An inaugural dissertation on pulmonary consumption

by Edward Delafield

As stimulating and bitter medicines, the Polygala Seneka and Aristolochia Serpentaria have been recommended in this stage of Phthisis Pulmonalis.

The stimulating balsams and gums are also proper in this stage. They have been highly recommended by Morton; and myrrh in particular is prescribed with great confidence by Simmons. They are objected to by Fothergill, on the ground, that by their stimulating properties, they increase the inflammation of the lungs. His objection appears well founded, while symptoms of acute inflammation still exist; but after they have subsided, the cough and other distressing symptoms of the last stage of Phthisis, may be much alleviated by these medicines. By their stimulating effects upon the whole system, also, they may be useful at a time when the patient is sinking under great debility.

As stimulating applications are frequently found necessary and useful to indolent ulcers on the surface of the body, it naturally occurred that similar applications might be made with advantage to ulcers of the lungs. With this view, the steam of tar water, and the vapour of sulphuric æther inhaled in respiration, have been used in the treatment of Consumption.[9] With the same restrictions as are necessary with the stimulating gums and balsams, these remedies may be beneficial. It is not probable, however, that any permanent relief can be derived from them; they can only mitigate symptoms.

To check the profuse sweats, which occur at this period, and add materially to the debility of the patient, the elixir of vitriol is an useful medicine. As a general tonic it acts beneficially also upon the whole system.

With the view of quietting the cough and procuring rest at night, opiates are necessary; and fortunate are we that we have in our possession, a remedy, which although it will not permanently cure the disease, palliates the symptoms, at least for a time; and makes more smooth the path to death. It is true that opium produces some ill effects. It debilitates the stomach, and injures the appetite; but when the symptoms are urgent, it cannot for these reasons be dispensed with. By lulling pain, and giving rest to the watchful patient, it more than counterbalances these disadvantages. The humulus lupulus or common hops, does not possess the objectionable properties of opium, but with its anodyne combines some tonic powers, and promises to be an excellent substitute for that medicine.

The large and frequent use of syrups in the form of expectorant mixtures and linctuses, to alleviate cough, is very injurious. They cloy the appetite, destroy the tone of the stomach, and prevent the taking of nutritious aliment, which is now so necessary; and frequently without producing any material relief of the symptom for which they are prescribed.

The use of opiates is necessary also, to check the profuse diarrhœas, which now alternate with costiveness, and reduce the already debilitated patient. With the same view, the chalk mixture may be used with advantage, and the astringent medicines, Kino and Catechu, with others of the same class.

It is not unfrequent for hæmoptysis to occur at this period, as well as in the earlier stages of Consumption. Sometimes it is the effect of some temporary excitement, and may be relieved by the loss of a few ounces of blood. But frequently this evacuation cannot be borne; and the hæmorrhage proceeds rather from debility in the vessels of the lungs, than any increased force of the circulation. We must then trust to astringents—muriate of soda, sulphuric acid, and alum.

We come now to speak of the diet and regimen of patients labouring under Phthisis Pulmonalis; a subject no less important than the remedies to be exhibited. In the first stage, the diet should be perfectly simple, and such as will least tend to increase the inflammatory action of the system. For this purpose nothing is better than milk. So sensible have physicians, at all times, been of its propriety, that in many cases, they have trusted the cure entirely to a milk diet. It is highly spoken of by almost every author who has written on this subject, and with reason. It is light, easily digested, and does not produce any excitement. Many have preferred Asses’ to Cows’ milk, but it does not appear that there is any material difference, which should influence our choice. The former is thinner and less nutritious, and perhaps, to very delicate stomachs, may be more acceptable; but in general, the latter is as useful. Milk, however, is very offensive to some stomachs, and not so easily digested as other food; in such cases it must necessarily be prohibited.

As a general rule, with regard to diet, in this stage, animal food is improper, and the patient should be confined to the use of vegetables. Fresh sub-acid fruits are proper; and, indeed, of so much importance have they been considered, that Hoffman mentions a case of confirmed phthisis, cured by confining the patient to the use of fruits, and particularly strawberries. Mucilaginous and diluent drinks, as those formed from barley, sago and flaxseed are also useful. Among these may be classed, the Lichen Islandicus, which has gained with some the reputation of curing Consumption. Weak is the foundation for hope of those who depend on it. As an article of diet, from its mucilaginous property, it is useful; and in the last stage, from its possessing slightly better and tonic virtues, it is also proper; but as a remedy for phthisis it is altogether inert. Nor are its tonic powers sufficiently great, to render it injurious in the early stage of the disease.