Mercury, given until it produce salivation has frequently cured Phthisis Pulmonalis. It is used with greatest advantage in its first stage, but after the inflammatory action has been in some measure reduced, by means of blood-letting, and the other remedies proposed. Before these evacuations have been premised, it would tend rather to increase the inflammation; while in the advanced stage it would add too much to the debility of the patient. It generally succeeds only when it affects the mouth, and therefore to secure this effect and prevent its running off by the bowels, it should be combined with opium. But the best form of exhibiting mercury, is one much in use with my worthy friend and preceptor, Dr. Borrowe. Calomel, combined with small doses of antimonial powder, given morning and evening, until it affect the mouth, is the form proposed. In this way it may be given at an earlier period of the disease, than would otherwise be proper, by the constant determination to the skin kept up by the antimonial powder, obviating the tendency which mercury has to increase inflammatory action. At the same time it serves to keep the bowels open, and makes almost every other medicine unnecessary. On the other hand, if it acts too much on the bowels, it may be usefully combined with opium, which adds to its diaphoretic effect. The good effects of this mode of exhibiting mercury, is strikingly illustrated by the result of the following case, which occurred in the practice of Dr. Borrowe within a few months past.
“Miss ———, aged about 14 years, had been for six months past, afflicted with some cough, pain in the chest and difficulty of breathing. She was affected with loss of appetite, emaciation and profuse sweats at night. Her pulses were frequent; she had the peculiar pearl-like appearance of the adnata; frequent attacks of diarrhœa, and an expectoration much resembling pus. She was attacked with chills about the middle of the day, followed by considerable excitement, aversion to motion and drowsiness; succeeded by great prostration of strength; palpitation and hurried breathing on ascending a height or engaging in any considerable bodily exertion; attended with a livid appearance of the lips, evidencing a difficulty in the passage of blood through the lungs.
It was determined to put her upon the use of Calomel and Pulv: Jacob: which were given in small doses every night and morning; a blistering plaister was also applied to the chest, and kept in an irritable state for a considerable length of time. The diet was ordered to be soft, mild and nutritious. The mercury and antimonial medicine were occasionally omitted when they acted more on the bowels than the skin, or occasional anodynes were administered to restrain their action on the alimentary canal.
Some weeks elapsed before the mercury produced any effect upon the salivary glands, which was one of the objects aimed at. As soon as the mouth became sensibly affected, the symptoms were generally mitigated. A temporary suspension of the use of the remedies became necessary, in consequence of the considerable effect produced by the mercury. When the soreness of the mouth abated, small and less frequent doses of the calomel were given so as to keep up a tenderness of the gums several weeks longer. The affection of the chest became now entirely relieved, and it was thought advisable to suspend the use of the mercurial treatment, the effects of which were suffered to pass off, rather than be relieved or cured.
From this time no medicines were employed, except a small quantity of a weak infusion of colombo as a tonic. Long before the patient’s mouth enabled her to eat, her appetite became craving. She was indulged in eating moderately of such food as she had a particular desire for; and she soon was enabled to take exercise without inconvenience. She did not now complain of any pain in the chest, the cough left her, the bowels became regular, there was no recurrence of night sweats, she began to gain flesh, the countenance assumed the healthy aspect, and the peevishness under which she had long laboured was effectually cured. She now slept well, and gradually returning to her former habits, is at the end of five months after discontinuing her remedies, in perfect health.”
Digitalis is a remedy in Phthisis, which has excited much acrimonious controversy among practitioners of medicine. As always happens in these contests, it has been praised too highly by one party, and condemned too severely by the other. When first introduced, it seemed to promise the complete eradication of Consumption: and it almost appeared that digitalis was as specific in the cure of that disease, as mercury, in syphilis. Dr. Magennis of the Royal Navy Hospital at Plymouth, England, published a paper, containing an account of seventy-two cases of incipient or confirmed Consumption, in seamen and marines, treated with digitalis. Of these, twenty-five with ulcerated lungs recovered; and fifteen from the stage previous to ulceration. Thirteen of the seventy-two in an early stage of ulceration were discharged, greatly relieved; and nine in the previous stage. In ten cases, the medicine failed; but in some of these it gave considerable relief. Beddoes assures us, that three cases out of five of tubercular consumption, in his practice, had recovered under the use of digitalis. Kinglake insists that one in three cases of the tubercular stage of Consumption, may be cured by this medicine. Dr. Currie informs us, that digitalis may be used with safety and success in cases where the lancet can no longer be employed. These results in the practice of men, distinguished in their profession, although they may be somewhat warped by prejudice, are extremely flattering, and prove at least that the medicine has some power. But like all other new remedies, digitalis has been rated too highly by those who first used it. Delighted that they had discovered a medicine, which, in some cases would cure a disease, which they had been accustomed to look upon as totally incurable, these physicians have suffered themselves to attend too exclusively to its successful results, and to neglect cases in which it has failed. Other practitioners, on reading their exaggerated statements, have tried the remedy, but finding themselves frequently disappointed, have gone into the other extreme and condemned it entirely. Their representations are to be admitted with as much qualification as those of their opponents, and the judicious physician will not suffer himself to be exclusively guided by either. That in certain cases, digitalis will cure Consumption, cannot be doubted; but we have also to regret, that it very frequently fails. It was prescribed in the New-York Hospital, under the direction of Dr. Hamersley, during the last winter, in six cases which I have witnessed, of evident and well marked Phthisis. Of these, two patients were perfectly cured; one has nearly recovered, and is only retained in the Hospital for a slight cough, which is yielding; a fourth was discharged at his own request, but evidently relieved; the fifth commenced the use of digitalis, at a very advanced period of the disease, and soon died; in the last it failed entirely, and appeared rather to have done injury.
Having ascertained that digitalis does sometimes succeed in curing Phthisis Pulmonalis, it remains to discover what are the cases in which we may exhibit it with success. For this purpose it would be desirable to ascertain the modus operandi of the medicine. Here writers have differed as widely as in their account of its success in practice. One author determines it to act by diminishing the force and frequency of the circulation, and reducing inflammatory action; a second attributes its salutary effect to its operation on the kidneys; while a third believes it no longer to be of advantage, when it increases the discharge by urine, excites nausea, vomiting, purging or any undue excitement, but attributes its beneficial effects to its stimulant efficiency, in invigorating the arterial and muscular energy of the system: and a fourth insists that by promoting the action of the absorbents it cures Consumption. These conflicting and opposite opinions constrain us to admit, that farther enquiry is necessary, before we can rest satisfied as to the mode in which digitalis acts. It must be confessed that this medicine is extremely uncertain in its operation. Its most evident effect, and that most insisted on, of reducing the frequency of the pulse, is by no means certain; and indeed, it is the opinion of Dr. Beddoes, that the force and strength of the pulse are increased by it. In the N. Y. Hospital I have witnessed frequent cases in which its continued exhibition produced no effect in reducing either the force or frequency of the pulse; and in some instances no effect at all seemed to be produced by it. A case occurred in that institution in October last, in which a patient, by his own carelessness took six drachms of Tinct: Digitalis with no evident injury. In examining the effect of this medicine on the pulse, it is necessary to recollect the remark of Beddoes, that it is very different in the recumbent and erect posture; the pulse frequently being found to be reduced in frequency and irregular in the former, but recovering its frequency and regularity in the latter situation. From the same author we learn, that if this remedy do not produce any good effect within three weeks, we can expect no advantage from it at all. It is generally admitted that digitalis will succeed only in the first stage of Phthisis Pulmonalis; in the last or ulcerated stage of that malady, it will not save our patient, but we are apprehensive, will rather hasten his dissolution. As it is acknowledged to be an uncertain medicine, we should not place our whole dependence upon it, nor suffer it to take the place of blood-letting and the rest of the antiphlogistic treatment before recommended: it should be used rather as an auxiliary than a principal remedy. From its uncertainty of operation it requires a cautious exhibition. The dose for an adult is from ten to fifteen drops of the saturated tincture, three times a day, and gradually increased until some effect is produced.
The use of factitious airs in Consumption is now very much abandoned. No essential benefit has ultimately appeared to be derived from them; although in the first instance, they produced some apparently good effect.
Of much more advantage is a sea-voyage and a mild climate. The benefit evidently derived from sea-voyages has been attributed to various causes. The nausea and vomiting from sea-sickness, the uniform motion and gentle regular exercise produced by sailing, and the uniformity and mildness of the atmosphere of the ocean, so evident at a distance from the land, probably all combine in producing these happy results. We can hardly suppose, however, with Dr. Mudge, that the exhalations from the tar and pitch about the ship, taken into the lungs in respiration, have any agency in the effect produced. But whatever be the cause, it is not at all unfrequent for consumptive patients to experience immediate relief after having been a few days at sea. A sea-voyage to produce permanent benefit, should be long continued, and what is of still more importance, terminate in a mild climate. Every winter, instances occur in this city, of consumptive patients being restored to health by a voyage to the south of France, or some other country of similar temperature. The climate most grateful to these patients is one whose temperature is uniform, not subject to any sudden variations, and where the atmosphere is dry and pure. The island of Madeira possesses all these requisites. The part of it best adapted to the purpose in question is thus described by Dr. Adams, a physician of that island, in a letter to his friend in London:—
“The valley of Funchall is defended by immense hills from every wind but the south, where it is open to the sea-breeze; this preserves a temperature so even, as is unknown in any other part of the world. Our winters may be compared to your summers in every thing but the length of days, and those sudden changes from heat to cold, to which you are subject. The thermometer with us is often steady within doors, or varies scarcely a degree for weeks together. During winter its whole range is from 58 to 65; and in summer, from 70 to 75, rarely amounting to 80; the heat being always tempered by a breeze in proportion to the force of the sun. The dryness of our atmosphere is not less remarkable.”