If this description be correct, Madeira has a climate possessing every requisite to make it most favourable to phthisical patients. The southern parts of the United States are frequently resorted to, also, by the consumptive with great benefit. I have had the satisfaction of seeing a young friend return from Charleston, a short time since, perfectly restored to health, who, during the last autumn, was attacked with repeated hæmoptysis and other symptoms of Incipient Phthisis.
It is to be regretted, that change of climate, a remedy of so much advantage in the early stage of Consumption, should so often be postponed, until no possibility of recovery remains. It is too often the fate of such patients, to leave their homes in quest of health, merely to find a foreign grave; resorting to that remedy which should have been first, as the last effort of despair. To this cause alone, may we attribute its frequent inefficiency, and unfortunately the same cause has contributed too much to bring the remedy into disrepute.
Where from any circumstances, change of climate is impracticable, it may to some extent be imitated, by confining the patient to apartments whose temperature is kept constant and uniform. This has been tried and with some success; and is probably, the remedy of the same class, next in power, but much inferior to a warm climate. Beddoes made use of it in several cases with relief to his patients, but it has not yet been sufficiently tested to establish its character as a remedy in Phthisis Pulmonalis.
Besides the use of the remedies which have been enumerated, with the view of effecting a radical cure of this disease, there are some symptoms occurring in its first stage, which require immediate relief. Hæmoptysis sometimes comes on in such a manner as to be very alarming to the patient. Blood-letting in large quantities, and repeated in proportion to the strength and habit of the patient and violence of the symptoms, is then absolutely necessary. Unless the plethora, which is oppressing the system, and exciting the hæmorrhage from the lungs, be relieved by general blood-letting, blood will not cease to pour out from that viscus. At the same time the free exhibition of saline cathartics, a blister to the chest, a rigidly abstemious diet and a strict adherence to the antiphlogistic regimen must accompany this treatment. Peruvian Bark, Chalybeates and Elixir of Vitriol so often used, in active hæmorrhage during the inflammatory stage of Consumption cannot but be injurious. They increase the force of the circulation and consequently the disposition to hæmorrhage. In the same symptom arising from an opposite cause, they may be prescribed with advantage. Common salt, administered dry in the manner directed by Dr. Rush, has been found by experience to be very useful in abating hæmorrhage from either cause; but it should not be depended on alone, nor suffered to take the place of the treatment just detailed.
If possible, we should anticipate the occurrence of hæmoptysis with our remedies, and thus prevent the formation of a habit of spitting blood, which when once established, is difficult to destroy. The usual precursors of this symptom are, a saltish taste in the mouth, a sense of irritation at the upper part of the trachea, and some oppression and difficulty of breathing. At this time, before the hæmorrhage has commenced, blood-letting and the rest of the remedies mentioned above should be actively exhibited. “Venienti occurrite morbo.”
A distressing cough at this period also requires the attention of the physician. From its occurrence more particularly at night, it disturbs the rest and adds much to the sufferings of the patient. It should be alleviated by Opiates, accompanied with any of the mild demulcent remedies, generally denominated Pectorals. Mudge’s Apparatus for inhaling the steam of warm water, may also be used with relief, especially on going to bed.
When all inflammation is gone and the second stage of Consumption has decidedly formed, a different mode of treatment becomes necessary. Little indeed is now to be hoped for from any treatment, as a radical cure; but our patient is not to be abandoned; if he cannot be cured, his sufferings may be materially mitigated, and he may be directed to avoid such things as may increase his malady. Nor should we entirely despair of performing a radical cure; for solitary cases are related by many authors of consumptive patients being cured in every stage of the disease. Many of these cases, perhaps, have been mistaken for Phthisis Pulmonalis; but of some of them we cannot doubt. The authority from which they come is too high to permit us to hesitate.
The remedies last mentioned in the treatment of the first stage of Consumption may yet be proper, and although with not so great a prospect of success, should still be tried. These are a sea-voyage, change of climate, and confinement to apartments whose temperature is regulated. But all the debilitating remedies before recommended, are now to be avoided. The lancet in general is improper, although in some few instances, the occurrence of acute inflammation at this period, still requires its cautious use. Drastic Cathartics should not be used; the bowels if torpid must be kept open by gentle laxatives and Enemata. Antimonial and other debilitating Emetics should not now be exhibited, but the Vitriol Emetics may still be prescribed with advantage. The Sulphate of Zinc given in such doses as to excite occasional vomiting, is frequently very useful, and especially where much irritation is present. It was introduced and strongly recommended by Dr. Mosely in his Treatise on Tropical Diseases &c. His Vitriolic solution[8] is certainly an useful remedy in relieving dyspnœa and promoting expectoration. Instead of debilitating as antimonials do, he assures us, that its emetic effects are instantaneous, not harassing the patient, but always leaving the stomach strongly invigorated. Mr. Warburton, the present House Physician of the New-York Hospital, has assured me, that he has frequently prescribed it in that Institution with evident benefit. With similar intentions, Dr. Senter, in the Medical and Chirurgical Review, published in 1793, recommends the sulphate of copper.
At this time blisters will be preferable to either setons or issues, as they relieve the local symptoms without producing a constant debilitating discharge. Indeed they should be used in such a manner, as to produce as little discharge as possible. With this view, they should not be kept open by stimulating dressings, but be healed up, and occasionally renewed. With the same intention, stimulating plaisters may be applied to the chest with advantage, and in general are preferable to blisters.
To support the patient’s strength, as was proposed in the second indication, tonics are necessary. Of these some of the simple bitters are preferable, as columbo, gentian, boneset, chamomile, &c. But we should be careful not to exhibit them during the paroxysms of hectic fever, but during its intervals. Peruvian bark has not been found admissible. It produces a sense of stricture and oppression of breathing, adds to the cough, makes the pulse quick and hard, and hæmoptysis is not unfrequently the consequence of its exhibition. Dr. Fothergill dwells particularly on the abuse of this medicine in Consumption.