An Inaugural Dissertation on Pulmonary Consumption

Part 1

Inaugural Dissertation

PULMONARY CONSUMPTION.

BY EDWARD DELAFIELD, A. B.

----For want of timely care, Millions have died of medicable wounds. ARMSTRONG.

NEW-YORK:

PRINTED BY JOHN FORBES & CO. 78 WALL-STREET.

1816.

SAMUEL BORROWE, M. D.

ONE OF THE SURGEONS OF THE NEW-YORK HOSPITAL,

THIS DISSERTATION

IS DEDICATED,

AS A TESTIMONY OF GRATITUDE

FOR THE MANY VALUABLE PRACTICAL LESSONS

RECEIVED FROM HIM

BY HIS FRIEND AND PUPIL,

EDWARD DELAFIELD.

INTRODUCTION.

The attention of Physicians has for several years past been excited to the consideration of that inveterate enemy of the human race, the CONSUMPTION. Several works have been published, new remedies proposed, and the practice of former physicians revived with modifications and amendments, in the treatment of this disease. At one period, Consumption had been so long considered without the reach of remedies, that it had almost ceased to excite the enquiries of the learned in medicine. Fortunately, however, the spirit of enquiry has revived; and it is believed that the treatment of this dreadful malady has been so far improved, that many are rescued from its grasp, and the sufferings of those who are still its victims, are materially mitigated. Notwithstanding, it appears that in this city the mortality from Consumption has increased rapidly of late years. Formerly, its climate was considered remarkably salubrious, and diseases of the lungs were rare. Lieutenant Governor Colden, in a series of remarks on the climate and diseases of New-York, made seventy years ago, has the following observations: “The air of the country being almost always clear, and its spring strong, we have few consumptions or diseases of the lungs. People inclined to be consumptive in England, are often perfectly cured by our fine air; but if there be ulcers formed, they die. The climate grows every day better, as the country is cleared of the woods; and more healthy, as all the people that have lived long here testify. This has even been sensible to me, though I have lived but about twelve years in this country; I therefore doubt not but it will in time, become one of the most agreeable and healthy climates on the face of the earth.”

These anticipations have not been realized; but, on the contrary, Consumption has become the prevailing disease of our city. The causes of this increase of the disease are numerous. We are told by Dr. Rush, that it is unknown among the Indians of North America; that it is scarcely known by those citizens of the United States who live in the first stage of civilized life, and are generally called the first settlers; that it is less common in country places than in cities, and increases in both, with intemperance and sedentary modes of life; that ship and house-carpenters, smiths, and all those artificers, whose business requires great exertion of strength in the open air, in all seasons of the year, are less subject to this disease than men who work under cover, and at occupations which do not require the constant action of their lungs. By applying these facts to the situation of this city, the causes which have produced the increased mortality from consumption, become evident.

1. The growth of the city, and consequent state of the atmosphere, most distant from that of the pure air of the country.

2. The increase of all those causes which have enervated the bodies of men, and rendered them more susceptible to the influence of a variable climate. Among these are, augmentation of wealth, and consequently, luxury; increased dissipation, with its accompaniment, imprudence in dress; and extension of manufactures, affording greater opportunity for sedentary employments, and exposure to an insalubrious atmosphere. In general, the causes are, all those circumstances which tend to remove man farthest from that situation, in which the body is possessed of the greatest vigour, and of course, least subject to disease, that of the savage. In proportion as the city has enlarged, these causes have continued to increase, and probably still will do so. But in Great Britain, they appear already to have attained their acme, and as a consequence of the improvements in medicine, the causes not increasing, the disease is on the decline.

The following statement will show the proportion, which the number of those who die from consumption, bears to the whole number of deaths, in this city, during the last twelve years.

In 1804, 499 persons died from Consumption, and were to the whole number of deaths, 2125 as 1 to 4.25.

In 1805 462 2352 1 5.09 1806 354 2225 1 6.28 1807 464 2312 1 4.94 1808 429 2014 1 4.69 1809 413 2108 1 5.1 1810 569 2158 1 3.79 1811 595 2524 1 4.24 1812 669 2553 1 3.81 1813 562 2229 1 3.96 1814 618 2507 1 4.04 1815 572 1974 1 3.8

From this statement it appears, that the number of deaths from Consumption has gradually increased. The average proportion during the period mentioned, is as 1 to 4.36. Nearly one fourth of all those who die in this city are destroyed by this fatal disease.

These facts prove indeed that the power of medicine has little control over so destructive a malady. But it should not therefore paralyse our exertions. From what has been done already, in improving our knowledge of its nature and treatment, a hope may be indulged that consumption may one day, like many other maladies formerly deemed incurable, be placed no longer among that number.

INAUGURAL DISSERTATION

PULMONARY CONSUMPTION.

Part 2

The term Phthisis, or Consumption, in its broadest sense, is applied to all those diseases, in which the system sinks under a gradual waste of the powers of life. These diseases may be divided into two great classes--1. That form of Consumption in which the lungs are unaffected.--2. Phthisis Pulmonalis, properly so called, where the lungs are the seat of the disease.

Under the first class are included,

1. Atrophia, or Consumption from want of nourishment, or excessive evacuations, but without hectic fever; excluding all those forms of disease produced by immoderate evacuations, in which the lungs become affected.

2. Tabes, accompanied with hectic fever, frequently attended with disease of the mesenteric glands, and produced most commonly by scrophula.

The second class, Phthisis Pulmonalis, to the consideration of which this essay will be more immediately confined, may be also subdivided into,

1. Primary, where the lungs are the original seat of the disease, and as a consequence, the general system becomes affected.

2. Secondary, where the system being first reduced by any debilitating cause, the lungs become secondarily affected, as a symptom of the general disease.

These two forms of Consumption, although somewhat similar in their symptoms, yet proceed from opposite causes, and require opposite treatment. The one is a disease of pure inflammation; the other of unmixed debility. In the one, an active antiphlogistic treatment is necessary; in the other, the system requires all the support, which tonics and good nourishment can afford.

Phthisis Pulmonalis is thus defined by Dr. Cullen, “Corporis emaciatio et debilitas, cum tussi, febre hectica, et expectoratione purulenta.” This definition is peculiarly incorrect, because it leads us to neglect, the first stage of the disease; if the symptoms of an Incipient Phthisis were stated to us, and we were asked, what was the disease, from this definition we would be perfectly at a loss for an answer. Except the cough, none of the symptoms there stated are to be found in the first stage of Consumption. And yet that is as truly a part of it, and of as much importance to the practitioner, as the last stage, which alone is included in Cullen’s definition.

Agreeably to this definition, in his view of Phthisis Pulmonalis, Dr. Cullen makes ulceration of the lungs and hectic fever essential to its existence, and seems rather to consider the preceding symptoms a cause of this ulceration and fever, than as constituting an integrant part of the disease.

Nor is the place assigned by him to Phthisis Pulmonalis, in his Nosological Arrangement, more correct than his definition of it. He places it in the order Hæmorrhagiæ, and considers it merely as a consequence of Hæmoptysis. Even if it were always excited by hæmorrhage from the lungs, it would be improperly thus placed; but as that, even by Dr. Cullen, is considered merely as one among many exciting causes, the arrangement is altogether inadmissible. But if it be admitted, according to the view which will be hereafter taken of Hæmoptysis in this treatise, that it is rather a symptom than a cause of Consumption, the propriety of another arrangement will be evident. Accordingly Phthisis Pulmonalis is placed by Dr. Hosack, as one of the Phlegmasiæ. This disposition appears to be the most proper that has hitherto been suggested, and as such I shall adopt it. But before we can ascertain the character and treatment of any diseases, it is necessary minutely to examine their causes and symptoms.

Primary Phthisis Pulmonalis first claims our attention. Its predisposing causes may be mostly arranged into five classes, as they depend on organization, age, sex, occupation and climate.

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