Secondly, the external ulcers in scrophulous habits are pale and flabby, and naturally disinclined to heal, the deposition of fluids in them being greater than the absorption; these ulcers have their appearance immediately changed by the external application of metallic calxes, and the medicines of the article Sorbentia, such as cerussa and the bark in fine powder, see Class [I. 2. 3. 21]. and are generally healed in a short time by these means. Induced by these observations, I wished to try the external application of such powders to ulcers in the lungs, and constructed a box with a circulating brush in it, as described in the annexed plate; into this box two ounces of fine powder of Peruvian bark were put, and two drams of cerussa in fine powder; on whirling the central brush, part of this was raised into a cloud of powder, and the patient, applying his mouth to one of the tin pipes rising out of the box, inhaled this powder twice a day into his lungs. I observed it did not produce any cough or uneasiness. This patient was in the last stage of consumption, and was soon tired of the experiment, nor have I had such patients as I wished for the repetition of it. Perhaps a fine powder of manganese, or of the flowers of zinc, or of lapis calaminaris, might be thus applied to ulcers of the lungs with greater advantage? Perhaps air impregnated with flowers of zinc in their most comminuted state, might be a better way of applying this powder to the lungs, as discovered by Mr. Watt. See Dr. Beddoes on Pneumatic Medicine. Johnson.
Thirdly, as the healing of an ulcer consists in producing a tendency to absorption on its surface greater than the deposition on it; see Sect. XXXIII. 3. 2. other modes of increasing pulmonary absorption, which are perhaps more manageable than the preceding ones, may be had recourse to; such as by producing frequent nausea or sickness. See Sect. XXIX. 5. 1. and Art. [IV. 2]. The great and sudden absorption of fluid from the lungs in the anasarca pulmonum by the sickness induced by the exhibition of digitalis, astonishes those who have not before attended to it, by emptying the swelled limbs, and removing the difficulty of breathing in a few hours.
The most manageable method of using digitalis is by making a saturated tincture of it, by infusing two ounces of the powder of the leaves in a mixture of four ounces of rectified spirit of wine, and four ounces of water. Of this from 30 to 60 drops, or upwards, from a two-ounce phial, are to be taken twice in the morning part of the day, and to be so managed as not to induce violent sickness. If sickness nevertheless comes on, the patient must for a day or two omit the medicine; and then begin it again in reduced doses.
Mr. ——, a young man about twenty, with dark eyes, and large pupils, who had every symptom of pulmonary ulcers, I believed to have been cured by digitalis, and published the case in the Transactions of the College, Vol. III. But about two years afterwards I heard that he relapsed and died. Mr. L——, a corpulent man, who had for some weeks laboured under a cough with great expectoration, with quick pulse, and difficulty of breathing, soon recovered by the use of digitalis taken twice a day; and though this case might probably be a peripneumonia notha, or catarrh, it is here related as shewing the power of pulmonary absorption excited by the use of this drug.
Another method of inducing sickness, and pulmonary absorption in consequence, is by sailing on the sea; by which many consumptive patients have been said to have received their cure; which has been erroneously ascribed to sea-air, instead of sea-sickness; whence many have been sent to breathe the sea-air on the coasts, who might have done better in higher situations, where the air probably contains less oxygen gas, which is the heaviest part of it. See a Letter from Dr. T. C. below.
A third method of inducing sickness, and consequent pulmonary absorption, is by the vertigo occasioned by swinging; which has lately been introduced into practice by Dr. Smith, (Essay on Pulmonary Consumption), who observed that by swinging the hectic pulse became slower, which is explained in Class [IV. 2. 1. 10]. The usual way of reciprocating swinging, like the oscillations of a pendulum, produces a degree of vertigo in those, who are unused to it; but to give it greater effect, the patient should be placed in a chair suspended from the ceiling by two parallel cords in contact with each other, the chair should then be forcibly revolved 20 or 40 times one way, and suffered to return spontaneously; which induces a degree of sickness in most adult people, and is well worthy an exact and pertinacious trial, for an hour or two, three or four times a day for a month.
The common means of promoting absorption in ulcers, and of thickening the matter in consequence, by taking the bark and opium internally, or by metallic salts, as of mercury, steel, zinc, and copper, in small quantities, have been repeatedly used in pulmonary consumption; and may have relieved some of the symptoms. As mercury cures venereal ulcers, and as pulmonary ulcers resemble them in their not having a disposition to heal, and in their tendency to enlarge themselves, there were hopes, from analogy, that it might have succeeded. Would a solution of gold in aqua regia be worth trying? When vinegar is applied to the lips, it renders them instantly pale, by promoting the venous absorption; if the whole skin was moistened with warmish vinegar, would this promote venous absorption in the lungs by their sympathy with the skin? The very abstemious diet on milk and vegetables alone is frequently injurious. Flesh-meat once a day, with small wine and water, or small beer, is preferable. Half a grain of opium twice a day, or a grain, I believe to be of great use at the commencement of the disease, as appears from the subsequent case.
Miss ——, a delicate young lady, of a consumptive family, when she was about eighteen, had frequent cough, with quick pulse, a pain of her side, and the general appearances of a beginning consumption. She took about five drops of laudanum twice a day in a saline draught, which was increased gradually to ten. In a few weeks she recovered, was afterwards married, bore three or four children, and then became consumptive and died.
The following case of hereditary consumption is related by a physician of great ability and very extensive practice; and, as it is his own case, abounds with much nice observation and useful knowledge; and, as it has been attended with a favourable event, may give consolation to many, who are in a similar situation; and shews that Sydenham's recommendation of riding as a cure for consumption is not so totally ineffectual, as is now commonly believed.