me, he was, as may be supposed from the above 
 account, apparently a complete wreck. On exploring the 
 state of his chest, I ascertained the existence of a well- 
 marked cavity in the summit of the right lung ; in that 
 of the left the respiratory murmur was highly obscure. 
 It is unnecessary to detail the varying symptoms that pre- 
 sented themselves, and the treatment by which they 
 were met ; as this would be a mere recapitulation of 
 much that has gone before. During the time that he 
 remained in town under my care, he suffered several 
 temporary relapses from the softening down of the tuber- 
 culous deposits previously formed, and underwent all the 
 fluctuations common to the most trying symptoms of 
 Consumptive disease. These constitutional symptoms had, 
 of course, to be treated as they arose, at times by anti- 
 
APPENDIX. 186 
 
 phlogistics;, at others by sedatives, and occasionally by 
 tonics. At the proper juncture he commenced inhala- 
 tion ; and here I must again insist upon a point to which 
 I have several times adverted in the course of this work, 
 that although inhalation i& of vital consequence in the 
 cure of Phthisis, yet it is likewise essential that the con- 
 stantly changing constitutional symptoms be treated as 
 they occur by the proper remedial measures. Hence the 
 necessity for the watchful superintendence of the physi- 
 cian skilled in all the minutiae of Consumptive disease, to 
 counteract the ingression of every unfavorable symptom, 
 to take advantage of every circumstance calculated to 
 forward recovery, and to regulate the treatment, medi- 
 cal and dietetic, according to the emergency. 
 
 No case that ever came under my care has ' afforded 
 more satisfactory proof of the remedial powers of inhala- 
 tion, combined with proper constitutional treatment, than 
 the present. The patient was naturally delicate, had 
 had his health so impaired by indigestion as to pass into a 
 Phthisical state, which, becoming confirmed, had brought 
 him to the brink of the grave, and — he is now well. Con- 
 scientiously can I affirm, and I do it from no impulse of 
 vanity (for there is too much yet to be learned for any 
 right-thinking physician to feel vain) that death must 
 have been the result under any other system than mine. 
 
 CASE XXI. 
 
 Inefficacv of Removal to a Warm Climate. 
 Mr. A., a Deputy Alderman of one of the city wards, 
 
 B B 
 
186 
 
 APPENDIX. 
 
 was recommended to consult me^ in the spring of 1835, 
 by Alderman Harmer. He had but lately returned 
 from Italy, whither he had been recommended to repair 
 for the benefit of his health by his former medical adviser, 
 who was an assistant physician to one of our London 
 hospitals. This advice had been given after the ascer- 
 taining the existence of a cavity in the summit of the 
 right lung, and the presence of a very slight catarrh. It 
 was well meant, but was attended by the usual nugatory 
 or worse than nugatory results, since during a residence 
 of some months his complaint got worse rather than 
 better. Singularly enough he first heard my name men- 
 tioned abroad, and the recommendation he there received 
 to apply to me, was supported, as I have just stated, on 
 his return to England by Alderman Harmer. On explor- 
 ing his chest, I found the cavity above mentioned still ex- 
 isting, and that the summit of his left lung likewise was 
 in an unsatisfactory state. His catarrh had yielded to 
 the influence of a warm climate, and the interposition of 
 Nature in his behalf had thus been entirely superseded. 
 His deterioration had of course been sensible to himself, 
 but he was not a little surprised to be told that the only 
 safeguard, artificial means excepted, which he could pos- 
 sess against the inroads of Consumption, was the catarrh 
 on whose removal he had congratulated himself. It re- 
 curred not long after his return ; but since, as I have al- 
 ready had occasion to observe, the expansion of the pul- 
 monary tissue necessary to heal up a cavity is much more 
 agreeably and equally effected by inhalation, I of course 
 would not trust to the dilatory results of a catarrhal cure. 
 
APPENDIX. 187 
 
 and ordered immediate recourse to the above mechani- 
 cal process. The constitutional symptoms have present- 
 ed the usual variations in the course of this gentleman's 
 attendance, and some time back, finding himself much 
 better, he was tempted to comply with a call upon him 
 for a song at some civic festival, and a hemorrhage was 
 the result. About three months ago he had an attack of 
 what now goes under the appellation of influenza, and I 
 seized the opportunity of once more examining his chest. 
 The cavity had nearly disappeared, and the state of the 
 rest of the thorax was in the highest degree satisfactory. 
 This favourable result was for the most part owing to his 
 steady perseverance in inhalation ; since, with this ex- 
 ception, he has been a very careless patient, negligent of 
 himself, and seldom letting me see him : a circumstance 
 originating, perhaps, in his acquaintance with a clergy- 
 man who cured himself by the use of this means alone. 
 However, this is an unsafe example, since constitutional 
 symptoms will often arise to call for the immediate, 
 thcv^h temporary, suspension of inhalation. 
 
 I may here o'^:?"^^. that notwithstanding the super- 
 vention of catarrh on Phthisis is the mode by which 
 Nature endeavours, and often does effect a cure, still it 
 is so far imperfect in its operation, inasmuch as it substi- 
 tutes for the Consumptive state a difficulty of breathing 
 which often terminates in confirmed asthma. Hence the 
 superiority of inhalation, which both acts more efficiently 
 and entails no troublesome consequence. Hence too, 
 although catarrh have set in so as to afford the benefit 
 of its protection to a Consumptive patient, I at once 
 
188 APPENDIX. 
 
 order recurrence to inhalation, not only for the beneficial 
 agency it exerts in Phthisis itself, but as a means of 
 curing the catarrh. Its influence over the last is partly 
 owing to the completeness it gives to the expirations. In 
 catarrh the air is imprisoned, as it were, in the air-cells, 
 and embarassed breathing is the result. Inhalation here 
 steps in as an auxiliary, and not only renders the expira- 
 tions more perfect, but contributes in other respects to 
 the removal of the catarrh. 
 
 Another benefit of mhalation, and this is a physical 
 fact no less novel than important, is the security it affords 
 against the ingression of pleurisies, so frequent, accord- 
 ing to the testimony of Laennec, in the Consumptive. 
 The same exemption from pjeurisy is observable in the 
 asthmatic. 
 
 Again if from any cause there exist empyema, or a 
 collection of matter, in one side of the chest, (even for 
 months), a state in which the lung of this side is compres- 
 sed, the lung of the other side undergoes increased ex- 
 pansion. Now the lung thus expanded, if previously 
 healthy, never becomes the seat of tuberculous deposit. 
 I have verified this in several instances ; and this is a 
 strong collateral proof of the inestimable value of inha- 
 lation. 
 
 To return to the "Inefficacy of Removal to a Warm 
 Climate." I have never known a cavity healed by a 
 residence in a southern clime, though I have known 
 many a Consumptive case fatally confirmed by it. Three 
 times did an officer in the army to my knowledge try a 
 residence in Madeira : the voyages certainly did him tern- 
 
APPENDIX. 189 
 
 porary good, but he ultimately returned with the deadly 
 eiiemy in his bosom— the cavity — as distinctly marked as 
 ever. 
 
 To the above cases, which bear a slight proportion 
 indeed to the number I have at this moment lying on the 
 table before me, detailed as well by the thankful patients 
 themselves as minuted by me, I append two letters from 
 medical gentlemen illustrative of the happy results of 
 pulmonary expansion. The first of these stands in need 
 of no other explanation than my observing that the 
 writer has omitted, that, on exploration of the chest, the 
 physical signs of Consumption were distinctly marked. 
 Mr. Graves, the brother-in-law of my patient, who en- 
 joys an extensive practice in the east end of the town, 
 and has been long accustomed to auscultative examina- 
 tion, fully concurred with me in the opinion I expressed 
 of the existence of cavities, and entered into my views as 
 to the plan of treatment I had laid down. 
 
 ''Dear Sir, 
 
 "In compliance with your request, I beg to 
 give you the following statement relative to my health : 
 
 '' In the winter of 1832 I was troubled with a cough, 
 after which my health continued indiiferent, and in the 
 month of May last I had a violent attack of pain in my 
 chest, for which a blister was applied and medicine 
 taken, apparently with great effect ; but in about eight 
 days the pain returned with increased severity. After 
 being twice bled copiously from the arm, and the local 
 application of leeches and a blistf-r, the pain was allayed 
 
190 APPENDIX. 
 
 SO as to allow of free respiration. I Avas now^ of course, 
 extremely weak. In about four weeks the pain again 
 returned in my chest. Leeches and blisters were re- 
 peatedly applied, without effecting its removal, and al- 
 though the general state of my health was of course 
 attended to, my strength of body soon so much decreased 
 that it was thought I should not recover. Under these 
 circumstances, I applied to yourself in July, and am 
 happy to say that under your skilful treatment I soon 
 began to amend, and that for the last two or three months 
 I have entirely left off taking medicine, being now stout- 
 er and stronger than before the commencement of my 
 illness in 1832. I have been for some time without any 
 cough. 
 
 "Hoping these particulars may be useful to you, be- 
 lieve me to be, " Dear Sir, 
 
 " Your much obliged, humble servant, 
 
 "CHARLES ROSE. 
 
 24, Beaumont-square, Feb. 5, 1834, 
 "To Dr. Ramadge, Ely-place, Holborn." 
 
 It affords me much pleasure to state that this gentle- 
 man is in the enjoyment of excellent health. 
 
 The following is from a gentleman of the name of 
 Langley, a general practitioner, and, as will be seen, a 
 former patient of mine. 
 
 " Dear Sir, 
 
 "The bearer appears to me to have in- 
 cipient Phthisis, and has been suffering from an indom- 
 
APPENDIX. 191 
 
 itable cough, with dyspnoea and nocturnal perspirations. 
 I have taken blood from him, used counter-irritants very 
 freely, and attempted to abate the pulmonary irritation 
 by sedatives, combined with ipecacuanha and nitre. His 
 ill state of health has reduced him so much in circum- 
 stances that he approaches you as a gratuitous patient. 
 Any suggestion you may be kind enough to advise shall 
 be strictly attended to. Under your direction I have 
 myself recovered my health, and with many thanks for 
 your kindness,— I remain, 
 
 " Dear Sir, 
 " Very faithfully yours, 
 
 " JOHN LANGLEY. 
 "36, Tottenham Street, Fitzroy Square. 
 "To Dr. Ramadge, Ely Place." 
 
 It has so happened, that within the last three years 
 I have had several cases of Consumption, in medical 
 men, under my care, and in nearly every instance the 
 result has proved satisfactory. 
 
 I subjoin to the above testimonies to the value of inha- 
 lation the following letter from a professional friend of 
 mine, whose abilities need no encomium from me, and who 
 is very generally known among his brethren, from the 
 circumstance of his having been Secretary to the Medical 
 Society of St. Bartholomew's Hospital some years since. 
 The gratification I experienced in receiving so powerful 
 a corroboration of my opinions from so excellent a judge, 
 was enhanced by its having been entirely unexpected. 
 Several years had elapsed since through business, and the 
 
192 APPENDIX- 
 
 every-day cares of life, our correspondence had ceased. 
 To have it renewed was in itself a pleasure ; which was 
 doubled by the manner of the renev/al. I shall not apo- 
 logize for inserting remarks so favourable to myself. 
 The writer is too independent to have written any other 
 than his conscientious opinion ; and I have not the false 
 pride which would conceal praise when praise is honour- 
 able. His residence on a part of the coast to which 
 Consumptive patients are frequently sent, has given Mr. 
 Bowden peculiar opportunities of studying the nature of 
 Phthisis. I feel that he is well qualified to pronounce a 
 judgment on any mode of treating the disease which may 
 be propounded:, and am grateful for the manly liberality 
 with which he has come forward. There are many 
 reasons for the opposition to my views which, I know, 
 exists among many of my medical brethren : disinclina- 
 tion to unlearn is, perhaps, among the chief. Were it 
 the only one, I should not step out of the way to notice 
 it. • I should be well contented to undergo what Harvey, 
 Sydenham, and Jenner have undergone before me. The 
 thought of the future would indemnify me for any tem- 
 porary annoyance, and I should anchor my hopes upon 
 the indisputable axiom, " Magna est Veritas et prcBva- 
 lehit : " — but unworthier motives have been at work. 
 I was one of the firsts if not the first, to point out the de- 
 ficiencies of the medical education of the day ; and had 
 my suggestions been attended to, many M. D.'s might 
 have been spared the pain of their confessions before the 
 Medical Committee lately sitting at Westminster. 
 
APPENDIX. 193 
 
 '' Dawlish;, Devon., 
 
 '^ My DEAR Doctor, '^ June 20th, 1834. 
 
 •^I have just purchased, and read your book on 
 Consumption with much gratification. I perfectly coin- 
 cide with your views, in every particular, and am satisfi- 
 ed of their accuracy. It is, perhaps, paying myself a 
 compliment at the expence of my professional brethren 
 to say, that I have, ever since I had the pleasure of 
 knowing your sentiments, differed from them as much as 
 you do. With regard to their treatment of that plague- 
 spot in the English constitution — Consumption — it has 
 ever appeared to me founded on false principles, or dic- 
 tated by the hereditary prejudices of our profession : of 
 you they are particularly jealous, and would gladly rob 
 you of your dearly-earned knowledge and fame. I call 
 it dearly-earned, for I remember the many unpleasant 
 situations we have been placed in, amongst the haunts of 
 London disease and misery, particularly in the purlieus 
 of Saffron-hill. I must say honestiy, and without flat- 
 tery, that I never knew one of your profession who la- 
 boured so zealously, and constantly, as you did in post- 
 mortem examinations ; or who was so thoroughly con- 
 versant with morbid appearances, and their anatomical 
 detail and minutiae. I have myself experienced the ac- 
 curacy of your observations, in the persons of several of 
 my own patients ; and so nearly have our ideas coincided 
 that I have been in the habit of making my patients 
 inhale, through an QEsophagus tube, to oblige them to 
 inspire deeply. I am quite certain I have cured two 
 
 c c 
 
194 APPENDIX. 
 
 cases of Tubercular Phthisis by your me^ns. 
 
 j» * * * ♦ 
 
 "Believe me to be, 
 
 " Dear Doctor, 
 Very sincerely and truly yours, 
 «R. B. BOWDEN. 
 
 To Dr. Ramadge." 
 
 It is about twelve months ago that Mr. Ward, a 
 gentleman practising in the vicinity of London, took my 
 advice for Consumptive disease, at the suggestion of Dr. 
 James Blundell. I detected a well-marked excavation in 
 the summit of the right lung, and was informed by him 
 that he had had several attacks of hemoptysis. Without 
 entering into any details, which indeed would present 
 no novelty either respecting symptoms, or my usual 
 practice, I at once give the satisfactory result which is — 
 restoration to health. I shall conclude these instances of 
 cure among my medical brethren by adducing the name 
 of Mr. Paine, son of the ingenious inventor of the illu- 
 minated dials now becoming common in our churches, 
 who consulted me about three years since, and has been 
 enabled to resume his profession which he had then 
 abandoned as beyond his failing strength. 
 
APPENDIX. 105 
 
 EXPLANATION OF THE PLATES. 
 
 PLATE I. 
 
 Fig. I. displays a section of the upper lobe of the 
 lung, taken from a person who had recovered from Con- 
 sumptive disease many years preceding death, but had 
 died asthmatic. Like most lungs of the kind, it exhibits 
 on the summit adhesion of the two pleural surfaces ; and 
 an emphysematous state is indicated by large, transpa- 
 rent vesicles, full of air, formed by the rupture of several 
 air-cells into one. The semi-cartilaginous external 
 wrinkling, or pursing, is the mark of internal cicatrix. 
 The size to which this lung had attained is not shown by 
 the drawing, frequent handling having compressed it. 
 
 a. A portion of the pleura costalis. 
 
 b. The point of adhesion between the pleura pulmon- 
 alis and the pleura costalis. 
 
 c. c. Large air-vesicles, the products of imprisoned 
 air, chiefly arising from bronchial affection. 
 
 d. External wrinkling, the result of internal cicatrix. 
 
 e. Black pulmonary matter, in unusual quantity, seen 
 through the serous surface of the lung. 
 
196 APPENDIX. 
 
 Fig. 2. represents an old excavation with semi-carti- 
 laginous lining, and the marks of cicatrization both fibro- 
 cartilaginous and cellular ; also ancient crude tubercles 
 surrounded by black pulmonary matter. The individual 
 from whom this superior portion of the lung was taken, 
 had had Consumptive disease arrested more than six years 
 previous to his death, which was occasioned by apoplexy. 
 
 a. Emphysematous vesicles. 
 
 b. Chronic pleurisy, with jelly-like effusion beneath it. 
 c- A line passing through semi-cartilaginous, as well 
 
 as cellular, cicatrizations. 
 
 d. Tubercles, of long date, in a state of crudity, and 
 in the midst of widely diffused black pulmonary matter. 
 There are two smaller tubercles above the horizontal 
 cicatrization. 
 
 e. The lining membrane of an ancient cavity. 
 
 /. The semi-cartilaginous lining of the same cavity. 
 
 g. Passing over an external wri nkling, and terminating 
 in the opening of a bronchial tube . 
 
 h. Shows the bottom of the section of the lung, and 
 the dissemination of black pulmonary matter. 
 
 PLATE II. 
 
 Fig. 1. Showing a section of the summit of the lung, 
 with the partially complete cicatrix of a tuberculous ex- 
 cavation. The preparation, from which the drawing is 
 taken, is part of the lung of a cured Consumptive person. 
 
 a. Large tuberculous nodule, environed by black 
 pulmonary matter. 
 
APPENDIX. 197 
 
 b. Indicates the point where adhesion is completed. 
 
 c. Opening of the trachea, the lung inclining forward. 
 
 d. Vesicles, generally seen in cured Consumptive 
 cases. 
 
 e. External depression, the sign of cicatrix. 
 
 f. Edge of the section, resting on black pulmonary 
 matter. 
 
 Fig. 2. Another summit, taken from a cured Consump- 
 tive individual. 
 
 a. Small excavation of long standing. 
 
 b. Crude tubercles. 
 
 c. Black appearance of the lungs from inordinate se- 
 cretion of black pulmonary matter. 
 
 d. Semi-cartilaginous corrugation of the exterior sur- 
 face. 
 
 e. Calcareous deposit, lying loose, having fallen out of 
 an imperfect cicatrix. Another may be seen above, in 
 the line of cicatrization. 
 
 PLATE III. 
 
 Fig. 1. A section of a lung, lengthwise, taken from a 
 young man who died eleven months after the operation 
 of paracentesis. His case is the second described in the 
 Appendix. 
 
 a. Represents well organized cellular tissue, with a 
 portion of the pleura fibro-cartilaginous. 
 
 b. Dense cellular tissue, of a white colour, in a few 
 places semi-cartilaginous, running in various directions, 
 •iiid formed l)y (he adhesion of several excavations. 
 
198 APPENDIX. 
 
 c. A broad cicatrized band. 
 
 G. {on the right side.) Cicatrization all but complete. 
 
 d. Apparent thickening of the pleura investing the 
 lung. 
 
 e. A bronchial tube^, opening into an incomplete 
 iibro-cartilaginous cicatrix. 
 
 Fig. 2. Apparatus for inhaling, to be two-thirds filled 
 with warm water. 
 
 a. Air-vent. 
 
 b. Flexible tube, inserted into the cover of the inhaler. 
 
 c. Flexible tube, of narrow diameter, furnished Avith 
 ivory mouth- piece. 
 
 PLATE IV. 
 
 Fig. 1. Figure of a young Consumptive patient, who 
 underwent paracentesis, which operation was followed by 
 considerable reduction and impermeability of the right 
 lung. Instead of contraction of this side taking place, 
 through the emphysematous enlargement of the opposite 
 lung, and the unnatural intrusion of the heart into its 
 cavity, the anterior part of the chest assumed that pecu- 
 liar deformity which is denominated pigeon-breasted. 
 Contrary to the opinion of Laennec, even in cases of em- 
 pyema, in which, after long compression of the lung, reco- 
 very has taken place, I have more than once seen, in- 
 stead of lateral contraction which he concludes to be 
 the common result, the appearances pourtrayed in the 
 annexed drawing. 
 
 a. Unnatural elevation and squareness of the shoulders. 
 
APPENDIX. 199 
 
 b. Pigeon-like deforrtiity of the chest. 
 
 Figs. 2. and 3. represent two lungs taken from an in- 
 dividualj who underwent spontaneous recovery from 
 Consumption, and whose chest was deformed in the 
 manner shown in the figure above. Fig. 2. represents the 
 right lung highly emphysematous. An induration in its 
 apex is omitted in the drawing. Fig. 3. shows the left 
 lung, one-third less than the right, and semi-solid. On 
 making a longitudinal section, this lung displayed ap- 
 pearances nearly similar to those seen in Plate 111. I am 
 strongly inclined to believe, that interlobular emphysema 
 took place in this instance from violent coughing; and 
 that air, extravasated into the surrounding cellular sub- 
 stance, forced the several cavities into apposition. 
 
 PLATE V. 
 
 RepPvEsenting chronic ulceration of the larynx, in 
 which the vocal chords and ventricles are entirely des- 
 troyed, as well as a considerable portion of the anterior of 
 the thyroid cartilage. 
 
 a. The epiglottis suspended by a hook ; the mucous 
 surface exhibiting high vascularity; the edges much 
 thickened. 
 
 h. h. The cornua of the thyroid cartilage. 
 
 c c The aretynoid cartilages. 
 
 d. Lateral boundary of the large ulcer. 
 
 e. Denuded edge of the ulcerated thyroid cartilage. 
 /. Cricoid cartilage bisected. 
 
 g. (j Ulceration of tlip niucoiis follif-lcs of the trachea. 
 
200 APPENDIX. 
 
 I have given this plate, which was drawn on stone from 
 one out of more than sixty preparations of the larynx 
 contained in my museum, as exhibiting a highly interest- 
 ing specimen of the state of the larynx in laryngeal Con- 
 sumption. It is very seldom that the disease advances to 
 such a height as is represented in the plate. The pre- 
 sent specimen was obtained at the 'post-mortem exami- 
 nation of a gentleman, who had laboured for two years 
 under loss of voice, and had been an occasional patient 
 of mine for about six weeks before dissolution. It was 
 at the suggestion of Dr. Ridgway, who was on the eve of 
 leaving the country as physician to the embassy to Brazil 
 — at the head of which was Sir Charles Stuart, the pre- 
 sent Lord Stuart de Rothsay — that he put himself under 
 my care. Previously to this. Dr. Ridgway had favoured 
 me with a visit at the Infirmary, where he witnessed a 
 large number of similar cases ; indeed so large as to oc- 
 casion him to express surprise. 
 
 The talented and indefatigable M. Cruveilhier, whose 
 labours reflect so much honour on his country, asks, 
 ^^ Whether there may not be a primitive laryngeal phthisis, 
 independent of every pulmonary lesion ? " and appears to 
 conclude from several clinical facts, that there does. 
 My own experience leads me to doubt this ; or at least, 
 to explain the pathology of the disease on grounds over- 
 looked by this skilful anatomist In every body I have 
 examined of the male sex, — and I have examined a very 
 large proportion, — I have uniformly found the lungs tu- 
 berculated. M. Cruveilhier is undoubtedly in the right, 
 so far as appearances have formed his guide. In many 
 
APPENDIX. 201 
 
 instances;, even in the male sex, the disease— judging by 
 external signs — appears to be primary ; still, during ex- 
 perience in auscultation for fifteen years, I have found on 
 exploration of the chest, that disease in the summit of one 
 or both lungs has constantly co-existed. Exceptions to 
 this must be rare indeed. But in females, — a difference 
 unsuspected by M. Cruveilhier, — the disease, I acknow- 
 ledge, at times simulates a primitive form . The fact would 
 seem to be that there is a species of laryngeal affection, 
 of the nervous kind, occasionally met with in the hysteric, 
 which is often confounded with true laryngeal phthisis. 
 This pseudo-species is undoubtedly unfavorable to tuber- 
 cular development ; as, in this case, the larynx and tra- 
 chea are spasmodically affected, so as to oppose perfect 
 freedom of expiration. 
 
 Alarming as this disease appears, especially in the male, 
 it usually makes but slow progress in abridging life, when 
 compared with Consumption unaccompanied by the 
 laryngeal affection. This is referrible to the impediments 
 presented to free expiration in three ways. Firstly, by 
 a certain degree of sub-acute inflammation of the trachea; 
 secondly, by lateral encroachment a little above the 
 centre of the larynx, caused by a thickening of the vocal 
 chords ; and lastly, in a very advanced stage of the dis- 
 ease, by an cedematous state of the sub-mucous cellular 
 tissue lining the rima glottidis. The disease is first indi- 
 cated by a failure in the voice, which sinks to a whisper 
 and cannot be extended ; this results from inflammation 
 and want of suppleness in the vocal chords, and from a 
 closure of the ventricles of the larynx, produced byswell- 
 
 D D 
 
202 
 
 APPENDIX. 
 
 ing and ulceration of the mucous membrane lining them. 
 There is frequent cough, which seems to participate in 
 the suppression of the voice, being stifled, and singularly 
 husky. A feeling of constriction in the throat is often 
 complained of, as well as distressing dryness of the fauces, 
 frequently attended in the act of deglutition with pains 
 lancinating in the direction of the ears. Little pain is 
 felt from external pressure on the seat of the disease. 
 No complaint is more irritating and distressing than this, 
 in its advanced stage, when difficulty in swallowing is ex- 
 perienced, and the food is convulsively rejected through 
 the nose, underthe sense of impending suffocation. So an- 
 noying is this disorder, and so fraught with constant dis- 
 turbance to the sufferer, that he appears to live in a state 
 of constant excitement. The best temper and most 
 equally balanced mind, fail in resisting the continued 
 harass, and gradually yield to its influence. The patient, 
 finding no relief, flies from one medical man to another, 
 and this perturbed, unsettled condition, lasts until he 
 finally sinks beneath the struggle. 
 
 It may be asked, what this disease has to do with the 
 subject of the present work. I have already noticed the 
 circumstance of a Consumptive patient's living long, al- 
 though labouring underthe distressing symptoms usually 
 connected with aphonia, or loss of voice. Plates 5 and 6, 
 with their accompanying descriptions, have been given to 
 extend my proofs of the curability of Consumption. If a 
 patient's life be prolonged by the opposition to the free 
 egress of the air, presented by the three-fold condition 
 of the larynx and trachea above described, and conse- 
 
APPENDIxi 203 
 
 quent enlargement of the volume of the lungs, even 
 when the constitution is impaired by the exhaustion of 
 such adisease as the laryngeal affection, and when ulcer- 
 ation to such extent exists — how infinitely great is the 
 chance, or rather, how certain becomes the proof, that 
 Consumption, if timely taken, is curable ! "I pause for 
 a reply." 
 
 PLATE VI. 
 
 a. The upper border of the epiglottis, which part was 
 throughout considerably thickened, highly vascular, and 
 extensively ulcerated in the inferior or laryngeal surface. 
 
 b. h. Each pointing to the ulceration of the mucous 
 surface. The one on the right passing over the corni- 
 culum of the thyroid cartilage on that side, points to a 
 concavity in the line of the two lamellae. 
 
 PLATE VIL 
 
 Figs. 1 and 2, represent the exterior and interior of 
 the summit of a lung, taken from an individual who had 
 been consumptive thirty years previously to death, but 
 was saved by the ingression of chronic catarrh. He 
 died at an advanced age, having outlived many of his 
 family, who had fallen the prey of Consumption. Both 
 lungs were very voluminous. The other lung was 
 affected very similarly to the one of which a drawing is 
 given. 
 
 Fig. 1. Posterior view of the upper lobe of the right 
 
204 APPENDIX. 
 
 a. Well-marked depression^ with cartilaginous wrink- 
 lings radiating from a common centre — the sign of inter- 
 nal cicatrix. 
 
 b. Air-cells^ greatly enlarged^ and transparent. 
 
 c. Costal pleura^ vascular, and thickened. 
 
 d. Air-cells throughout slightly dilated. 
 
 Fig. 2. Section of the above summit. 
 
 a. Passing over the external puckering, points to the 
 semi-cartilaginous cicatrix, with bands of condensed cel- 
 lular and tibro-cartilaginous substance. 
 
 b. Aneient tubercles, surrounded by black pulmonary 
 matter. 
 
 c. Isolated tubercles, surrounded by black secretion* 
 
 d. Points to pulmonary tissue, stained by black secre - 
 tion in parts, I have reason to believe, formerly occupied 
 by tubercles, which underwent absorption. 
 
appendix. 205 
 
 Cases given by Dr. Hohnbaum in the Preface 
 TO HIS Translation of ''Consumption Curable."' 
 
 Case 1. A female^ 36 years of age, of weak and 
 sickly constitution, skin white and of delicate texture, 
 neck long and slender, chest confined, complexion very 
 pale, habitual stoop, had suffered in childhood from scro-^ 
 fula, the glands of the neck having frequently suppurated. 
 Her father is living, but has laboured from a boy under 
 disease of the chest, and has often appeared to be sink- 
 ing into a decline. Some years after her marriage, she 
 lost all the outward signs of scrofula, but became subject 
 to an occasional dry cough^ which would disappear after 
 a time. In 1833, anxiety, occasioned by the illness of 
 her only child, brought on a return of this cough, which, 
 however, did notleaveher as usual, but seemed to increase 
 constantly, and awakened much apprehension. The 
 patient was greatly dejected at this, despaired of reco- 
 very, lost sleep and appetite, fell away in flesh, and com- 
 plained of such extreme weakness as to be hardly able 
 to leave her bed. The coughing continued to increase, 
 and was particularly harassing in the evening, during 
 the night, and on awaking. At first, there was no ex- 
 pectoration; but afterwards, she brought up a little 
 phlegm the first thing in the moraing. The cough was 
 accompanied by pain in the chest, and occasional twitches; 
 her breathing was short, especially when going up stairs, 
 and was considerably affected by every bodily exertion. 
 
206 APPENDIX. 
 
 however slight. The pulse gave no indications of actual 
 fever; but the patient complained of frequent shiverihgs, 
 with burning hands, and morning perspirations. Her 
 whole appearance answered to the commencement of 
 Phthisis Scrofulosa. 
 
 Having continued in this precarious condition for a 
 year, reckoning from the first manifestation of the cough ; 
 having been under the care of two physicians, without 
 deriving any benefit; and having tried a variety of me- 
 dicines to no purpose, I recommended the system of in- 
 haling, advocated by Dr. Ramadge. Following exactly 
 the rules laid down in his work, I ordered her to inhale 
 the vapour from an infusion of hops in vinegar twice a 
 day, for a quarter of an hour each time. This period 
 was subsequently extended to half an hour. 
 
 The patient had scarcely tried this method for a week, 
 to the exclusion of all others, when her sleep became 
 sounder, and her cough seemed less frequent. In the 
 course of another week, it was perceptibly less so ; and 
 the expectoration had diminished. Her respiration gra- 
 dually became more free and deep, she gained flesh and 
 strength, the perspirations left her, her appetite return- 
 ed, she recovered her serenity of mind, and, in short, 
 rapidly approached a state of convalescence. 
 
 At the present time, she has used inhalation con- 
 stantly for three months ; the expectoration has entirely 
 ceased; the cough too has almost left her, being so slight 
 as to be scarcely deserving of notice. The patient has 
 returned to her household duties, and, in favourable 
 weather, walks daily in the open air ; in fact, with the 
 
APPENDIX. 207 
 
 exception of a little weakness and irritability, which, 
 however, were always peculiar to her, she is in perfect 
 health. Still, for security's sake, I have advised her to 
 continue inhaling. 
 
 Case II. A female, 21 years of age, healthy from 
 childhood, but of consumptive make, that is — neck long, 
 chest narrow and compressed, skin white and delicate, 
 with rosy transparent cheeks, and light brown hair, eye- 
 brows, and eye-lashes, contracted, about fifteen months 
 since, a dry, obstinate cough; in all probability, whilst 
 heated by excessive dancing. It was accompanied by a 
 pain in the chest ; but was entirely disregarded by her, 
 until she began to expectorate, at times, about half a cup- 
 full of bright red, frothy blood. This sanguineous ex- 
 pectoration was removed by appropriate medicine ; and, 
 in the course of the following summer the cough, like- 
 wise, was partially subdued. 
 
 I was called in to see her, in the autumn of this year, 
 aggravation of the above symptoms having taken place, 
 and found her in the following condition : her rosy com- 
 plexion gone ; pallid, much emaciated, strength greatly im- 
 paired ; chest contracted and sinking in, respiration quick . 
 and short, a rattle during each inspiration, particularly 
 marked in the right lung where a cavernous sound was 
 yielded on percussion ; a sense of pain in the same spot 
 with occasional twitchings over the chest; frequent cough, 
 partly dry, and in part accompanied by a yellowish 
 green expectoration, which, in the course of the four and 
 twenty hours might have filled a good sized cup. Her 
 
208 APPENDIX. 
 
 appetite was small^ sleep short and interrupted by fre- 
 quent cough, pulse quick; towards morning she fell into 
 profuse perspirations, had fits of shivering at noon, and 
 towards evening there came on a dry, burning heat, with 
 hot hands, flushing of one cheek in particular, and ex- 
 treme thirst; there was oedema of both feet, andmenstru- 
 ation had ceased for three months. 
 
 Under these circumstances, I ordered eight leeches to 
 be applied to the right side of the chest : but no relief 
 being afforded to the painful sensations there, I had six 
 ounces of blood taken from the right arm a few days 
 after. At the same time, the patient commenced inhaling, 
 taking no medicine, but observing a suitable regimen. 
 The progress of the patient soon convinced me of the 
 good effect of this method ; and she' herself was much 
 cheered by her sleep being sounder and less broken by 
 coughing. This amendment continued uninterruptedly, 
 so that in the space of six weeks the cough and expect- 
 oration had decreased to such an extent, that the latter 
 amounted in the four and twenty hours to no more than 
 about half a table-spoonful. At the same time, the pain 
 in the chest had disappeared, the rattle spoken ^f above 
 was no longer audible, the perspirations, shiverings, and 
 swelling of the feet had left her, her appetite had re- 
 turned ; and what with the refreshing nature of her sleep, 
 the increase of her strength, and the amendment in her 
 respiration, the patient was so much recovered as to be 
 able to take half an hour's walk every day in the open air. 
 Still the sensation of heat towards evening, the flushing 
 of the one cheek, the frequent pulse, and the fact of the 
 
APPENDIX. 209 
 
 patient's not increasing visibly in bulk, overcast the 
 prospect of perfect recovery. 
 
 After these favorable symptoms had lasted ' about a 
 week, the patient was persuaded to take a ride with a 
 friend when it blew a cold east wind. The consequence 
 was that in the evening of this day she was sensible of 
 cold in the head, hoarseness, pain in the throat, and in- 
 creased cough. Relying on the happy results which Dr. 
 Ramadge has observed to attend the supervention of ca- 
 tarrh, I ordered the inhalation to be discontinued and 
 patiently awaited the issue. But I was soon conscious 
 of the disappointment of my hopes ; for notwithstanding 
 the patient got rid in a few days of the cold in the head, 
 the hoarseness, and the pain in the throat, yet the earlier 
 symptom of pain in the chest returned with more than 
 its former violence. She now also felt a pain in the left 
 side, in the neighbourhood of the fourth rib ; her respi- 
 ration grew shorter, her cough became worse, the ex- 
 pectoration increased to its first amount, the nightly 
 perspirations returned, the feet swelled, and altogether 
 her state of health was worse than it had been] when I 
 first saw her. 
 
 I now recurred to the inhalation ; and again the re- 
 sults were so favorable that the cough and expectoration 
 decreased, but not to the degree that had taken place 
 previously to the relapse. 
 
 The unfavorable symptoms before described again 
 made their appearance, and the patient^ soon afterwards 
 died in a violent fit of suffocation. 
 
 Although it is doubtful whether inhalation would have 
 
 EE 
 
210 APPENDIX 
 
 effected a cure in this case, in which Pulmonary Con- 
 sumption had already made such considerable progress, 
 I can scarcely doubt that it would have proved success- 
 ful had it been adopted at an earlier stage. The patient 
 was loud in her praise of its beneficial effects, and I have 
 no reason to dissent from her as I am firmly persuaded 
 that I should not have effected more, but most probably 
 much less, with other remedies. 
 
 It was discovered by dissection that the immediate 
 cause of death was rather effusion within the cavity of 
 the chest, than extensive suppuration. 
 
 There is one point in the above case which requires 
 notice. Dr. Hohnbaum was correct in his general prin- 
 ciple when he concluded that the ingression of catarrh 
 on Phthisis was a favorable symptom, but wrong in its 
 application to this particular instance. The disease was 
 so far advanced that he should not have intermitted the 
 inhalation, and trusted, as he did, to the beneficial influ- 
 ence of the catarrh solely. Indeed, as I have already 
 observed, the process of inhalation will not only effect 
 thoroughly what nature, by means of catarrh, too often 
 brings about imperfectly, but will obviate the emphyse- 
 matous state which is entailed by the catarrh. 
 
 The following letter has this moment reached me. It 
 is in every way too gratifying for me to hesitate to pub- 
 lish it. By so doing I shall best fulfil the writer's intent- 
 ion, and shall be enabled to prove to the most sceptical 
 the positive powers of inhalation. The hypercritical may 
 
APPENDIX. 211 
 
 refuse to admit assertions as to the changes which pass 
 inside the chest, but can hardly withold credence from 
 those proved by measurement to take place outside. 
 
 Ten BY, 26th Oct., 1835. 
 
 Dear Sir, 
 
 I trust you will be pleased to hear of the suc- 
 cess of a course of six months' inhalation in my case. 
 
 In order to bring to your recollection the cir- 
 •cumstances under which I waited upon you for advice, 
 I beg to refer you to your note-book, in which, if 1 re- 
 collect aright, you will find the 29th of last March speci- 
 fied as the date of my first visit. But as you may have 
 kept no memorandum, I may remind you that mine was 
 a case of sinking in of the sternum so as to press on the 
 right ventricle of the heart ; you likewise described the 
 arch as being under compression and the ribs fixed. 
 The attendant symptoms I need not detail. 
 
 I commenced inhaling on the 30th of March. You 
 directed me to inhale three times a day ; but being 
 under great suffering at nigbt when 1 assumed a recli- 
 ning posture, 1 thought it desirable to inhale four times 
 daily, which I followed up for the first four months. 
 Finding myself greatly relieved at the expiration of this 
 period, I have inhaled for the last two months only three 
 times a day. It was not until the 22nd of April that I could 
 manage to inhale continuously half an hour at a time ; 
 and on that day my girth was taken immediately under 
 the nipples of the breast by Mr. Shaw^ our medical at- 
 tendant. 
 
212 APPENDIX. 
 
 May 22, Increase the first month, f of an Inch. 
 June 22, „ second month, f „ 
 July 22, „ third month, J „ 
 
 Aug. 22, „ fourth month, f „ 
 
 Sept. 22, „ fifth month, ^ „ 
 
 Oct. 22, „ sixth month, f ,, 
 
 2i Inches. 
 
 In the first measurement my girth was 2 feet 10^ in. 
 
 October 22nd, it was 3 feet 1 inch. 
 
 In June, I took six inspirations and six expirations per 
 minute while inhaling. In August, I took only five inspi- 
 rations and five expirations during the same time. This 
 month, I have taken only five inspirations, and four ex- 
 pirations, or the reverse— shewing, I presume, the in- 
 creased volume of the lungs. 
 
 This increase is, I think, great at my time of life, as I 
 am forty-six years of age. The benefit I have derived 
 is necessarily very great. My ribs, judging from the 
 heaving of my breast when I breathe, have, I should 
 conclude, come into tolerable play. My lungs are 
 amazingly strengthened : I can now sing at the yery top 
 of my voice, but not long together. I sleep in general 
 well, but I am not able to lie on my left side. The sink- 
 ing of the sternum however remains exactly the same, 
 and occasionally my pulse intermits— generally when- 
 ever I stoop to do anything. Nevertheless I can walk 
 at a great rate without inconvenience, and do walk from 
 three to five miles every day. I have gained consider- 
 able flesh, and my appetite is always good. 
 
APPENDIX. 213 
 
 I do not hesitate to say that I think inhaling has done 
 me more good, than all the blue 'pills I ever took for 
 bilious attacks. 
 
 If this communication will tend to illustrate any point 
 of practice;, you are quite at liberty to use my name and 
 reference. 
 
 I am happy also to inform you that Mr Shaw has made 
 a cure of Consumption in this neighbourhood, by follow- 
 ing your system. I visited the individual when he was 
 thought to be in a dying state, and he is now about pur- 
 suing his usual avocations. 
 
 I remain, dear Sir, 
 
 Your obliged, 
 
 J. GREAVES. 
 
SOUTH, Printer, ^05, Shoreditcli. 
 
iM.A'r 
 
 Fyyji. 
 
 d- 
 
 cc 
 
 ft— 
 
 
 ' han O^l' 'J i/f/i'-i' liil'/'.-.i'H 
 
1 
 
d PLATE n 
 
 Ti^. J . 
 
I 
 

 PLATE m. 
 
 J^r'^. 7- 
 
 
 Fu/. 5 
 
i\ 
 
 FL^ 1. 
 
 1 / 
 
 ^V/. 
 
 / 
 
 F7rf. r3. / 
 
 <.' fii^rton, df/x cJ, IjiOvoff It hrJc^^Si. 
 
d,- 
 
 fjll.il/ill.itfll 1 1 OlJl,l,i /l,/,!/! 
 
PT.ATF. VI. 
 
 CO. 
 
 ■ fliiiliin. ilrJ' ,/ lilhi'if MPtiMtli . 
 
PLilTE VIL 
 
%%/p/' 
 
 y J 
 
Q 
 
 -r> 
 
 =5^ 
 
 
 C-J— -g- 
 
 cn-=i 
 
 CO-=n 
 
 (ji - 
 
 Q^^" 
 
 CO r 
 
 cn==o 
 

 
 J?" 
 
 w:';;:rv.',;',tf; 
 
 i|ri?}-i 
 
 
 
 '^^l^il'Scl?i:*^S?^^ 
 
 '■'''■i^'- ""'^"^■^'v^'^^;!*^*^*'^*'*^^