An inaugural dissertation on pulmonary consumption

by Edward Delafield

The dress of the patient should also be regulated by the Physician. He should be clothed in flannel, and this frequently changed. A constant determination is thus kept up to the surface, and to some extent, diverted from the chest. At the same time, all exposure to cold, moisture, or sudden alternations of temperature must be studiously avoided. As in many cases, they lay the foundation for consumption, so after it has commenced, their repetition aggravates it.

Mental distress and consequent despondence, impedes the cure of those who otherwise might recover, and should be obviated as much as possible. Happily, patients labouring under Phthisis, generally with difficulty, resign hopes of recovery, and despondence from that source does not often depress them. But mental anxiety, produced by other causes, is very injurious. It should be relieved, as much as possible, by pleasant amusements, a journey, a sea-voyage or any other method most suited to the particular circumstances of the patient.

In the second stage of Consumption, the diet of the patient must be altered, as well as the medical treatment. The most nutritious articles of food are then to be chosen, and such as are at the same time the most easily digested. It is well ascertained that the older meats, as beef and mutton, possess these properties in a higher degree than veal or lamb; and generally, the brown more than white meats. With the same view, wild fowl and game generally, form nutritious articles of diet, proper for consumptive patients. Eggs combine a large quantity of nourishment in a small compass, and may be freely used. They should be taken either quite raw, or boiled a very few minutes. When boiled hard, they form one of the most indigestible and offensive substances, to the delicate stomach, that are used in diet. The various culinary preparations, of which eggs form a principal part, are for the same reasons proper. Jellies also contain a great quantity of nutritious matter, and are very acceptable to patients, who, as in Consumption, have little appetite. Oysters and some other of the testacea, are also extremely nutritious. Isinglass boiled in milk is frequently in use, and with advantage, in these cases. Of the vegetable nourishments, those should be chosen which are most nutritious and abounding in mucilage, as rice, sago, arrowroot and Tapioca. Chocolate, when prepared in such a manner as to be free from oily matter, is a very pleasant article of diet.

The drinks of the patient should also be stimulating and nutritious. Malt liquors combine both these properties with some tonic virtues, which they obtain from the bitter of the hops infused in them, and therefore constitute the best drink for consumptive patients. Wine, also, may be used moderately with advantage, but requires some caution; and should be immediately abandoned, if any undue excitement be produced by it.

In this, as in every other stage of Consumption, while the patient has sufficient strength, exercise is necessary to the recovery of health. Of so much importance is exercise, that in many cases, it has alone cured this disease. Dr. Rush relates many such cases, and particularly, three instances of persons in confirmed consumptions, perfectly cured by the hardships of a military life. Of so much consequence was it in the eyes of Sydenham, that he pronounced riding on horseback, as certain a cure for consumptions, as bark for an intermittent fever. Indeed, all writers on this disease join in recommending it, not only as a part of the regimen, but as a principal remedy in the treatment. The mode of exercise to be chosen, should depend entirely on the situation of the patient, at the time. While much pain and soreness subsist, denoting the presence of active inflammation, the most gentle exercise only should be used: at that time riding in a carriage or on horseback, would be as improper as for a patient labouring under pleurisy. The swing, so highly recommended by Dr. Carmichael Smyth, is the least fatiguing, and most gentle mode that can be adopted. It may be serviceable, too, when the patient is too much debilitated to bear other more fatiguing exercise. But I would, by no means, adopt the opinion of Carmichael Smyth, that the swing, in itself, and unassisted by other remedies, will cure Consumption. Experience has proved the contrary; and has taught us that it is only useful as an article of regimen, while the patient is under the influence of other more powerful remedies. When there is sufficient strength to bear it, and not too much excitement, riding in an easy carriage is the next mode of gestation which may be used. But when the patient is enabled to ride on horseback, we have more to expect from it, than any other species of exercise. To attain the greatest benefit from it, it should be made use of regularly and constantly; not during the cold air of early morning, nor the dews of the evening, but rather during the day, after the sun exerts some influence. A long journey on horseback affords the most useful method of obtaining all the advantages that can be derived from exercise. It is then made constant and regular; and the amusement afforded by travelling serves to divert the patient’s mind from his own feelings, and adds to its beneficial effects.

Secondary Phthisis Pulmonalis remains yet to be treated of. Under this order, should be included every form of Consumption, in which the system has become debilitated by any cause, and the lungs in consequence become affected. I would exclude from it that form of the disease occurring after measles, scarlatina, and some other eruptive diseases, which I would consider as primary Phthisis Pulmonalis; because, in those cases, the lungs do not become affected merely in consequence of debility, but these diseases seem rather to act as exciting causes, in constitutions already predisposed to Consumption; while in secondary Phthisis, the affection of the lungs is only one symptom of the general disease, which is wasting the body. Nor would the treatment, which will be advocated in the latter form, be proper in the cases alluded to. They require that, which should be used in the first species of Phthisis, and which has already been detailed. The reason, why the lungs become affected in consequence of debility induced by particular causes, I would not attempt to explain. It is one of those laws of the constitution, not better understood, than why particular parts are successively affected in consequence of syphilis, or that the breasts and lower extremities are more liable to disease than other parts, except the uterus, in females after parturition. Many laws of this kind exist in the human constitution, of whose effects, we are every day made sensible, but of the cause of which we are totally ignorant.

One of the most frequent causes of Secondary Phthisis, is Chlorosis, that disease which occurs in young females, in consequence of Retention of the menses. The constitution not having sufficient vigour to produce this evacuation at the proper period, if any predisposition to Phthisis exist, a determination takes place to the lungs, producing Phthisical disease. This case is not analogous to Consumption produced by Suppression of the menses, after they have been once established; for in that instance the suppression is not generally induced by debility, but by cold, or some other cause, not acting merely by weakening the patient; and it produces active inflammation of the lungs. But in the case before us, the affection of the lungs is merely a symptom of the want of vigour in the constitution, which shews itself in retention of the menses. Accordingly, in the treatment of this disease, our attention must not be directed primarily to the affection of the lungs, but to the state of the system, the cause of that affection.

Profuse evacuations, of any kind, may be the cause of Secondary Phthisis. Hæmorrhages from the Nose, Lungs, Stomach, Kidneys and wounds are all mentioned by Morton, as having induced Pulmonary disease. Mr. Hey, in his work on Surgery, observes, that he has seen a great many cases of pulmonary Consumption, the consequence of debility, induced by violent hæmorrhages, and in persons who had no apparent tendency to Consumption. In the same manner, loss of blood from Hæmorrhoids and in Menorrhagia, may act as causes. Debilitating evacuations, by means of Diarrhœa, Diabetes, Salivation, and Sweating, have had the same effect. But the most frequent causes of this class are, immoderate discharges by fluor albus, and too long suckling by delicate woman of robust children. They are particularly mentioned by Morton and Fothergill, and have been adverted to by most authors, who have written since.

Chronic Catarrh, terminating in Phthisis, may be ranked also in this class. The profuse and long continued discharge from the membrane lining the trachea and bronchiæ, is the debilitating agent in that case.

Long continued Fevers, and particularly Intermittent fevers, not unfrequently leave behind them, a state of debility, sufficient to induce Consumption.