An inaugural dissertation on pulmonary consumption

by Edward Delafield

The approach of summer frequently mitigates the sufferings of the consumptive, and gives them hopes of returning health; but when winter returns, these hopes are blasted; the patient sinks again into his former condition, and most generally is cut off during the cold season.

The symptoms of Phthisis are frequently suspended or mitigated by any cause producing a new determination in the system. The most prominent of these causes is pregnancy. It almost invariably happens that the symptoms of Consumption are relieved by the occurrence of this event; but after parturition the disease returns with all its former violence. The occurrence of mania has produced the same effect, and has even entirely cured the disease; but generally, when the mania is removed, the symptoms of Consumption return. An attack of rheumatism has frequently relieved phthisical complaints. Dr. Rush refers to three clinical patients in the hospital of Pennsylvania to exemplify this observation. In the same manner gout is observed to alternate with Consumption, and during its paroxysms, the complaint of the lungs is relieved. Frequent cases are related, in works on this subject, of eruptions on the skin alternating with Phthisis Pulmonalis.

Long continued ulcers, or fistulæ in ano not unfrequently relieve pulmonic complaints in phthisical patients; while the healing of these ulcers or fistulæ reproduces the disease with tenfold violence.

A farther circumstance worthy of remark in this disease is, the willingness with which the patient suffers himself to be flattered with hopes of recovery. Notwithstanding he sees daily victims of Consumption falling around him; notwithstanding the perfect assurance he has of the small number of those who recover from it; to the last his hopes are not abandoned. Although depressed at night by the evening exacerbation of hectic fever; in the morning, from his comparatively comfortable situation, his hopes revive. Happy is it for these miserable sufferers that they do not despair. In a disease whose progress is frequently so slow, and whose event is but too often so sure, fortunate it is, that a solace remains to cheer the unhappy patient.

The duration of Consumption is extremely various; from a few weeks to fifty years have patients laboured under it. In Bayle’s statement of the duration of the disease in two hundred cases in which the patients were destroyed by it, it was between two months and two years in 168 cases, four were less than two months, and 28 remained more than two years.

From the detail of symptoms which has just been given, it is evident, that there are two distinct stages of Phthisis Pulmonalis, each characterised by peculiar symptoms, and requiring peculiar treatment. The first, incipient, or acute stage as it is variously termed by authors, is the stage of inflammation, and terminates as soon as purulent expectoration and hectic fever commence. The second, confirmed, or chronic stage commences where the first terminates, and ends most generally in death. We would not however assert, that these stages can always be accurately distinguished, and a line drawn between them. On the contrary, hectic fever may occur early in the disease, before any expectoration of pus takes place, and inflammatory symptoms frequently attend its advanced stage. In general, the distinction can be made, and must necessarily guide the prudent physician.

Having taken a view of the causes and symptoms of Phthisis Pulmonalis, we are now prepared to investigate the proximate cause of the disease. From the nature and extent of these symptoms, it appears evidently a disease of the whole system, and not confined merely to the lungs. The proximate cause, as taught by Dr. Hosack, in his lectures, is, an inflammation of the lungs, terminating either in a purulent secretion, or ulceration in their substance. This opinion is much strengthened by the analogy before remarked between Phthisis Pulmonalis and Pneumonia. It is a little singular that Dr. Rush, notwithstanding he had remarked this close analogy, and although he speaks of inflammatory fever as a part of the disease, and prescribes blood-letting in its treatment, should yet have made debility its proximate cause. This is only one instance among many, of physicians arriving at precisely the same modes of treatment by directly opposite routes. If that theory of inflammation be admitted, which makes debility its cause, so far it is also the proximate cause of Phthisis Pulmonalis. In the secondary species of Phthisis, hereafter to be considered, debility may be fairly ranked as the proximate cause, and the indications of cure correctly drawn from it. But in the primary disease under consideration, if we were to found our indications on this basis, and thence deduce the propriety of exhibiting powerful tonics in the first stage of the disease, when brought to the test of practice, its error would soon become sufficiently glaring.

Various other causes have been successively treated of by authors, but to shew their inconsistency and absurdity, it is only necessary to observe that, “the existence of an acid or an alkali, of chemical acrimony, or mechanical changes in the blood, of corroding volatile particles, and even of animalcula in the lungs, have been vaguely conjectured to be the cause of pulmonary ulcer and hectic fever.[7]”

Assuming then, inflammation of the lungs, and consequent ulceration of their substance as the proximate cause of Phthisis Pulmonalis, we naturally deduce the following indications in the treatment of the disease.

1. To endeavour to relieve the inflammation of the lungs, and promote its resolution.