Edward Delafield

“ The disease having been excited into action, produces a succession of symptoms which are now to be detailed. Its attack is frequently extremely insidious and slow; at other times, well marked and rapid in its progress. It is to this insidious and gradual mode of attack, that Consumption owes much of its fatal character. Before the unfortunate patient suspects himself to be seriously indisposed, it but too frequently happens, that his fate is sealed, and death is inevitable. This arrives in part from the resemblance that Incipient Phthisis bears to a long continued catarrh. ”

“ When all inflammation is gone and the second stage of Consumption has decidedly formed, a different mode of treatment becomes necessary. Little indeed is now to be hoped for from any treatment, as a radical cure; but our patient is not to be abandoned; if he cannot be cured, his sufferings may be materially mitigated, and he may be directed to avoid such things as may increase his malady. [Pg 53] Nor should we entirely despair of performing a radical cure; for solitary cases are related by many authors of consumptive patients being cured in every stage of the disease. ”

“ To check the profuse sweats, which occur at this period, and add materially to the debility of the patient, the elixir of vitriol is an useful medicine. As a general tonic it acts beneficially also upon the whole system.
With the view of quietting the cough and procuring rest at night, opiates are necessary; and fortunate are we that we have in our possession, a remedy, which although it will not permanently cure the disease, palliates the symptoms, at least for a time; and makes more smooth the path to death. It is true that opium produces some ill effects. ”

“ Pneumonia is not unfrequently an exciting cause of Phthisis. Like catarrh, its frequent repetition is more dangerous than a single attack. Pneumonia may indeed act merely as a predisposing cause of Consumption, by leaving the lungs in a debilitated and irritable condition, favourable to the production of that disease; but it is an exciting cause, when in consequence of inflammation of the lungs, suppuration follows, and vomica or empyema is the consequence. This shews the close analogy between Phthisis Pulmonalis and ordinary Pneumonia. ”

“ It is not uncommon for parents who inherit this taint, to remain free from disease of the lungs, by the pursuit of laborious occupations. Nor is it more uncommon that the children of these very parents, whose active industry had preserved their lives, and amassed them wealth, should by being enabled to indulge in ease and luxury, fall victims to an inherited Consumption.
So the females of a family are sometimes all consumptive, while the males are free from pulmonary disease, in consequence of the more sedentary mode of life of the former. ”

“ If the patient’s occupation is one of those which predisposes to Consumption, unless it be abandoned, or at least so modified as to correct the objectionable parts of it, we cannot hope to cure the disease. If the disease arise from the suppression of an accustomed evacuation, our utmost endeavours must be made to restore it. Should suppression of the menses be the cause, means calculated to produce their return must be resorted to. ”

“ While a large issue is kept open between the shoulders, successive blisters may be applied to the chest. Many patients, perhaps, would not submit to so severe a mode of treatment; but it is only by such active and efficient practice, that we can hope to cure this formidable malady.
It is only in the first stage of Consumption that much benefit is to be expected from this class of remedies, or at all events, before the patient is much debilitated. In its latest periods, they would tend rather to add to the debility already induced by the disease. ”

“ The danger arising from catarrh is not a little increased by the popular mode of treating it: stimulating spirituous drinks, and a vast variety of remedies of the same class are the usual prescriptions. Almost every body has an infallible remedy for a cold; some of them innocent, but many injurious. The common prejudice in favour of “feeding a cold” increases the mischief, and unfortunately, the disease not generally affecting the system sufficiently to destroy the appetite, as in many other maladies, nature does not prevent the practice. ”

“ In the coldest of our winter nights, will these fair devotees of fashion issue from rooms, heated to a degree never experienced in our hottest weather, into the chilling air of midnight, with less clothing than they use at noon, when the sun exerts his greatest power. ”

“ It is generally admitted that digitalis will succeed only in the first stage of Phthisis Pulmonalis; in the last or ulcerated stage of that malady, it will not save our patient, but we are apprehensive, will rather hasten his dissolution. As it is acknowledged to be an uncertain medicine, we should not place our whole dependence upon it, nor suffer it to take the place of blood-letting and the rest of the antiphlogistic treatment before recommended: it should be used rather as an auxiliary than a principal remedy. ”

“ Blood-letting in large quantities, and repeated in proportion to the strength and habit of the patient and violence of the symptoms, is then absolutely necessary. Unless the plethora, which is oppressing the system, and exciting the hæmorrhage from the lungs, be relieved by general blood-letting, blood will not cease to pour out from that viscus. At the same time the free exhibition of saline cathartics, a blister to the chest, a rigidly abstemious diet and a strict adherence to the antiphlogistic regimen must accompany this treatment. ”

“ A frequent source of it is the mode of fashionable dress adopted by females. The corset, to which I allude, when worn only with moderate firmness, and by those not otherwise predisposed to Phthisis, serves but to add elegance and beauty to the female figure; but when applied with the object of converting into a delicate and slender waist, one naturally otherwise, it cannot but do injury. By immoderate pressure, it converts a well formed chest into the deformed and narrow one, or at least an approximation to it, which has just been described. ”

“ The force of so much authority with the evidence adduced, constrains us to admit the communicability of Consumption by contagion. But if this agent has any effect, its action must be extremely limited, and extend no farther than to those previously predisposed to the disease. For daily examples without number occur of the constant attendants upon those labouring under Phthisis remaining perfectly free from that malady.
Violence done to the lungs by blows or other injuries of the chest, has in some instances, excited Consumption. ”

“ 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. ”

“ Hæmoptysis occurring in persons not predisposed to Consumption, except the quantity of blood lost be so great as to produce it by mere debility, very frequently may be easily cured without danger of any consequent disease. Indeed not only in such cases consumption is not induced by it, but that disease has actually been prevented, by the occurrence of hæmorrhage from the lungs, relieving that inflammation, which the inert physician, by withholding the lancet, would have suffered to destroy his [Pg 23] patient. ”

“ Indeed, all writers on this disease join in recommending it, not only [Pg 61] 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. ”

“ If the abstraction of blood from the system generally is useful, no less so is it when drawn from the part itself, by the application of cupping-glasses, and the scarificator to the chest. This mode of obtaining blood is peculiarly useful in those frequent cases, where the patient is too much debilitated to bear the loss of much blood, but the existence of inflammatory action makes its abstraction necessary.
Emetics are a powerful remedy in the treatment of Phthisis. ”

“ If we may judge from the effect of ulcers and fistulæ, which palliate all the symptoms of confirmed Phthisis, while they continue, but whose healing restores the disease, it would appear that the establishment of similar drains, in the form of issues, ought to have a good effect. In caries of the spine, and disease of the hip joint, where the inflammation in the cellular structure of the bones seems to be very analogous to that in the cells of the lungs, issues are used with the greatest benefit. ”

“ In the course of the disease, dropsical effusions, constituting Ascites, Hydrothorax and Anasarca, are not [Pg 31] unusual, as in other diseases where great debility is produced.
In the advanced periods of Consumption, diarrhœa constitutes a prominent and troublesome symptom. This is sometimes produced by any cause which checks the profuse sweats; while on the other hand, if the diarrhœa be checked, the cough and dyspnœa, which perhaps had been relieved by it, frequently return with redoubled violence. Under these circumstances, the condition of the patient is hopeless indeed. ”

“ These symptoms may be so slight as hardly to attract the patient’s notice; at other times they are more severe and distressing. Frequently, on any little unusual exercise, the cough is increased, the patient feels a pain in [Pg 27] the side, and expectorates a frothy mucus, and blood is discharged from the lungs. This, perhaps, is the first symptom which excites the alarm of the patient. Expectoration of blood is generally preceded by a saltish taste in the mouth, and a sense of irritation at the upper part of the trachea. ”

“ As the disease advances, the symptoms of fever become more marked. The tongue is dry, attended with thirst, loss of appetite, nausea, and occasional vomiting, and a desire for acids. The secretions generally are checked. Perspiration is diminished, and the skin is hot and dry. The urine is at first diminished in quantity, and high coloured. The menses, in females, are either [Pg 28] suppressed or very irregular. The bowels are frequently costive. The patient passes restless nights, and is prevented sleeping by a tormenting cough, or if he sleeps, is troubled with dreams. ”

“ Among these may be classed, the Lichen Islandicus, which has gained with some the reputation of curing Consumption. Weak is the foundation for hope of those who depend on it. As an article of diet, from its mucilaginous property, it is useful; and in the last stage, from its possessing slightly better and tonic virtues, it is also proper; but as a remedy for phthisis it is altogether inert. Nor are its tonic powers sufficiently great, to render it injurious in the early stage of the disease.
The dress of the patient should also be regulated by the Physician. ”

“ But the indiscriminate use of blood-letting is not here contended for. Its judicious and cautious use, when inflammatory action is evident, alone is intended to be advocated. On the other hand, too timid practice may induce us to withhold the lancet when it is necessary; and we may thus do as much injury by losing the proper time for action, as we would have done by pushing the remedy too far. It is difficult to fix the period beyond which it is improper to bleed in Consumption. ”

“ When subsequent to a sense of weight and oppression in the breast, which scarcely amounts to a feeling of pain, together with cough, difficult respiration, and general lassitude, a quantity of blood is suddenly, and in a convulsive manner, discharged from the mouth, there can remain small doubt respecting the part from which it proceeds. ”

“ The mind is extremely vacillating, at one time depressed, at another, elated with hopes of recovery. Profuse diarrhœas, alternated with obstinate torpor of the bowels, exhaust the patient; the eyes assume a ghastly and pearly whiteness; the mouth becomes filled with apthous eruptions; sometimes hiccup ensues; the patient’s mind becoming more and more disturbed, delirium comes on, which soon terminates in death.
An assemblage of some or all these symptoms, constitutes Phthisis Pulmonalis, differing however very materially in number, degree and violence in different patients. ”

“ Sedentary habits of life, accompanied with hard study, and too intense application of mind, predispose literary men to Consumption. Loud public speaking, blowing on wind instruments, glass blowing and other circumstances requiring a laborious and continued action of the lungs, produce the same effect. Any one of these causes may frequently exist without injury, but their combined action seldom fails to produce pulmonary disease. ”