Part 6

In the treatment of Pulmonary Consumption, arising from any of these or analogous causes, our attention is first called to the removal of the primary source of the disease. If it be Chlorosis, remedies, calculated to cure that malady, must be prescribed. If profuse evacuations are the cause, all the means in our power, must be employed in restraining those evacuations. If the disease has been induced by the long continued suckling of a vigorous child, by a delicate mother, another nurse must be provided, or the child must be weaned. If Scurvy or Syphilis have produced it, the proper remedies for those disorders must be employed.

Our next object is to remove the debility, the cause of the pulmonary symptoms. For this purpose, Tonics are indicated, and at their head stands the Peruvian Bark. In the other species of Phthisis, this medicine has been much abused, but in the present one, its use is sanctioned by experience. In the cases proceeding from Leucorrhœa, and long suckling, it is highly recommended by Dr. Fothergill; but he cautions us against persevering in its use, longer than while it is doing good; and remarks, that if the breathing become more oppressed, the cough dry, the pulse more quick and hard, and especially, if slight transitory pains or stitches about the thorax, are more frequently complained of, a perseverance in the use of the bark will increase the disease. If, in consequence of this increase of symptoms, we are obliged to desist in the use of the Bark, other Tonics must be substituted. The combination of bitter and tonic medicines in the Infus: Amar: of the dispensatories may be then usefully prescribed. Columbo, which is sometimes an ingredient in that formula, is particularly recommended by Dr. Thomas Percival, as not possessing any of the injurious properties of bark.

The Elixir of Vitriol is also an excellent tonic, and may be usefully given at the same time with the remedies just proposed. But it requires to be administered with the same cautious hand as the bark, and to be discontinued, if the symptoms appear to be at all aggravated by its use. In general, no ill effects arise from it, but if the determination to the chest be so great, as to produce much inflammatory action, it may do injury. Independent of its tonic powers, it will be serviceable in checking any disposition, which may exist, to profuse sweating.

Iron, in its various officinal preparations, is also a good remedy, in this form of phthisis. Although, highly dangerous in the primary disease, there is now little danger of increasing the inflammation, which in that form, made it improper. Mineral chalybeate waters, will in this instance, be useful, not only by the journey to them, and the amusement derived at watering places, but may be drank with advantage by the patient.

In addition to these remedies, the diet and regimen should be such as is most invigorating to the constitution. A nutritious diet and the moderate use of wine will be proper; and country air and exercise with the same rules as were mentioned in the treatment of primary phthisis, are very important circumstances in the cure of the secondary form. A long journey, a sea-voyage and change of climate are also equally proper.

* * * * *

The prominent feature and primary object of this essay has been, to establish the distinction between primary and secondary Phthisis Pulmonalis. Although, perhaps, the minute parts of the arrangement may not have been distributed, in every instance, with perfect accuracy, I feel confident that the general plan is correct. Farther observation and experience will probably suggest a more accurate disposition of the varieties of Phthisis, under the two orders which I have proposed.

Probably from the want of the distinction between primary and secondary Phthisis, may be explained the various and contradictory practice, proposed by physicians of deserved eminence. A more frequent opportunity of observing one or the other form of the disease, has determined with each, his mode of treatment: and hence in diseases bearing the same name, we may see blood-letting and a rigid antiphlogistic regimen adopted by one party, and bark, iron, and a nutritious diet by another. Any error which may arise from these contradictions, may be corrected by the distinction, which has been proposed.

It has also been my object, to call the attention of the practitioner, to the earliest symptoms and first dawnings of Consumption. Were they not so much neglected by the physician, as well as the patient, our bills of mortality would not continue to present so frightful a picture of the ravages of this disease; while, on the other hand, a prompt attention to these incipient symptoms, and the interference of an active practice, would afford a reasonable prospect of saving many from Consumption, who are now its victims.

FOOTNOTES:

Amer. Med. and Phil. Reg. Vol. I.

Dr. Lettsom observes, that Consumption is decreasing in Great Britain.

Med. and Phil. Reg.

The following judicious remarks on this subject are made by Bayle, in his “Recherches sur la Phthisie Pulmonaire, D’après la notion que j’ai donnée de la Phthisie Pulmonaire, on voit que je dois regarder comme Phthisiques des individus qui n’ont ni fièvre, ni maigreur, ni expectoration purulente: il suffit que les poumons soient affectés d’une lésion qui tend à les désorganiser et à les ulcérer. On ne doit pas regarder cette lésion une simple cause de la Phthisie, mais comme le premier temps de cette maladie, puisque la Phthisie est cette lésion même dont la continuation et le developement successif amènent la mort. Il seroit donc bien peu raisonnable de vouloir attendre, pour reconnoitre la Phthisie Pulmonaire, qu’elle fut constamment parvenue à son dernier degré qui est le moment où ses symptômes pathognomoniques sont bien marqués.”

Dr. Reid.

Dr. Hosack.

Dr. Lind states, that out of 360 patients whom he attended between July 1, 1758, and July 1, 1760, in consumption, the disease was brought on one fourth of them by falls, bruises and strains, received a year or two before it made its appearance.

Dr. Reid.

℞ Vitriol: alb: Ʒ iij Alum: rup: Ʒ j Coccinnel: pulv: griij Aq: ferveut: ℔j. Misce in mortareo marmoreo. Solutio a fæculantia vel residendo expurgetur, vel per chartam bibulam fittretur. Dos. ℥ss.--

Dr. Borrowe formerly had a patient labouring under Consumption, a manufacturer of tin ware, who was uniformly relieved of his phthisical symptoms when engaged in soldering tin, a process in which a great deal of resin is used, and constantly inhaled in respiration.

ERRATA.

Page 10 Note, for d’après read D’après. 22, line 25, for which like the inert physician, read which the inert physician. 25, line 13, for dysentary, read dysentery.

Transcriber’s Notes

The errata have been fixed.

Punctuation errors and omissions have been fixed.

Page 10: “peculiary incorrect” changed to “peculiarly incorrect”

Page 40: “very analagous” changed to “very analogous”

Page 54: “frequenty prescribed” changed to “frequently prescribed”