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The! shall TINU whic Map! diffe entin begii right requi met^ This item is filmed at the reduction ratio checked below/ Ce document est fiimi au taux de reduction indiqu6 ci-dessous 10X 14X 18X 22X 26X SOX \/'' 12X 16X 20X 24X 28X 32X i The copy filmed here has been reproduced thanks to the generosity of: L'exemplaire fiim6 fut reproduit grice d la g6n6rosit T 11 ONTO : ■FL&. T-x TJ i>T HP ID :e\. cfc iN/i^ J.o o:r.3s/r, 18G5 y DISEASES OF THE THBflAT & LtlNGS. A PRACTICAL TREATISE ON CONSUMPTION, BRONCHITIS, ASTHMA, AND KINDRED DISEASES. WITH A DESCRIPTION OF THEIR TREATMENT BY INHALATION. 8T J. KOLPH MALCOLM, M« D.. PHTMCIAN FOR PULMONABY D1BSA8BS. i^i ■ ■» TORONTO: DFLS- UTTI^TEIFL dte Ivl -A- Ij O O Xj 3S^. 18651 V fi taaaBeafSBsx- — - PBEFACE. * « I„ prMenting thb Tre.li» l« the C««ii.n p.W«, I -»f,^™l"«' '»'.'' * «OTfal i>eru«J, not K. miioh on weoant of the manner in which the .ubjeot is tre»- tr^ „r^«nt of the ,«t importanee of H« subjeet itaelf. When we roSect on A<, indiiimtaMe faet, that of aU the manifold disea»« whieh afflict humanity, there « i^ tCuent in it. oconrreace or « fatal in ite isaue aa Pnlmona^ Con^imption Td Lidl that it ooeur. at all age. and ir-"? 'f "Vj f I naut"^ ri«htly to eomprehend the importonoe of inorea^ng our Vnowledge of the nature of 2 toaae and of deviaiag some more effioient meana of arreating ita proper and XSreul So long aa the people remain ignorant of the c.u»s whieh pro- Z*lmptio" -d of the aymplirwhieh mark ita Srat stealthy and insidiom, .rro^h™ we oannot hope that any timely .tep. will be Uiken for its prevention, ^r^HTti wh^ are unhappily struck by the fatal arrow, will be spared the danger and the «.«erings arising from confirmed disease of the tanpi. That this w»t of information does esist among the people '""^^^^'^■^^ to obviate it a. much a. lies in my power, I have written and "o^P'l"* *" ^'fT^ In doine so I have endeavored to avoid technical terms as mm=h as possible, in ordek I^t roTrsona, whether profesaional or non-profe^ional, may the be«.r understand TbLtfnthepr.eti«,of the majority of medical men io -""f .'"^^tf j^ in mystery, and keep their patients as much in the dark as po^ible in regard to he LatZSeir disel This is certainly wrong. Medical men should cast off Ih. dSse ^d lay aside the mystery by which it has too long been their custom to mS^TverTthin^lZiiuing to' flie healing "*, and stand forth a, te«>hers of th^ rl PWn pr^ieal clay, on Physiology. Hygiene and Medicine wiU advan« "cL of «.ience, diffuse useful knowledge, and inealculably beneSt aU classes of "^i^lpo^ to confine this treatise to a description of the various disease, of to Lungs .^Air-pa»ages, most frequently met with, and a short description of the rational method of treating them by Direct Medication by Inhalation. I would first call attention to the fact that the.e diseases canK o«^/o«rtA of dl the diX in Canada, and that hitherto ail the various method, of treatment m gen- r^l ut^r ftl eure'have utterly failed; hen^ the necessity for -•""S--*- method of medication. By universJ consent among the people, and with few and ^n leptioD. among the profession, these disease, have been regarded as ...«r«. 1 r^ C^bt th^ no art of medicine could drive them out or destroy hem, tL heZldreoht^ned possossionof the lungs. Thenceforward the,we,.te^^^ Z^riasure amons the delicate ^r^cetts; to ravage as tbey would «.e fine mem- ima^us e«f.«e of'thi. e»,uisite organ of breath; to cUote wim ™ocr»..=, vr IT i I corrode with ulcers, this inlet and gatherer of life; the remedies applied, of a char- actor by no means suited to the nature of the disease; the mode of administeriujr them, still less so. No sooner is it discovered that the lungs of a patient are diseased, than pills, pow- ders and syrups are administered by the stomach. Its regular functions are diBturbed; Its digestive powers are weakened; and its assimilation of nutrition is rendered im- perfect. Dyspepsia follows with its train of miseries. The organs depending ou the stomach for their daily employment are thrown into confusion. The heart no %] onger propels its stream of generous blood in an equal current; the impurities in ^ the blood promoting fitful pulsations. The liver, cut off from its healthy occupation sinks into languid inaction. The kidneys, unused to foreign secretions, are yet ^ compelled to labor beyond their design, in removing impurities from the system — Every department in the economy of life is disturbed and thrown out of order; and • 18 it surprising if all sink together, shattered by the effects of the impurities circula- ting throughout the system? i On the othet hand, let us change our method of treatment. In' other diseases we ^ apply our remedies to the diseased organ : Why should we not do so in consumptioa and other diseases of the lungs? We know the influence exerted on our bodies by ' " the natural air we breathe; and feel, most sensitively, the slightest change in the con- dition of it. Charge it with a noxious gas, and we become oppressed : inspire it j with a salutary balm and we are elated : soothe it with a narcotic odor, and we yield 1 ourselves to its drowsy influence : sweeten it with the fragrance of flowers, and plea- sure runs tingling through our nerves. And so we change the effect produced on ou-- senses, our symptoms, or our lives, as we vary in its elements the air we breathe. In no medium around us have we a conductor of greater power; and yet so finely drawn, — so minute, — so natural,— that it enables us to act on the system by the gentlest means; to apply our remedies with certainty; and to reach the disease with- out doubt. Shall we not, then, take advantage of this natural method of introducing remedies into the system; or shall we continue an un-natural, disagreeable and in- \ effectual treatment, by drugs sent on a blind mission, through the stomach? ll Medicines, properly administered through the stomach, are of inestimable impor- ^^ tance in regulating and raising the tone of the system : nor is their proper use by any means mconsistent with inhalation. They ought, if need be, to cc^work together. JJy inhalation we bring the remdies to bear directly on the diseased lung; as by rem- edies administered through the stomach we aet dixectly on it ami the bowels. Inhalation, in the treatment of consumption, is the appUcation of the remedy in the most direct manner to the seat of the disease. But inhalation is merely the mode of administration: the medicine prescribed, its nature, strength, times and other contingencies must depend on the judgement of the physician; and he must form his opinion on a thorough knowledge of tlie case, — its stage, symptoms and peculiarities; hence it will be at once seen how impossible it is to reduce the prescrip- tion to a common standard, and applicable to all cases, no matter how different ia habits, temperament, staere of the diseasfi. nr nonafUnfj^noi \A\^a^^,^^^ n be no specific so long as men differ so much in constitutional peculiarities. of a char- [Qiniateriug I p'IIb, pow- I dnturbod; ndorod im- [Hindiufg on ) heart no purities in )coupation, ns, are yet sjsteir. — order; and ies circula- liaeases we usumptioa bodies by b the con- : inspire it d we yield and plea- xluced on e breathe. t so finely em by the ease with- itroducing le, and iu- 1? )le impor- 3r use by together. s by rem- Is. eniedy in erely the ;ixaes and i he must toms and prescrip- Oferent in II -__ I do not ask for faith in the many suooeatftil oases I have treated by inhalation, without presenting at the same time, the reasons upon which the treatment is groun- ded. I wish persons to be well informed as to their condition, before they are called upon to judge of the reasonableness of my advice. I wish their confidence, it is true, not on grounds of credulity, bUt on those of rational conviction. By giving them information regarding the nature and causes of Consumption, Bronchitis, and Asthma and the means of applying the remedies, I hope to arm them agains* the dishonest pKUjtice of empirics, uneducated, and inexperienced in the many phases of pulmonary diseases, whose blundering experiments are too apt to bring unmerited odium on in- halation, rather than on him who abuses it. It having been the opinion of the majority of medical men, until recently, and is now that of the non-progressive members of my profession, that "consumption cannot be cured," many persons will hesitate to believe any peison who holds viqws at vari- ance with the stereotyped views of some of the older physicians; but this is a pro- gressive age, and medical science is keeping pace with other sciences. That con- sumption can be and has been cured, even after cavities have been formed, or in other words, after portions of the substance of the lungs have been disorganized and expectorated, is beyond doubt, and can be readily substantiated by any medical man who has taken the trouble to examine the lungs of the dead subject in post mortem examinations. I have frequently seen the cicatriceb remaining where cavities have, healed. Further proof of the curability of consumption can be found in the works of the immortal Laennec, who demonstrates it beyond doubt; of Sir. Jame? Clark, who asserts "that Pulmonary Consumption admits of a cure is no longer doubtful;" of Dr. Carswell, the distinguished Professor of Pathological Anatomy in the Lon- don University, who declares that "Pathological Anatomy has never afforded more conclusive evidence of the curability of a disease, than it has of tubercular consump- tion;" of the late Dr. Swett, of New York, who says, "I have known a number of patients during the last fifteen years who have had the evidence of consumption, and some of them in an advanced stage, who finally recovered, and are now in the enjoy- ment of good health;" of Dr. Wood, of Philadelphia, who mentions several cases of the disease perfectly cured; of Professor Bennet, of Edinburgh; of M. Boudet, of Paris; and many others whom I might mention, did I not think these sufficient. To a physician who has grown grey in practice, and cannot call to memory from, among the many consumptive patients he has treated, one whom his ministrations have saved from an untimely end, this skepticism is perfectly natural. Drawing his conclusions from his own experience, he rightly judges that consumption is incurable;, and so it would continue to be did we follow the same mode of practice which he did: but under the uto of the recent discoveries in medical science, it is now found quitet curable. The bitterest pill a patient can administer to his physidian is io express an opinioa that some other medical man can perform what he has failed to accomplish, and hence this class of nhvsiniana rln nnf liMfnfo tr> oTiamnl-APizo oil Tr>o(1i<'inn /^ooir^^od to effect the cure of consumption as ''dishonest" and "empyrical." It l« gratifying to me, however, to kn .4. ;.♦<.. ....'.' 10 CHAPTER IIT. On the Causes which predispose to diseases of the lungs ...tu ui.i, li CHAPTER IV. Acute Bronchitis, Chronic Bronchitis, their varieties and treatment wi...* 19 CHAPTER V. Pulmonary Consumption, Comparative prevalence of, in diflferent dountrles.... 21 Nature of consumption. Description of tubercles i; ;; 22 Symptoms of consumption. Enumeration and comparative value of . . . . ^ i j . . , 23 Cough, Shortness of the breath, Expectoration.;;. 4^ i..u...n'i'.'..'. 24 HsDmoptysisj or spitting of blood. Pain in the chOst .<; ...* JJ,,', 26 Circulation, Eectic fever, Night sweatsj Thirst 4 .; ....wu...,*.*.!! 26 Diarrhoea, Emaciation, Appetite, Menses, Hoarseness, CEdema ....44....!!..".*!! 27 CHAPTER Vt. Causes of (k)nBnmption,4 4 4.v...t4. 44 44; ..44.. ..44.. »..»♦.... 18 CHAPTER VII. Diagnosis of eonsuaption. Inspection, Percussion, Auscultation, as means of, 30 CHAPTER VIII. Prey«nti(m of consumption, (iraotioal rules for, ....44 ,..t,**»t 3i CHAPTER IX. Varieties of flonBumption, Acute or galloping consumption ...#...«.. 83 vf a a rg A J. xixy u&i. Chronic consumption, Symptoms and course of,.... 34 vm CHAPTER XL Latent consumption... CHAPTER XII. Consumptiou in infancy and childhood oi* CHAPTER XIII. Complications of consumption , ^_^ ^ op CHAPTER XIV. Duration of consumption ., on CHAPTER XV. Treatment of consumption , An „ by the stomaflh, do. by the skin !.'..*.!.!.!....!!!." 41 „ through the lungs, effecta of climate, inhalation of medicated vapor's* 43 Medjcmes used for inhaling aa CHAPTER XVI. Asthma, symptoms, causes, and treatment of, 45 APPENDIX. Statements of patients recently cured >« OMNiONS Dl* TflB 'Prkss' , ..................,..>. 65 'f4fc / 'J ^ . INTBODUCTORY. 37 38 39 40 41 ited Vapors 43 44 46 40 65 My views on pulmonary diseases will probably be better understood by tbc maior- ity 01 my rcide.H, ,t, beluro de.c; ibinf-' the diseases, 1 give a short dcscnption of the parts compnstrl by tlio tonns Air-pas.sujes and Lnngi^. In the fiiht place I will notice die mouth and nasal passages, which terminate posteriorly ii> one cimnion civity called the throat, fauces, or phrruiix. This is that part unmcdintcly behind the mouth, and is seen on opening the mouth widely and depresHng the tongue, and includes the «(;«7f,, a small body dopenaing from the centre ot the posteuor termination of the mouth, on cither side of it the soft palate, which uivides into two pillars on each side of the root of the tongue, enclosing two Rranmar bodies called the tonsils, or (wiyyduW, the surface of which is covered by iolliclcs which in the healtl.7 state of the puts, assist in secreting a thin mucua which lubiicitcs the throat. Upon cxauiiriation, the following openings will bg found commuiiic.iting with the throat: above, the ^wsto'ior )t«irs or openings from the nohc; in fiont, the posterior termination of the mouth; and below, the terminal passages of the pharynx in the a;v>phngm or gullet, which conveys the food, etc. to the stomach and Inc opening leading io tlie larynx, or the passage to the lungs. In the nasal passages we find several openings which communicate with cavities and ducts, liuod by the same eontinuous mucms membrane, of which we will name tlie following:— 1, a communication from each of the cavities situated beneath the eye and on the external side of the nose, known to anatomists as the antrum max- illare: — 2. (hose of the hr.lmjmal ainah, which convey the tears from either eye to the nostrils: — 3. those communicathig with i\\e frontal sinuses, two cavities eituated behio I and between the eye-brows, and capable in some instances, of con- taining half an ounce of fluid : — and :. the openings of the eustachian tubes, which •admit air to the inner side of the drums of the ears. The Luri/vx is situated immediately behind the prominence of the throat, known as "Adam's apple", or 2>»mum Adami, and terminates infcriorly in the in the edioated inhalation. CHAPTER I. COLDS, CATARRH, OZ^NA. By far the most frequent of all the diseases to which the air-passages are subject, is cold. This is not at all surprising when we consider that the whole extent of the delicate membrane is, at each breath, exposed to every change in the state of the atmosphere, whether from natural or artificial causes. Our Canadian climate is exceedingly changeable, and our civilized (?) habits render us still more liable to take cold, on account of the frequent changes from crowded, over-heated, ill-ventila- ted apartments, to the cold air out of doors. How frequent an occurrence it is for persons to leave the ball room, concert hall, or evening party, on a winter's evening where the room has been heated to a temperature of nenrly 100°, and walk or drive home without a sufficiency of clothing to protect the body, and without any protection to the mucous membrane of the lungs. The extensive mucous membrane is exposed to the cold air, its secretion is suspended, congestion and inflammation follow, and the patient suffers from an attack of acute catarrh, laryngitis, bronchitis, or inflammation of the lungs, according to the part on which the disease has located itself. Other fruitful sources of colds are, from sitting in a draught when over-heated, wearing damp clothing, and insufficient protection to the feet and limbs. Acute catarrh, or "cold in the head", is the most frequent of all the varieties of cold, on account of the mucous membrane of the nose being first exposed in breathing naturally through the nostrils. The first symptom usually noticed is a dryness, and "sense of stuffing in the hose"; the mucous membrane becomes red, inflamed, and swollen, until the patient cannot breathe through the nostrils, or does so with difficulty. There are frequent, arid violent attacks of sneezing, and if the disease extend to the frontal sinuses, there will be acute pain in the forehead. This form of catarrh is known as influenza. It may also extend through the lachrymal canal, which conveys the tears from the eye to the nose: if so, the tears may flow down the face, and, being acrid, will excoriate the skin. A thin ichorous fluid begins to distil from the nose, and inflames the surrounding integument. This gradually changes to a bland yellow mucus, and in a few days the complaint has subsided or lost its acute character : but if left to cure itself, it fre- quently terminates in chronic catarrh. Sometimes the iuflammation extends along die eustachian tubes and causes deafness. This is especially the case in scrofulous constitutions. Treatment. — Acute catarrh is best treated by an active purgative at the outset, low unstimulating diet, cooling diuretics, and the frequent use pf warm ano- dyne or soothing inhalations, to allay the irritation of the mucous membrane. During convalescencr, it will be found necessary to use more than ordinary precau- tions to prevent takini,;' a fresh cold and suffering from a relapse, which renders it much more liable to pass into the chronic form. Chronic Catarrh, is generally the sequel of an acute attack. After a longer or shorter time, the liability to attacks of acute catarrh becomes increased, and the patient finds, after these attacks have passed off, that there still remains a discharge of yellow mucus. On looking into the nose we find the mucous membrane thickened, inflamed and in some instances ulcerated. ''tC 12 «1 J'"'" ^^^''?^ '' T* "^'^^ ^" '^^^'•^^ f«'"'"«. ^''^ 'n«y consist in ''hawfein-" ar d.^ matter. When .„e u,co.,aio,. L con^dcnS I ^u:CZ '^.t!^ tiont much n^ore Kable to suffer fron, at ar^s of lolrl nn l'"' vT'^' ''"'^''' *^" P"" extend itserdormards atn" 7hl T '^" l'"^""'^ ^I*^'^'' ^''^ '^'•^^"^ f>^« *« <3bia« tubes to r intnn ll^r '..nd V ":?* "^^^''^'^'^'h <^'ctond,s alonj,^ the casta- «.«»♦ f %/i '"^""'" *^'^'^» "nd thus destroys tho 8onKM>fboirin«r T»„-a 5= - .4. T"/^*^^"'"^« .^"•^^IV iinportant that catarrh be ron.nv.d .t one- h --''" - a»Ciu thvsv most scnuus consequences. ' ' "*"" '*' %..-— )» tisiht in "hawking", or r Straw colored niucus^ ig the thio.it, mny bo ^aiu, sniull ulcers i'orut piitiont cjnnot refraitf ?i exude, and are roiuo- •facH of the tt! neck, low diet, and warm anodyne inhalations, witli aitcMtivea by tliij sioiiiMch. VVlien the disoiso progresHes to Hiicli an extent as ti) rihhiur HuUocation innninent, it becomes necessary to make an artilicial opening in the windpipe; into which a silver tube is inserted, in order to permit respiration to proc >'mI uninterrup- tedly. This Hliijuld never bo put oi!" too long, for if it b,;, tlie bli.oj becDUies ho poiS(Micd that the patient may die from the effect of the poistjn on ilie brain, and other vital organs. Chronic Laryngitis, or Clergymen's Sore throat. This may occur either as a result of an rente attacH, or be produced by frequent and prolongod use of the voice, or the constant irritation produced by inhaling irri- tating substances with the breath, as in the many occupations in which people breathe a dusty atmospliere. It is attended by hoarseness, uneasiness in the throat, a slight h'.icking cough, or perhaps uicroiy a hcmhlvg or nisjiing from the throat of a clear mucus having the appearance of starch. There is frequently a sense of heat, dryness, constriction, itching, or may even be pain in the throat on pressure or use ol' the voice. The voice gets hoarse on using it and the patient finds himself unable to speak or sing, tor more than a lew minutes, without diificulty. As the disease advances there is frequently complete loss of the voice. The cougli, which was dry and hackipg at the outset, soon becomes loose, and the patient now expectorates mucus, altered in its character, or perhaps pure pus. If the fauces be examined they may be found inflamed, or may exhibit patches of ulceration. From whatever cause it arises, chronic laryngitis is always a serious malady; for it not only threatens complete loss of the voice, but, when left to revel at pleasure, rarely terminates until it has involved the lungs in disease. It will not recover of Its own accord, for every slight cold, — every change in the weather, — every breath containing dust, sustains the irritation ajid increases the inveteracy of its hold. Treatment. Being a local affection, it should always be treated by the appli- cation of astringents and alteratives to the diseased part. On account of the great irritation produced by the application of solids or liijuids, even when in vei-y mmute quantitiis, and the difficulty of introducing them, it becomes necessary that they be introduA^d in some other manner; hence the utility of mild medicated inhalations of vaporized niedicines, and by breathing them with the atmosphere, introducing the reniedies in such a gentle manner, as to reach the disease directly and without diffi- culty. In additi(>n to the use of the inhaling instrument, warm, sedative and astringent fumigations at night on retiring, will materially assist the removal of the disease. Very few cases of it will fail to be removed by this treatment, and those few will generally be fbunfl complicated with extensive tubercular depositions in the lun^s and the cure will depend on the possibility of removing the disease from the lungs! This being a local disease, docs not require that the stomach be tortured wi'th nauseous and unnecessary medicines, which certainly can do no good, and may possibly do harm. Neither is it advisable te burn the throat with stioiK^ solutions ot causue, as it is very rarely that they can be introduced into the larynx, on account of the instantaneous closure of the gloitis on the approach of foreign substances; and in the few cases where a drop is forced through the opening it causes so great sense ot suffocation as to render the operation very hazardous, and occasionally fatal coo- ' sequences have resulted from the attempt to burn the throat. Many consumptives attribute their disease to the frequent and unnecessary appli- cation of strong caustic solutions to their throats. : (l''i)letion, mustard , wii.li aitt'Mtivoa by A) roihliir Hullbcation J tlio windpipe; into procnl uiimtonup- lu! blt.oj bucDiiies HO !on on Uic braiu, aud iroat. roduccd by frequent cod by iiibuliu!^ irri- vhich people breathe t h'.icking cougb, or iir mucus havinj^ the Irynoss, constriction, J ol" the voice. The ble to ,sj)eak or bing, Hu advanccH tliere ia dry and hackipji; at !S niucuH, altered in they may be found serious malady; for ;o revel at pleasure, . will not recover of weather, — every •eteraey of its hold, •eatod by the appli- ccount of the great hen in vei-y minute Bssary that they be iatcd inhalations of re, introducing the J and without diffi- arni, sedative and the removal of the 17 If the diaease be not checked by the nse of prdjitr titeafancBt, it mmm readily down through the bronchial tnbcs to the lunga, and the patient too frequently finds to bis sorrow, that it is but a step from chrdiric larr^ngitis to disease of the Ittags. the nawe hroncMtis is frequitotly, and v^y Jrtrippr(!yiyriately appliea t6 tliis dis^ ease, and too many physicians misl6a(d tbe*^ patieWts bjr m\h^\t{nms pfrpal^f acceptation of the term. The patient is told "that his diaeas^ls only bronchitis" which he has always understood to mean an affection of the throat, and of little consequence This is most emphatically wrong. — There are no bronchial tubfifi until the trachea or windpipe has reached below the temrinotron of the throat in the cheat, and hence there cannot possiWy be bronchitis without the disease beins? situ- ated in the lungs, ta the bronchial tubes form part of the lungs. Let us then, hear no more, the application of the term bronchitis," in this p^tmlftf sense; and I entreat medical men to no longer prote themselves to be "false li-'hts" by misleading poor unwary victims to neglect immediate attention to their disease, by leading them to bfeheve bronchitis to be an affeotioH of triviai importance. How nsany valuable lives Wotlld artmually be sa^ed, — htfw many heA»t-rehding sorrows, bitter pangs, social ties severed, sorrowful pattings fr#m kyted (mfes fondly cherished, be averted, were this ftarfril misconceptioti rmb<^ I H6W numerous are the hearth-steire circles which ate aimniiHy broken, and the r^suMining members clad m the habiliments of mourning, as a result 6f this tfnJtiStifiaMe ertot ? Can it be possible, that a sensible man Will wilfttlly defceive a cofifidirig patient, by such practices, when he knpws foil well that his opinion is only indueiiig the patient to delay seeking that aid, which cartftot be applied a m9 WiOked prac- tice I ~ Let us patrte, contemplate the result, attd rtti-1^ dtxi trfox, bfefore any m6»e pi-ecious lives ate sacHficed b^ this Jwggertaant of ert-ot ! It* tiitlws are to6 numerbtts already ! — In the future, let us be 6ani3id Witb our ^tl^Ms, and inform them as to the true nature of their disease; and no longer sin %MAst an Almighty Father by deceiving them, and thus lead them to hasten an ineritable doom, which alM, comes but too eocm, when all the mo»t improved methoda of ti^atmeat ate skdiftilly applied I CHAPTER III. and those few wiU itit)ns in the lungs, se iVom the lungs. \\ be tortured with 10 good, and may th strong solutions larynx, on account gn substances; and uses so great sense isionally fatal con- unnecessary appli- ^N 7BI: OA^^BS WHICH FHSDISIN^SS TO SISEA^B \ f Hfi HJNGSi i have now completed the description of" diseases of the nbse andlhttat, ftM. before taking up the diseases of the chest, I propose to briefly notitie the jiriitcipal causes which predispose to those diseases. It will be well for us to recall the statement previoualy made as 16 the extent c^ the mucous membrane exposed to the air at each breath : — viz. fifteen hundred square feet, that this is also exposed to any irritating or poisonous ingredients which may be contained in thg.t air, and that, in the various mechanical pursuits of 18 life, the atmosphere inhaled is filled with more or less minuti particles of dust, and other irritutin-j; materials. In the persons of stone cutters, grinders, polishers of wood and metals, workers in cotton and woolen factories, &c., where quantities of dust and spiculae of metal, are continually floating in the atmosphere, there is a very alarming proportion of disease of the lungs, caused, no doubt, in many instances, by the irritation of the mucous membrane by the foreign matters inhaled with the' air. The comparative prevalence of disease of the lungs in the various professions and trades, will como under our notice again, when treating on consumption; hence I will devote no more space to the more minute details at present, but confine myself to merely mentioning the causes which render the lungs more liable to take on dis- eased action. Other fruitful causes, are the frequent changes in the density and humidity of the atmosphere; both from natural and artificial causes. The natural causes lie bsyond the control of man : — the artificial ones are more subject to our power; and would ba far less productive of disastrous results, did we not follow to so great an extent, the customs and habits of the mischievous fashions of the present day. It is an every day occurMnce to sec persons crowding together iu the theatre,* ball- room ,conc3rt-hall, lecture, or evening party, where the atmosphere is heated to a high temperature, and the rooms poorly ventilated; where they are compelled to breathe the noxious emanations from the lungs of the numerous assemblage; and then immediately go into the open air where the temperature is from fifty to eit^hty degrees lower than that of the room just vacated. The poisonous effluvia arfsini from many of the lanes, cess-pools, and poorly drained portions of our cities, where at every breath, we are compelled to inhale the poisoned air, which, conxinc^ in con- tact with the delicate structure of the lungs, cannot fail to exercise a deTeterious influence on the health of the body; j^hich depends to so great an extent, on the purification of the blood by means of the oxygen absorbed through the mucous membrane of the lungs. The unnatural positions of the body assumed by many tradesmen also predisposes to disease of the lungs, by preventing the chest from expanding sufficiently freely to allow the lungs to take in enough air to keep the blood in a proper state for the due performance of its functions. This will be more especially noticed in persons who stoop or draw their shoulders forward while engaged at their regular oc-.apations; and also in those votaries of fashion who indulge in the injurious practice of tight lacing. The various forms of intemperance are also very fruitful predisposing causes of disease of the lungs. In consideration of these, and many others which might be mentioned, is it at all to be wondered at, that consumption and other pulmonary diseases arc so prevalent' In so far as we depart from the course which nature has marked out for us in these matters, we render ourselves liable to the penalties which she has imposed on the violation of her laws, and until we pay more strict attention to those laws, the couch of sickness and the premature grave will not want for tenants from the ranks of youth and beauty. Having noticed the principal causes which predispose to pulmonary affections I will proceed in the nc-t chapter, to a description of those diseases. ' 19 ti particles of dust, and •8, grinders, polishers of &c., where quantities of nosphere, there is a very 3ubt, in many instances, aattcrs inhaled with the various professions and in consumption; hence I sent, but confine myself re liable to take on dis- lensity and humidity of The natural causes lie bject to our power; and ot follow to 80 great an of the present day. It lier in the theatre, ball- nosphere is heated to a they are compelled to nerous assemblage; and ! is from fifty to eighty •i^onous effluvia arising as of our cities, where, , which, conxing in con- 3 exercise a deleterious great an exteat, on tho i through the mucous lesmen also predisposes ng sufficiently freely to )roper state for the due noticed in persons who lir regular oc;.apHtion8; irious practice of tight predisposing causes of mentioned, is it at all eases are so prevalent? ied out for us in these lie has imposed on the 3 those laws, the couch ints from the ranks of ulraonary affections, I ases. CHAPTER IV, ACUTE, AND CHRONIC BRONCHITIS. Acute Bronchitis, is the name given to a cold which affects the mucous membrane lining the bronchial tubes, and is sotuctinics called "cold in the cliest". It may be slight in extent, or involve the whole mucous lining of the bronchial tubes. It usually commences with a chill, more or less severe, fever, dry, hoarse and painful cough, and a sense of tickling, heat and fulncps, or FluflBrg in the chest. Tl.a cough is very severe, occurring in paroxysms which give prcat iinncynrce to tl:e patient from the sense of tearing or Fcrnping in the chest. After a time tie ccugh becomes more loose and the expectoration becrmesfi'^ll y at fiut, end tl en gradually changes to a yellowish color, or may even exhibit etrcnks of bleed. The expiclcra- tion is of a tery tenrcious nature and the patient finds it very difficult to ren.cve it from the mouth. The rcf-piration is usually more or leys bun led and diffcult; the membrane, in the early stage, being dry and swollen. This may vary from a slight oppression to a sense of very great difficulty in getting the breath, and usually is less troublesome as the expectoration is increased in ejuantitv. If the dieease be very extensive and affect the smaller branches of the brenchial tubes, it may prove fatal from the want of sufficient capacity of the tubes to admit enough air (o support the system and purify the blood. In cases of great debility of the system the same result may take place, from nature not possessing sufficient strength to remove the quantity of tough, viscid mucus which is secreted; thus allowing it to obstruct tho tubes and preclude the passage of air to the lungs. This latter is most frequently seen in the extremes of age. The disease may pasn through the several stages without the occurrence of serious results, and the expectoration gradually diminishes in quantity until it ceases alto- gether; or it may subside into a less active state and lurk in the lungs in the form of chronic bronchitis. It has a great tendency to extend to the air-cells of the lungs, and involving them in the disease, bring on an attack of inflaiamation of the lungs with the bronchitis. Treatment. Acute bronchitis is an active inflammation and requires prompt and vigorous treatment at the outset. Medicines by the stomach, which, by control- ingthe action of the heart, diminish the quantity of blood forced through the lungs, are very useful. Emollient, soothing, and expectorant inhalations are also very beneficial in removing the viscid mucus from the tubes; and in the more advanced stages, it may be found necessary to use those of a stimulating nature, to arouse nature, and assist her to tBrow off the mucus, which, if not removed, would obstruct the tubes and imperil the life of the patient. The diet should be of a non -stimulating nature during tbe early stages; but may be changed to a more nourishing one as the expectoration becomes of a yellowish, color, and profuse in quantity; or it may be necessary to support the system by means of wine, rich soups &c. Chronic Bronchitis is generally the sequence of an acute attack, of greater or less severity, or of a series of neglected colds. It, too, may vary much in the extent and severity of its attacks : not unfrequently ebowing itself only during the winter, and disappearing on the recurrence of warm 20 ijlli - weather, and is then known aa a winter couqh. On the appcnrenco of Sprinp, tho T:t^ i"""^!, ^T^ ^' u, '°^''''y' "^^ ^ ^i''*^ ^"^'^^^ 'c'l "gain; but no sooner docs the cold and changeable weather of Autumn appear, than he finds himself subject lo lake cold and perhaps has scarcely recovered from one before another woi se ouo Shows Itself; which, m its turn, is succeeded by another; and so on until tlie aisoase extends to the lungs. In more severe cases it is marked by a troublesome cough, accompanied by expec- toration of a transparent, blueiijh, straw-colored, or greenish mucus, most abundant 1a -e l"°'"l"fi on w»«wng. There are occasional darting pains through the chest. ??1 '"T ^? a^rayated by a recent cold, there may be heat and a sense of ightnoss across the chest He finds himself much more short of breath on exertion than he was when in health, much more liable to take cold, and, as the disease pro- gresses, loses considerable flesh, has hectic fever, or perhaps only slight flushings in the afternoons and followed in some iustanoes, by night sweats, which increase more and more until the disease terminates in death, Jronchoprh<^a is another variety of bronchitis, in which the cough and cxpecto- Mtion occur m paroxysms; tlie p(^tient sometimes expectorating from a pint to Wveral quarts pf transparent, frothj, or glairy mucus during the twenty- four hours W n'S-f'"'"*'^'^" ^ T*^" *^^' ''"^ '^ characterized by a thickening of the b^ojohial mucous mcmbriMie, with corresponding diminution of the calibre of the m^ with a comparatively slight e^cpcctoration of transparent, blueish, or pearly #uta: of a very t^naciou^ consisteoce; or perhaps with no expectoration. «<'^!i,"^^i^T *^^ ^ ^^^^^ throughout the whole of both lungs, or any part ««!!;^*'^• • ""• ?"" *^^ '"'^'^"^ meaabrane may be ulcerated; in which oases the tJT^^^r "IV^'i*^' *^ «l««ely reBeittJt,le8 tjbat of the second st^ge of consuinp- ^'v J '^ '^'''''''^ ^ ''^^y °^''«^»^ discrimination to accompUsh c*J I w ® ^^^J^ terminates in recovery under 'h ordinary treatment by the foj?"i f proceeds uninterruptedly to the lungs, uad th. j. tient pasa^s inU> tho fir*t stage of^onsuKvpUon before he is «ware of it Thi. m^v our in the wilowinc manner :--tlie muccMw i^mbE»no of the brwchi.* ...^e hecoiMing thickened, d? mxnishjjB the«»«e of tiie tube.- ^d tb-us prevent* the a4aia«sion of aif in a sufficient quantity, on which depends the proper performance of respiration; for if an S J^cnt^s^pply of oxygen be admitted into the lungs to burn oflF the siparfluo^ carCn Si '3- ^f >««t* t^ *^ ^^. «M«1 &UH convert it into pure, or arterS ^<,od . portion of the carbpn remamTtn it, which, by accumulating in the system 1 ^Tti^r""^'' may produce tubercle. That consumption may be proluced ^ wi'^. .olJ.ag pure air, W been demonstrated by confining healthy lower animals- |.' a.t.me, m pooriy ventilated apart,mentfl, when they soon die of c^nsumptionrand on^Mmining the lungs after death, they aj-e found studded with tubercles 'o.^^f-^^'^^i' Chronic b-onchitis being situated within the chest, and bein- a .9f ai^pase, IS best treated by. local remedies; but, as it is exceedingW difliicult if ZTXf'^'f^'-l' T^.^^^P"^ by the y,e of solid or liquid n^diines^k is W? L ? "'^\r^ L'* ?'*! ^^'^^^y^' by ^be ordinary methods of treatment ^nythSalr.- -' '"^^^ '"'^ ^^^-^^^"^^ introduced in the gaseous In the first place it will be found neces'^ary to cleanse the tubes of the diseased mucus, by using expectorant inhalations, and then to soothe and heal Te d ea ed snrface by meana of otharg rent, blueish, or pearly pectorution. both lungs, or any part ited; in which oases the 2cond Btfige of consump* mijoation to accomplieh. inary treatment by the £.; tient pass'^s into tha y "-our in the allowing lecowing thickened, di- on of air in a sufficient ration; for if an insuifi- ^ the superfluous carbon it into pure, or arterial tnulating in the system ption may be produced healthy lower animals: ie of consumption; and with tubercles. the chest, and being a xceedingly diifiicult, if liquid medicines; it is methods of treatment: reduced in the gaseous 3 tubes of tbe diseased and heal the diseased rfl. which la given on next «e may require, and a the v^pqr of wj^oh is instrumentr The Inhaling iNSTRUMErrx. The patient should inliale the medicated vapor, gently and deeply into^the luagg bv djrawing in tlic breath through the flexible tube, and glass mouth-pieoe, until the 9Rcat U expanded; but not to bo great an extent as to cause uneasineae or violence from straining. This is continued from five to fifteen roinutCB, and repeated from two to four times a day according to the requirements of tho case. Inhalation is tho method of using the medioines; but the kind of medicine u«ed and the quantity to be given at each dose, can only be determined by due enquiry into the peculiarities of each particular ca.«c of di-soasc; henco the abHuvdity of redu- cing the prescription to one common standard, and treating every case alike, withiqtut regard to the stage of the disease, or the peculiarities of the constitution of the patient. Treated in this manner few cases will fail to be cured; but if \efi to run on without interruption to its progress, it sooner or later ex,tcnda to the lHng§:«pd iQvp)v($s tl;tJ9iU ip 4^»eaiie albo. CH^PTJJl V. PIJMONARY CONSUMPTION. I shall now proceed to the description of this' melancholy disease, which is so immensely prevalent, and almost universally fatal tliroughout the greater portion of the civilized world. That it prevails to a great extent is nev,er denied; yet there are few who know the actual percentage of deaths from it, or rightly compreh^d tjj^e fearful mortality from its ravages. The following table, compiled from the statistical reports of the troops s^tioned at the places mentioned, shows the proportion of deaths from consumption a^a^g them, compared with the total number of deaths from disease, rr-rr^r— West Indies, blacks, ... one-fourth die from consumptio?, „ „ whites, ... one-fifth „ „ Great Britain, one-third „ „ France, one-third „ „ Canada, one-.fourth » „ North & Middle States, one-third „ „ Southern States, one-fourth „ ,, Mediterranean, ,,,,,,,,, one-sixth * C^^p^ of Good Hope, . . . one-seventh . „ „ E|st Indies, one-thirty-thiid „ „ Australia, one-thirty-fifth „ „ 22 li HI ill «i It will be seen from the foregoing table ihat in Canada, our home, and nccessarih ..LST 7u-"°'* 'nt?'--?i"8 to us, oncfourth of all the deaths from disease arj vaused by this one. It then becomes us to seek for some means by which, if possible it' Pf ''^^"t^S^^^y be lessened and the mortality froir. this scourge, in some meas! ^nl fr i'''-/«"^«'^ 9«rk, m calling attention to this subject in England A^^:^7^ fu" ^ ^?« catalogue of human infirmities, tuberculous diseases are un- doubtedly the most deserving of the study of the physician; whether we re-art; their frequency or mortality. Confined to no country, age, sex, or condition of life, they destroy a larger proportion of mankind than all other chronic diseases taken together *_ * * * * * if, to the frightful destruction of mankind b consumption itself we add the numerous crippled and disfigured sufferers whom we daily meet with, and couple these results with the painful reflection that the predisposition to tnburculous diseases is transmitted from parent to off"pprine it will surely be unnecessary to press upon medical practitioners the claim which this class of diseases, above all others, has upon their earnest consideration". Yet how few are there among the medical men of this Province who devote even ordinary attention to it. They content themselves by allowing a patient to pa^s from the incipient stage of the disease, when it can nearly always be removed if properly treated, thiough the second, into the third and last stage, without even an inquiry whether anything more can be done than palliate their suff-erin-s for the time being and soothe the passage to the grave. If asked why they do so-^hev will C(uote m justification of their course, the old adage, "consumption cannot be cured '' in defiance of the most positive fact, and the united testimony of every author of cbihty who has written on the subject. I may mention the follcwingf- Bavle Fl3'% K ^'^^• ^°"'^r"' ^'''i.T' ?''^' ^^"""^y- ^^'"^' J^^cudamo^, CoiJini Flood, Forbes, Has ings, Watson, Clark and Carswell, in England; and Parrish Morton, Gerhard and Swctt in America. ° ' ^»^"«^' .oL'^''" ^T^^"* \ take up, in this and subsequent pages, the nature, symptoms Td fkitEv'^' "■\ '"'l'^ '\r. principles of practi^e,%hich, if adopted in S disease ' ^"^ "" successful issue of the treatment of the Nature of Pulmonary Consumption. w Jn^!r'"V''"'TP'°" '"''' ^''^^'^y 'PP^^'^^ ^'^ '"^ ^«"^*y ^'Ii^-onic diseases which were characterized by a wasting away or consuming of the flesh; but of late years has been applied to that form of emaciation etc., depending on, and asscciated^w th thejresence of tubercles m the system; and they are usually developed chiefly in the Tuhercks are small granular bodies deposited from the blood, usually beneath the the mucous membrane of the smaller bronchial tubes or the ai. 'cells of Ihc lun-^s- or they may be deposited on the surface of that men.brane. They are fi.^ seen a small greyish, semi-transparent, granular bodies studding the mucous mcn.brane and a e known asmdtary tnherdes and constitute the frst stage of consumption. Thc"e vary in size fioma millet seed to that of a common pea, and unless very numerous cause ittle variation in the feelings of the patient. He „,ay not he avvare 5 any Seal^ on p3" '''''^' '" ''T'""-'^ ^"^^'"" ^^"f^^^' «"^ ^^^t shortness of the breath on exertion, as ascension of stairs or walking up hill. These miliary tubercles increase in size by accessions of fresh particles, also deri- veUow T ] \^'°°^-' '""^ S^«^"^"y change their color until they becLe opaque, yellow, and cheesy m appearance. These are called crwc^e f^im^.; and oonstitut if.Z f^' "^ ^"^''J^''' ^[."r"* i°*o «t thi« «tage they are found softer in con- Bistence. and verv mnoh rpRAinblinr, «u «],««-„;„ " .. . mi » lu wn ^, '"•'£, <^'Ki tneese in appuuraucu. iney iiia\ vary lu 23 our home, and necessarily ^c deaths from disease are iieans by which, if possible, his scourge, in some meas. > this subject in England, iberculous diseases are un- n; whether we regart; their s, or condition of life, thej ;r chronic diseases taken lestruction of mankind bj disfigured sufferers whom painful reflection that the parent to offspring, it will le claim which this class of lion". Province who devote even illowing a patient to pass iriy always be removed if ast stage, without even an te their sufferings for the ! why they do so; they will niption cannot be cured," tiiiiony of every author of the following: — Bayle, ills, h'cudamore, Coregan, in England; and Parrish, 5s, the nature, symptoms, which, if adopted in lime le of the treatment of the chronic diseases which le flesh; but of late years i; ouj and associated with y developed chiefly in the ood, usually beneath the air-cells of the lungs; or They are first seen as 3 mucous membrane, and if consumption. These i unless very numerous, y not ho aware of any d slight shortness of the resh particles, also deri- mtil they becme opaque, tubercles and constitute are found softer in con- tec. They may vary iv tizo from a small paa to a filbert, or even in some instances that of a hen's ewf . Ihey will cause more or less shortners of breath according to their size and number' (imd there may ba cough and expectoration of mucus, on account of the irritation E reduced by them in thn surrounding tissues of the lungs. They will also cause a )ss of flesh if they be numerous. Tubercles may remain in either of the above conditions for a greater or less time according to the constitution of the patient and progress of the disease; but sooner 9r later they become softened and break down, destroying the surroundin"' tissues frhich, together with the tubercular matter are expectorated in the form of pus' leaving an ulcerated cavity in the lungs, which gradually extends its dimensions tmtil large portions of the substance of the lungs are expectorated. This is usually Jbrought about by a fresh attack of cold, and as tubercles continue to be produced We may have successive crops of them form, enlarge and soften from time to time during the progress of the disease. Not unfrequently the ulcer lays open some of the smaller blood' vessels of the lung, and then blood will be mixed with the puru- lent expectoration, or if the vessel be larger the patient may expectorate consider- ;kble quantities of pure blood. .:, After the first shock sustained by the system on account of the ulceration and ^expectoration of a portion of the substance of the lung, there is generally an im- Iprovement in the symptoms and the patient imagines himself recovering; but alas |he too soon finds another crop of tubercles begins to soften and be expectorated, funtil the system becomes so much reduced, the result of the repeated shocks sustain- led by it, that hectic fever, night-sweats, and great loss of flesh and strength super- |ene, the powers of life are gradually undermined and the patient sinks into the i|grave, another victim to the ravages of this fell destroyer. I Such is a brief outline of what takes place in the lungs in the three stages of |consun)ption. I have told you that consumption is caused by the presence of tubercles |in the kings; and you will naturaly ask— what is the cause of tubercles? This is a |question upon which authorities have long diftered, but the most approved answer to |it is that tuberdes depend upon an improper oxidation of the blood in the lungs; plius leaving an excess of carbon in the bbod which in turn is deposited in the fonn ^tubercles in the lungs. The deposition of this tubercular matter in the lungs I depends on its pre-existcnce in the blood. Now whatever tends to retard the due loxygenation of the blood in the lungs predisposes to the deposition of tubercles; |hence any obstruction to the free passage of air to the lungs; whether from partial |obliteration of the bronchial tubes from thickening of the mucous membrane by jinflamraation, or a blocking up of them by mucus; any deficiency in the quantity of |air admitted from constrained positions of the chest; or any deficiency of oxygen in Ithe air caused by other impurities supplanting it, favors the production of tub(^cular ;matter in the blood and the deposition of that matter in the lungs. i Symptoms of Consumption. Having described the usual course of the disease, I will now take a more minute survey of th^ particular symptoms which mark its presence in the lungs. It is a matter of great importance to distinguish the commencement of disease in the lungs; as it is much more easily removed if subjected to proper treatment in the early Stages. The symptoms which indicate the first existence of it are unfortunately ; Tery equivocal; to which may frequently be added the difficulty of obtaining a ^knowledge of the state of the patient, on account of the unwillingness on the part of :him and his friends to disclose his true symptoms: but I fear in the majority of J cases too little attention is paid to the symptoms in the early stages by the medical I attendant, who too often characterizes' it "as "a mere cold" ox "a slight bronchial u affeetwn which will pass off in a few days of its own accord, and contents himietf with prescribing by the stomach some palliative ''cough mixture" which masks th* real state of the disease, and leads hiu; to neglect it until it has passed into a more advanced stage and become firmly seated. He should in every case where there is the slightest suspicion of pulmonary disease carefully enquire into every symptom and make a thorough examination of the lungs, in order to be fully satished as to the nature of the disease before prescribing remedies for its removal. In order that the comparative "alue of the various symptoms met with in thete cases may be better understood, I will take them up one by one, and give a brief deseriptioa of them. In the first place I will speak of cough. Cough. This is generally the first indication of pulmonary irritation, and the first ciroum- Btance which attracts the attention of the patient or his friends. It is slight dry and hacking during the first iew weeks, and occurs chiefly in the morning on arising from the bed. It is often so slight as to escape the notice of the patient, or if noticed IS thought to arise from some irritation in the throat, and to be of little consequence : ha rarely suspects that it has any connection with the lungs. It may continue thus for weeks ov even months without any expectoration; but by degrees it increases in frequency until it occurs occasionally during the day; but to a far less extent than in the mormng; and then perhaps is attended with an expectoration of a transpM-eat ropy fluid resembling saliva, which is supposed by him to come from the throat. When such a cough steals on a person without any apparent cause it should exoite suspicion, and lead to a thorough examination of the chest. Ii may prove unimportant; for cough does not always indicate consumption; but nevertheless it IS an indication of the approach of serious miscihief. Gough is not always present in consumption; for it sometimes runs through ka vanotis stages without there having been any cough, save a gulping kind of effort in raising the matter from the lungs. This, however, is rare : for mOre frequently as the disease advances, the cough increases in frequency and severity; oceurrinc/ at aU timee, without any evident cause or excitement : but as a rule, is most severe ia the morning and evening. It not unfrequently disturbs the sleep very much and by day o^tcn causes vomiting and pain in the chest, and towards the termination of thi disease causes so m-uch exhaustion as to lead the patient to imasioe himieif to bd Buffwating. ^' Shortness of Breath, or Hurried Breathing. This is generally the next symptom which makes its appearance, Th« nuiAbei' tf respitatious in health varies from fifteen to seventeen in the minute; but in this di*' ' ease it is no unusual thing t9 find them increaead to twenty-five or thirty and thai too without exciting the attention of the invalid. It is usually first noticed on niakingsomemore violent exertion than usual, as walking quickly, or rutoing up a flight of stairs, and probably would not have been taken notice of then but lor the accidental occurrence of more tightness across the chest after the exertion than usual 1^.1 *^^.*^^"s^o*■ the.disease this is one of the most troublesome symptoms, and cattses the patient the greatest amount of uneasiness. Expeotoration. Expectoration is seldom present at the outset; but occurs after the cou<^h aas continued for a longer or shorter time. On first making its appearance it is a transparent ropy fluid ^resembling saliva; assuming by digree/a more tenacious naVuTv, a«« gijiuuiuij oewmiug ydhw w gremish in the moraingi or; may exhibit and contents himSeM' Mre" whioh masks the as passed into a more ry case where there is e into every symptom )e fully satisiied as to moval. »m8 met with in theie one, and give a brief , and the first ciroum- Is. It is siight, dry le morning on arising patient, or if noticed of little consequence : It may continue thus egrees it increases in iv less extent than in ition of a tranbpaieot from the throat, irent cause, it should lest. Ii may prove but nevertheless it Qes runs through ita ping kindofeftbrt in ir more frequently as rity; occurring at aU le, is most severe ia p very much, aad by lie termination of tfee oaegiQe himself to W Og. ice. The nuiAbei' tf nute; but in this di*' e or thirty, and that illy first noticed op kly, or rutoiog up a 'of then but lor the exertion than usual, jome symptoms, and after the cough aas appearance it is a » a more tenuoious lingi or may exhibit as streakB or specks of a yellow matter floating in the transparent or frothy mucus As the disease advances still farther the yellow matter is increased and is expecto^ rated with less difficulty, and muy be streaked with blood. It may either float on water or sink to the bottom, when thrown into it, according to the violence of the cough necessary to raise it, and the number of bubbles of air mixed through it. There is no uniformity in the quantity of the expectoration in different cases, in the same stage of the disease; in some instances being very diminutive even where there is extensive disorganization of the lungs; while, on the other hand it may be in considerable quantities from the commencement, and gradually increase until it reaches a pint or more, during the twenty-fcir hours. Others do not ex- pectorate at all during the whole course of the disease : but this is a rare excention- not the rule. ^ ' Haemoptysis, or Spitting of Blood. Haemorrhage from the lungs, or spitting of blood, is a symptom which does no* always occur m consumption; but seldom appears unless there is disease in the lungs- It rarely occurs unless tubercles are now in the lungs, or the lungs are congested and m a condition very liable to a deposition of tubercles. It may take place at any period during the progress of consumption : being, in some instances, the first symptom noticed; or it may not appear until just befoie dissolution takes place • but usually before the disease has made much progress. It seldom proves immediately fatal : or m other words, patients rarely bleed to death from the lungs. By spitting of blood I mean every discharge of blood from the lungs; whether It be a few streaks of blood mixed with the matter expectorated, or in quantities of several pmta of pure blood. In some form or other it occurs in about four-fifths of all cases of consumption. It is by no means a rare occurrence for the physician to cheer up his patient by te Img him that "the blood only came from the throat": but the throat so very seldom bleeds, that m nine hundred and ninety-nine cases out of every thousand where blood is coughed up, even in small quantities, it comes from the lungs and' speaks a terrible warning. ' It may be caused by disease of the heart, injury to the chest, or suppression of the monthly flow in females: but haemorrhage occurring in any individual not sufienng from either of the above, is generally indicative of tubercles in the lungs bo much IS this the case, that M. Louis, who wrote an elaborate work on this disease, found no single instance of haemorrhage from the lungs, out of twelve hun- dred cases, which was not associated with tubercles in the lungs, or followed by their development, save in those cases occurring from the three causes above named. If you value health, or have any desire to prolong your life, begin at once to combat the disease ere it proceeds any farther, for delay is death. Pain in the Chest. Pain in the chest is present in about two-thirds of all cases of disease of the lungs at some time during the course of the disease, but varies much in extent and seventy. Sometimes it partakes the nature of a stitch, or sharp pain in the side, at other times merely a sense of weight or oppression in one side of the chest or beneath the collar, or breast bones; and in other cases merely a sense of kerning in the chest, or beneath the shoulder blades. It may be in the opposite side of the chest, or low down in the side, while the tubercles are nearly always deposited in the top of the lungs. The pain is not situated in the lungs, but in the walls of *\,' ' — I'' r" •>'" J'"" i"' "-"' ""^> »^=*"ra ajuiya.iii\:iiv, la raruiy luic immeaiaieiy over the seat of the disease. Sometimes it may resemble rheumatic or neuralgic pains- 26 and in other cases may be so troublesome as to make it extremely unpleasant, or even impossible for the patient to lie on one side. From the great variability in its presence or extent, it is by no means a reliable symptom of consumption; inasmuch as in about one-third of the cases of this disease, it never makes its appearance; and in many others does not do so until nearly the last stage of the disease. When it is present, and is associated with any of the other symptoms of consumption described in this chapter, it should always be regar- ded as a suspicious circumstance, and lead the patient to have the lungs carefully examined, in order that, if disease be present, it may be eradicated while yet in the early stages. Circulation. The pulee is generally more frequent in this disease than in health; but in some instaness may be perfectly natural, or even slower than usual. In all cases it is necessary to guard against error in this symptom, by first ascertaining the natural frequency of the pulse in each particular case. The average normal standard of eighty beats per minute may be too high, in many instances; but if the frequency of the pulsations exceed this, and cannot be traced to any other cause, it should at once lead us to examine the lungs for tubercles. It corresponds very nearly in a ratio with the frequency of the respiration, and for each additional one of the latter, per minute, above the standard of health, there will generally be found an increase of five in the number of pulsations. Those cases in which it is least disturbed are more favorable than those in which it ranges from 100 to 120 per minute. The ctrengh of the pulse should also be attended to in forming our opinion of the state of the lungs : being usually more feeble in this disease than in health. Hectic Fever, followed by Night Sweats. During the early stages of the disease, the irritation produced by the tubercles frequently causes a sensation of chilliness, in some cases amounting to a slight shiv- ering in the after part of the day, after which the patient notices the palms of the hands and soles of the feet feel hot, or burn; or there may be a slight fever after going to bed, which towards morning is succeeded by a perspiration; but he rarely experiences well marked hectic fever and night sweats until the tubercles have begun to soften. It may hie very slight at first, only being noticed by the patient feeling a desire to turn his back to the fire in the afternoon; or it may make its appearance by a chill, followed by fever, when it is frequently mistaken for a par- oxysm of o^we, and treated accordingly, without any attention to the cause on which it depends! As the disease advances the paroxysms of hectic fever become more marked, and the night perspirations so profuse as to drench every thing near the body of the patient while sleeping, and appear to be very closely connected with sleep. It occurs in nearly aii cases of the disease; not more than one in ten escaping its attacks, and is one of the most distressing symptoms attending its progress, becoming so fearfully so at times that the patient dreads the approach of the night, on account of its concomitant attendant, night sweats; which are very exhausting to the feelings of the patient, and cause rapid wasting of the flesh. Thirst. This is not a very remarkable symptom; sometimes existing only liwtt^A/l Av^An4- an/^ o^ /\4-liav*a tTAi^Tr Hiof T*oaoinrr • iMif ciAl#4i^m Anfivtal^r nnctanf is found it present in three-fourths of all the cafies which came imder his notice, to a very 2T imely unpleasant, or no means a reliable cases of this disease, so until nearly the ited with any of the uld always be regar- e the lungs carefully ited while yet in the X health; but in some il. In all caseR it is ertaining the natural ! normal standard of but if the frequency er cause, it should at ds very nearly in a )nal one of the latter, be found an increase is least disturbed are r minute. ng our opinion of the in health. iced by the tubercles Qting to a slight shiv- tices the palms of the 3 a slight fever after iration; but he rarely 1 the tubercles have loticed by the patient n; or it may make its ly mistaken for a par- to the cause on which jcome more marked, ; near the body of the with sleep. n one in ten escaping tending its progress, )proach of the night, are very exhausting ssh. sting only to a very under his notioe, Diarrhoea. During the incipient stage of consumption the bowels are more or less costive, but as the tubercles are deposited they become more regular, until after some time diarrhoea sets in, which adds very materially to the discomfort of the patient. In some cases it makes its appearance at the commencement of the disease, but is generally a symptom of the more advanced stages of it. It may occur in paroxysms, and be followed by, and alternated with constipation, and is one of the most debiliating of the symptoms of the disease, and, according to the frequency of the evacuations, will generally be found the loss of strength and flesh. During the continuance of the diarrhoea the cough and expectoration are sensibly lessened : the former being diminished in frequency, and the latter in quantity. It not unfrequently alternates with profuse night sweats : and is nearly always present at some time during the progress of the disease. M. Louis only found it absent in four cases out of one hundred and twelve. In those cases where it be- comes chronic and resists all treatment, it depends upon ulceration of the small glands scattered over the inner surface of the bowels, and is a symptom of ominous signification. Emaciation. When the progress of the disease is not fatally interrupted by eome accidental occurrence, few patients die from consumption without being very much reduced by emaciation. Often the losing a little flesh is the first symptom which calls his attention to the state of his health; while in others, especially young females, the disease has made considerable progress before the patient becomes aware of any visible change. It may gradually increase, although the appetite be good, and the quantity of food taken be abundant and nutritious. When diarrhoea has set in it progresses rapidly, and before death closes the scene, there is frequently little left but the integuments and the bony skeleton. When a person becomes thin, without any apparent cause, and has at the same time, a quick pulse and hurried breathing, you may almost certainly conclude that there is mischief in the lungs, even though there may be no cough to lead the patient himself to suspect disease in that quarter. The Appetite. The appetite varies much in different cases, and at different periods in the same case. Sometimes it is ravenous, and at others is very poor or entirely gone. Not unfrequently, a poor appetite and weak digestion are among the earliest symp- toms; and many consumptive patients hav^e been first treated for dyspepsia. The Menses. The menstrual discharge is frequently suppressed soon after the commencement of the disease, and in many instances is the first noticeable change in the health of the lady; and after the discovery of the disease in the lungs, the careless physician attributes it to the suppression of the monthly flow; when in reality, the tubercles Existed before, and were the cause of that occurrence; only requiring a careful examination of the lungs to detect their presence. Hoarseness. Hoarseness may be present in the earlier stages of the disease, and then results from inflammation and thickening of the mucous membrane of the larynx : but in the latter stages arises from ulceration. In the latter fcm it is generally asso- ciated with Apihoe, or soreness of the mouth, which first appears as a red and glossy appearance of the sides of the tongue and throat; but tlus is soon changed S8 M i! into ulearation, which may also extend to the glottis and cause complete loss of the voice, and sharp pain on attempting to swallow. These are two of the most distressing of the symptoms which are associated with the latter stages of consumption, and harrass the patient exceedingly. Apthse, and ulceration of the mouth and throat, in 'this disease, rarely precede death more than a few weeks. Some writers attribute them to the excoriating effect of the expectoration which accompanies the latter stage of the disease. (Edema. GBdema or dropsy generally is present towards the termination of the disease; but may, in some instances, make its appearance in the earlier stages of its progress. It is generally first noticed as a swelling or bloating of the feet, and gradually extends up the ankles and legs, but seldom affects the body. The face and arms may be dropsical in the mornings as the disease approaches a fatal termination. Incurvation of the Nails. This is frequently present in consumption, and causes them to be shaped like oyster shells; but is not a symptom of much importance. With this I close my description of the symptoms; and will next proceed to notice the causes of consumption. a,! CHAPTER VI. CAUSES OF CONSUMPTION. I have already stated that consumption is caused by a deposition of tubercles in the lungs, and that these tubercles are caused by an excess of carbon in the blood, from the want of a suflScient supply of oxygen for its removal. The function of the lungs, as I have before stated, is to remove carbon from the blood, and substitute for it pure oxygen. The average quantity of carbon removed from the system by the lungs of an m<^dium-sized man, taking moderate exercise, is thirteen ounces per day of twenty- four hours; and for the removal of this, ihirtyseven ounces of oxygen are required. This is performed through the mucous membrane cf the 150,000,000 of air cells in the lungs. If from any cause the supply of oxygen be deficient, or the capacity of the lungs for its absorption lessened, a portion of this carbon is retained in the blood, which favors the deposition of tubercles in the lungs. By far the most pf>tent cause of consumption, in this climate, is the frequency of attacks of Cntarrh, Sore throat and Bronchitis. These cause it by obstruction to the passage of air, consequent on partial closure of the bronchial tubes; either by a thickening of the mucous membrane, or a collection of tenacious mucus in them. In bronchitis we often find the bronchial tubes reduced in calibre to ono-half the usual size, thus cutting off a large proportion of the supply of air, and making the patient very short-breathed. Any impurity in the atmosphere, whether from improper ventilation or particles of dust floating in it. may cause consumption. It is well known that artizans who are confined in dusty workshops, and the inhnbitants of low, filthy apartments where the air is not purified by ventilation, are all very subject to be carried off by ill 1 I ) complete loss of ire associated with giy- sase, rarely precede to the excoriating f the disease. :ion of the disease; ees of its progress. feet, and gradually rhe face and arms ital termination. to be shaped like 11 next proceed to on of tubercles in bon in the blood, 'C carbon from the y the lungs of an )er day of twenty- 1/gen are required. OOt) of air cells in or the capacity of is retained in the 3 the frequency of by obstruction to tubes; either by a s mucus in them. )re to ono-half the r, and making the ilation or particles that artizans who filthy apartmenta ) be carried off by 29 this disease. The following are among those most liable to consumption from breathing a dusty atmosphere : — Stone-cutters, Miners, Coal-heavers, Flax, Cot- ton and Wool-drcssers, Dressers of Feathers and Hair, Brass and Steel-polishers, Gnnders, Needle-pointers, Grain-heavers, Ricc-dressers, &c. Dry-grinders seldom live beyond 32, and Stone-cutters, Flint-dressers and Mi- ners. 4U. Wet-grinders may live to 48 or 50, as less dust is floated on the atmos- phere from the wetted stones. Another class of artizans is peculiarly liable to consumption from the constrained positions of the body necessary for the performance of their work, or acquired ^rough inattention, while at their work. Of these I may mention Shoe-makers' Tailors, Weavers, Seamstresses, &c. &c. Insufficient expansion of the chest to ad- mit enough air to preserve the proper balance between the oxygen and carbon in the blood, is the chief cause in this instance. Fanners, Seamen, Butchers and Tanners are the least liable to consumption, probably on account of spending so much of their time in the open air; and in the case of the latter two, being so much in contact with fatty matters. Is Consumption hereditary'? Yes, but not to so great an extent as iii generally believed. — A child may inherit consumption if its mother had the disease at the time of Its birth; but not otherwise. It may inherit a predisjjcntion or tendency to the disease, which renders it more liable to incur the disease on exposure to any of Its exciting causes. This predisposition may be only an increased liability to attacks of catarrh on slight exposure, or increased irritabilitv of the bronchial mu- cous membrane. Even where predisposition is present, a large majority will escape the disease altogether by proper care and attention to the general principles of ii6&pitn« _ The statistics of consumption show that a very small percentage of the cases of it have been predisposed to it by family. Not more than one out of five can trace any family taint of constitution. The remaining four have acquired the disease, usually by^ inattention to a slight hacking cough, a series of neglected colds, or continued irritation of the throat and bronchial tubes from inhaling irritating mat- ters with the air. • Let no one then neglect any of these premonitory symptoms of the disease be- cause he or she may not be able to trace any family predispositisn; for we have already shown that a very large majority of the cases of consumption had no such predisposition; but had acquired the disease. Neither let any one suppose, that because he may not be of a consumptive family, he may recklessly expose himself to all kinds of inclemencies, for the same reason. It is customary for persons who have large and full chests to suppose that they are free from danger on that account. They frequently strike themselves a severe blow on the chest and say "there is no danger of me dying from consumption; , see the development of my lungs". They should understand that with proper care I they are less liable to take the disease than others of weak and poorly developed lunra, but that it is not an impossibility for them to take the disease. Very nearly one-half of the patients applying to me for the treatment of their disease are of this class; having large, full and well-developed chests. With a proper supply of pure air and good diet, and due attention to the ordinary rules of health, they would f probably have escaped; but, laboring under the impression that they were invulner- able, their fancied security has become the cause of their downfall. Supposing themselves to be free from danger, they have neglected a slight cold until it became a icuieu ttacicivg cough, which iu turn has terminated in covfirmed consumption, and he discc vers, perhaps too late to remedy the evil, that a full and well-developed . i I ' 1' 1 1, hi ar- chest is no certain safeguard against ^^e attacks of pul»o^^^^^ It will be observed, from the above, ^bat what^v^r «^^^^^^^ with the ^j^y^ of pure air to the lungs will predispose to disease of them, ana renaer l^deposition of tubercles in the lungs or consumption. CHAPTER VII. DIAGNOSIS, OK DETECTION OF CONSUMPTION. Disease in the lungs U demoted by Ao seW mean., In,pcCion. Percnmon and Auscultation. Jl^^cTonf t^^'examination of the shape, size fj;^^yZ^J,'::^Z:^ the two sides of the chest. If, for »°^^'^«%::,;°l'^,^'e^t^^^^^ ^i^le contracted, with the spaces between the ribs more jle^ d^^^^^^^ expansion of that side on inspiration, we at once suspect a de^c^«J«y^^^^^^^^^^^^ ^ ^^^ of air entering that lung; but from '"^\'^'''';'Zne^^^^^ adhesions other signs associated with ^K I^YvUve "Sfro^tb^^^^^^^^ of a large from an abscess of the lung from some other cause. Pefc^fsTmefntsimply tapping on the walls.of a P-^^^^f^^-^.^ oT^^^^^^^ dens ty of the contents of it; on the same principle as he ^f y^/^^^^P^^^e fu^ barrel to know the quantity of cider still '^^f;"^"? ?" ^^/^^^^^ 5fe bwer porUon ^i" «mind will be dull over the whole surface of it —it halt-Wiea, ine lowcr pui S a dull Ind when struck, and the upper part a remnant or "ow ^i The lunes in their natural state, contain a large proportion of air and emit a and blood are more dense than air. Ac^ain • if there be a large cavity near the surface of the lung, the sound over it wilt be mo e hoi ow than that of healthy lung; hence it becomes very ncce^ary that The phySusCuld acquaint himself tLroughW the healthy sounds of the SngVelse he cannot distinguish preternatural fulness or resonance. If t^?af be^llpUed to the chest in the natural condition of the lungs, a gentle rusUine sound is hS,Vhich is known to medical mea as the respiratory murmur^ rusuing souna »» "'^^ » , , , , ^ ^]^q ^^q of an instrument called a Wow^cund telwing threaused b, blowing through a tube w.ll he heard. 7„ 1. ■ -• Ar r* "*• *^'' "Vipst whfirft the resDiratorv murmur should De distUytrd:i:find^nn¥sti;cVo7 for t we know that the lung beneath that portion of the chest is m an unhealthj, Suditionj but what that condition is, can only be learned by long ezpenenco, and SI Bumption. th the free supply ader him liable to TION. ection, Percuttion aount of motioifl of 10 chest very much in, and very little ncy in the quantity by attention to the risy, and adhesions itraction of a large ar portion of it; or 5ct the comparative r taps on his cider- ! barrel be full, the e lower portion vrill hollow sound, n of air and emit a ntained in them be ecause the tubercles the sound over it very necessary that Ithy sounds of the nee. F the lungs, a gentle 'espiratory murmur^ instrument called a of the chest than is le bronchial tubes a will be heard. J murmur should be er sound substituted is in an unhealthy long experience, and careful comparison with the healthy sounds; and with the appearances found after death. If there be a small quantity of fluid in the air-passages we will have a bubbling sound, varying according to the size of the tube or cavity in which it is produced, from a fine crackling sound in the smaller tubes, to one of gurgling in large cavities. These sounds can only be learned properly by careful attention at the bed-side of patients. One thing must be said of medical men : — very few of them ever acknowledge an error in diagnosis, or admit an error in judgement; and yet I fear it is not too much to say, that not one general practitioner in a hundred is able to distinguish, by the stetheECope, one stage of consumption from another, or between pundent bronchitis and tuberculous ulceration of the lungs. Who, then, can feel surprise at the frightful ravages of consumption, when the great mass of physicians to whom invalids first apply for relief are incompetent to pronounce a proper judgement on the state of the lungs until the time for the most successful treatment has passed. This evil must continue so long as medical men resist the division of the profession into special departments, and until they encour- age their patients to apply to those whose devotion to one class of diseases gives them the skill and experience essential to correct diagnosis and successful treatment. It is very seldom that a general practitioner, however skillful, has the time or suflfi- cier^t experience to become a good stetheKCopist; and yet, so long as he continues to ti-eat consumption, the lives of his patients hang upon his skill in this science. The remedies employed must depend on the stage and form of the disease, and no physi- '^ian can skillfully and successfully treat a patient while he is in doubt and uncer- 7 as to the nature and extent of the pulmonary afiection. ' the other hand, when a physician devotes his whole time and attention to the i^ition and treatment of one class of diseases, he cannot fail but to become :^\.,.^ skilled in those diseases than if that same time were divided among the whole catalogue of diseases to which human flesh is heir. CHAPTER VIII. PREVENTION OF CONSUMPTION. "Prevention being much better than cure", it becomes very advisable for us to seek by every available means to ward ofi' the disease from those who may be pre- disposed to its attacks, and also to protect the healthy person, as far as possible, from those influences which are known to produce the disease. Prevention in Infancy. The most important part in the case of the infant is to procure a nurse free from any hereditary taint. If the mother be unhealthy another nurse should be obtained; but if the child have inherited the predisposition from the father, and the mother be free from the taint of disease, she should nurse her own child; taking care to avoid all habits of life which could in any way interfere with health. The child should not be weaned before it is from twelve to eighteen months old, in order that it ma^ have the natural easily-digestible nourishment during the trying period of teething. It should have no other nourishment than the milk of the mother until after it has attained the age of six months; and then should only (1 88 be allowed a small portion of other easily-digcfitible nutriment, composed chiefly, for the first two or three years of its life, of milk and farmaceous articles ot diet. The dress should be loose, and sufficiently warm to protect* the infant from all inclemencies of the weather; taking care to '•^'"^'"ber that the infant can cndu^^^ less cold than the adult. It should always be especially attended to, to keen the extUSies wdl protected. No infant sliould bo allowed to go .^'^th the arms nuked "and the legs chilled, from the want of proper coverings during the cold weather Nothing is more erroneous than the prevailing opiniou that exposure of infants in a half-covered state to the cold atmosphere will harden them, and render them less liable to take cold. — This practice is fraught with evil consequences and destroys many children. Bathing is very essential to the health of infants and should be performed by spon-in- with tepid water, follo^7ed by friction with a warm dry flannel m the morntii and immersion in a warm bath in the evening, before the child is dressed for the night. .1 . j Air It should alway be an indispcnsible item in the nur6ei7 to see that a good supply of pure fresh air is furnished for the infant to breathe, as nothing tends more to the production of consumption than the want of a due supply ot pure whole- some atmosphere. Therefore, too much attention cannot be paid to the ventilation of the nursery. It should be situated in an elevated part of the house, ot a good size with lotty ceilings, and so arranged as to admit plenty of the sun s rays. In moderate weather, an infant, after the first four months of its life, should be carried into the open air daily for several hours; but if the weather be at aU cold and disagreeable, it will be advisable to keep it within doors. Prevention in Childhood. The same general rules about clothing and ventilation which have been laid down in speaking of the care of the infant, will apply to that of the child : and in addition to these, it will be well to attend to the amount of open-air exercise the child takes. When a child has attained sufficient strength to play out of doors, it can scarcely have too much of it, allowing its own feelings to be its guide when to discontinue it. It is also advisable to allow it to select the method according to its own desires, only forbidding such as are positively injurious. Girls should be allowed the same plays in the open air as little boys, during the early years of their life; as the free use of their arms and limbs will materially tend to strengthen them. The clothing of children should at all times be suitable for the season of the year, taking care to wear dannels next the skin during the greater part, if not the whole of the year. If exchanged for a lighter material during the extreme heat ot bum- mer it should be rerumed early in the Autumn and continued until late m the Spring. Cotton may be substituted for it during the nights with advantage. Education. Children who may be at all predisposed to disease of the lungs, should never bo confined in a close school-room until after they have attained the a^e of nine years; and then the school hours should be much curtailed. From five to six hours a day for young children to be confined in a school-room is far too long. The injudicious practice of teachers stimulating the precocious unhealthy child to increased exertion, beyond its powers, because it does great credit to the class, w very reprehensible; and should meet the disapprobation of every seusiDle parent, xt is far more advisable that he should urge the clild to pay more attention to the physical development of the system, in order that it may not suffer from the precocious development of the bri in. i m composed chiefly, for articles of diet, ct'the infant from all the infant can endure tended to, to keep the ) with the arms naked, ring the cold weather. LpoBure of infants in a , and render them less equences and destroys lould be performed by rm dry flannel in the ire the child is dressed 5ery to see that a good jathe, as nothing tends 3 supply of pure whole- paid to the ventilation of the house, of a good if the sun's rays. i of its life, should be J weather be at all cold Had due attention been paid to this matter, many unhealthy men and women would have been more robust at the present day; and we would now have, amon^r our friends, a far less number of consumptives lau^uiMliing und(!r the tortures of this fearful malady. Prevention in Youth and Adults. The same general rules apply to tlic youth and adult: — a due amount of open - air exercise, with gymnastics etc., not too much confinement, or clo.se application to studies, regular habits, temperance and good diet, will, in the majority of cases, prevent the disease from making its appearance, even in those who may bo strongly predisposed to it by inheritance. The most healthy exercise for both sexes is riding on horseback; as no other ex- ercise calls the whole muscular organization into action to so great an extent, as a g )od gallop over the country, on the back of a noble steed. In conclusion I would call the attention of parents and children to the choice of a proper profession. No occupation should be selected unless there be full satisfaction in regard to the capability of the constitution and strength of the candidate lor the full and complete performance of all the duties of that profession. Persons of a scrofulous habit should never choose a profession which entails on them habits of a sedentary nature; but on the contrary, should select some occupation which necessi- tates them to be in the open-air a considerable portico of tlie day. i ich have been laid down 2 child : and in addition jxercise the child takes, of doors, it can scarcely I when to discontinue it. :ding to its own desires, 18 little boys, during the mbs will materially tend r the season of the year, er part, if not the whole le extreme heat of Sum^ mtinued iintil late in the s with advantage. I to disease of the lungs, r they have attained the ch curtailed. From five aool-room is far too long, ocious unhealthy child to reat credit to the class, is ■very sensible parent. It )ay more attention to the lay not suffer from the CHAPTER IX. VARIETIES OF CONSUMPTION. ACUTE CONSUMPTION. There are four distinct forms of consumption recognized among medical men. each having some peculiarity in its character, rendering it necessary that the medi- cal attendant should recognize the variety before prescribing remedies for its removal. Acute, or Galloping Consumption. The usual duration of consumption is from nine months to two years, from the first appearance of the disease to its final termination; but this variety is that which fl*uns its whole course in from two weeks, to three months. There are two forms of it: the first, appearing to depend, for its short duration, on the violence of the dis- ease; and the second, on the feeble powers of the constitution in which it occurs. The symptoms which attend the first form are usually but little different from those of a low inflammation of the lungs, and too frequently the true nature of the disease is not discovered until after death, when, if the lungs be examined, they are found studded with tubercles. It is most common in young persons, between the ages of fifteen and twenty-five, of full habit, clear complexion and ruddy cheeks, and frequently follows an attack of some acute febrile affection, as measles, small-pox, scarlet fever etc. It generally commences with a severe cold, which appears from the first to be deeply seated in the chest, causing a sensation of great oppression, shortness of the breath and cough, which, though slight at first, soon increases in severity, and is consumption in a few days. Hectic fever and night sweats soon set in, and not un- frequently diarrhoea contributes its share to the de.../ruction of the patient, who :li 84 sinks rapidly, until, at the expiration of a few weeks, death puts an end to his " Xirtond fbnn of acute eo.«.nptic.o.ur«^lu^{; iL^StSS^^ (more especially females) o ^««M>^>wers *^ Utc, w th^^^^^^ and cannot be exposed to a lower one without chillincsH. • .. nf ^Hp its symntoms^are often ve^yj"^^^^^^^^^^ freW than in health; but ^^^^-'i ^^^^^^^^^ render its symp- beeome alarmed I^"*^ %t'ru^h J adua^^^^^ Sot wo^^se, expectoration appears, toms very promment The ^^^g^^^rwmes very much hurried, night-sweats frequently tinged with blood, the b'^^^"; "-J^^^^ ^ith a pale leaden hue be- flupirvene, the countenance becomes pale 'J""^";'"' J^^" , [^o plainly the near neSh the eycB, the lips Ir^^^V^^^CbX^^ tcom rnJ mui reduced m.v die more suddenly from a fainlingflt on aouie slight exert on. "'^ulTl of the iisesso U »- of the ^^ i^«^^^^^^^^ it by the patient's friends. CHAPTER X. 't 't CHRONIC CONSUMPTION. By far the most frequent form of consumption is Chronic <^?«f""^i'fj- ^ ?,^^j' thus named in contradistinction to the acute or galloping variety just described, because it takes a longer time to run its course, and destroy its victim. It may commence with a slight, dry, hacking cough occurring in a person who is somewhat debilitated and appears out of health, which is so slight at first as to. 'ra^ the notice of the patient; he has no fever, and on taking moderate exercise has Tgood appetite. At first the cough usually comes on just alter ariBing from he bed in the looming, and rarely causes much annoyance during the day; but as the disease advances, octirs at all times and causes the patient great annoyance. It may entirely disappear on the appearance of fine weather in the ensueing ^Pn^gi <"^ ^ h« t^ke another cold, and suffer from an attack of acute catarrh, he finds on the disap- nearance of the catarrh, that the cough still remains, a slight dry haclcmg. —— Ur ?^ recommence by setting of Uood, either in . .aantities of fresh red blood, or in streaks of it mixed 4ith the Expectoration. — - Or as a general debihty, o^^ing of the tissues which gradually increases as the disease advances. In this atter case 1 paS may feel fhilly, or may only have cold hands and feet, alternating in the SLCobs rCards evLng, with dryness, heat and feverishness in the palms of aicernoouB, ui_ tu»T»i«*p ^ &» ^ ^^ •L„x:„L* i,;^c»il?. K,,f ia nni\opA bv bia friends ?n sSg h^ds ^th him. Afte/retiring he may feel the soles of the feet hot and burning. He may have slight flushings in the afternoons, which, m some instances, are followed during the night by perspiration. 8ft ts an end to his ito young personH, circulation, whose ilth i8 one of great rithout oppreHsion, »nt variety of the nd unattended by I! somewhat more ly delicate, do not to render its symp- Bctoration appears, irried, night-sweats sale leaden hue be- too plainly the near 38 so much reduced ' the patient; or she n. requires the closest ed, both on account jrtance attached to '^Consumption. It is ,riety just described, irictim. ig in a person who is slight at first as to. g moderate exercise, fter arising from the g the day; but as the annoyance. It may eing Spring; or if he le finds, on the disap- Iry liaclcing. Or 'resh red blood, or in d debility, or wasting (. In this latter case et, alternating in the hness in the palms of noticed bv bia friends Bs of the feet hot and ub, in some instances, I 1 In females, monthly irngnlaritirt arc occasionally the firnt noticeable nymptflmd, and are freriucntly wrongh/ charged with producing the diBease m the lungs. In other cases the first Hymptoin« which attract the attention of the patient are those of derangement of the stomach and digestive organs; many patients having been dys- peptic before the cough made its appoaiancc : but in others digestion remains healthy and the appetite good, until the discmse has made considerable progress, when there is frequently a loss of appetite, with diarrhaMi. After hectic fever and night sweat* make their appearance, the progress of the disease is more rapid, and the loss ot flesh much more visible; being noticcul more especially in the limbs, which appear shrunken, and the joints much more prominent than usual : the features, at the same time, becoming sharper and the eyes increased in brilliancy. The couqh, which at first was dry and hacking, sooner or later becomes more moist, the matter expectorated becoming transparent, blueish, vellowish and greenish in turn. At first it is a frothy mucus; but after a time exhibits small specks of Yellow or straw-colored matter interspersed through the other; and still later, becomes completely yellow, or greenish-yellow. Sometimes it has a sweetish and at others u saltish taste. When the tubercles are softening it is always of a yellow color, and purulent in character. , u There is generally more or less pain in the chest, side, or beneath the shoulder blades. Sonietimes it is only a .ense of oppression, and in a few 7«« °«^" ™^^e« its appearance during the entire course of the disease. When ^^e tubercles are softeniTig in considerable quantities, there are hectic fever, night sweats and consid- erable emaciation. After the first crop of tubercles have softened, broken down, and been expectora- ted, there is generally an improvement in the symptoms; the cough partially disappears, the expectoration improves in character, the hectic fever and night swea s abat^and if thJ^patient gain a few Pounds m weight, he readily imagines h^^ nettinq better, and that he will soon recover; but too often this is only like a tempo- ?ary calm in a storm, and is soon followed by the re-appearance of the disease with increased strength, when another, and perhaps a larger crop of tubercles are softened which, occurring from time to time, steadily and surely undermines the strength of The patient, ^hcse repeated attacks recur until the bodily vigor becomes so much reduced that, an attack of diarrhoea supervening, rapidly reduces the little strength remaining, and the patient sinks, another victim to this merciless destroyer. The cause of this apparently paroxysmal recurrence of the attacks is that the tubercles have been deposited at various periods, usually on attacks of cold wMoh have been neglected. After the cold disappeared the patient seemed quite well again; but the deposit of tubercles still remained in the lungs. -- After a longer or shorter time another cold was taken and another crop of tubercles deposited j and so on, until those first deposited commence to soften and break down the tissues of the lungs; forming nlcers, which corrode deeper and deeper, untU they lay open some of the small vessels of the lungs, when he has an attack of spittL of blood. As each successive crop of tubercles soften and are expectorated apportion of the lung is destroyed; until finally so much of it i«/>«0Wf M^a not enough is left to perform the prftper purification of the blood, when the patient speedily becomes emaciated and death relieves him from his sutterings. This is the usual course of consumption, when allowed to pass on unchecked to a fatal termination. In the next chapter I will describe the latent variety of the disease. 36 CHAPTER XL LATENT CONSUMPTION. This name is civen to certain cases of the disease not marked by any of the usual local symptoms \hich point to disease of the lungs; such as cough, expect<)ration shortne^ss of the breath or spitting of blood until the disease ^as neariy com^^^^^^^^ its course. Nevertheless the disease is making steady, silent and stealthy progress and sbw'y but surely undermining the health of the patient. The tubercles are kitent or concealed. .114. It may occur at any age, and from its insidious advancement, requires the closest scrutiny of a well-experienced physician to detect its presence. It usually begins by a general debility of constitution, so slight for some time as to escape the notice of the patient or his friends. After some time he feels not quite so well as he lor- merly did, and finds that he is slowly declining in bodily strength and vigor has slight fever, or occcsionally derangement of the bowels, (perhaps even diarrhoea) or nieht sweats; but the sensations are usually so slight as not to be thought sufficiently important to justify him in applying to a physician. If, by some accidental occur- rence he take cold and suffer from pain in the chest, or other symptoin ot consumption, and apply to a physician not very well experienced m disease of the lungs he will probably be told that ''-it is a slight cold, and will get well in a few days'' or that his loss of strength, etc. arise from liver complaint, ivdige^tim or dJLepsM The eye of a physician experienced in the disease would at once detect in the countenance, that which would induce him to carefully examine the lungs with the stethescope, when the cause of the bad symptoms would be immediately disclosed; but the general practitioner, whose time is so thoroughly occupied with attendance on acute diseases, and sees so few chronic affections of the lungs, or from habit takes so little notice of them, that he does not observe the change nearly so soon as one, who, by devoting his whole attention to those diseases, becomes more thoroughly acquainted with them than he possibly can. Let it not be supposed that latent consumption is a rare disease; for in hospitals, and other institutions where it is customary to make post mortem examinations ot the bodies of those dying in the institutions, it is found on examination that a very large percentage of those who have been treated for other diseases, have had tuber- cuUr deposits in the lungs: but during life no symptoms pointing to the lungs as the seat of disease were present. Laennec, the great authority on this disease says; "We may indeed say that .L^ greater number of cases of consumption are toere^, since nothin'^ is more common than to find tubercles in the lungs of persons dying of what was Supposed to be some other disease, they never having shown during hie, any symptom of consumption. It has frequently appeared to me, from carefully compwing the history of my patients with the appearance on dissection, that the greater number of first attacks are mistaken for colds." And Sir. James Clark, m sneaking of the liability to mistakes of this nature says : "I have known more than one example of extensive tuberculous disease of the lungs, discovered by a post- mortem examination, where, during life, the disease was looked for m the stomach, liver, or bowels." From the above facts it will be well understood that we may have extensive -.. :„ ♦!,« i„v,r»a TpUliAiif nnv nf ihfi iihiirI annarent svmptoms of the disease, and that those persons who imagine that they cannot be consumptive because they never had cough, pain in the chest, or expectoration, are frequently very much m error. 1>¥J m by any of the usual )ugh, expectoration, las nearly completed id stealthy progress, The tubercles are , requires the closest It usually begins to escape the notice ite so well as he for- ength and vigor, has IS even diarrhoea) or ! thought sufficiently me accidental occur- other symptom of ced in disease of the will get well in a few plaint, indigestion or would ai once detect ly examine the lungs ^ould be immediately aughly occupied with itions of the lungs, or rve the change nearly ose diseases, becomes 3ease; for in hospitals, Mem examinations of amination that a very eases, have had tuber- linting to the lungs as Y on this disease, says; msumption are latent, ungs of persons dying ring shown during life, to me, from carefully on dissection, that the 1 Sir. James Clark, in lave known more than discovered by a post- :ed for in the stomach, NQ may have extensive )ms of the disease, and bive because they never very much in error. Experience has proven that many persons are now carrying in their lungs tubercles in the latent form, who have none of these symptoms, and that it is only a question of time until the disease shows itself by some of the more evident symptoms, when too often it has progressed beyond the reach of curative efforts. By taking it in the early stages, when it is masked or hidden by the other symptoms which are attributed to the affections of the stomach, liver, or bowels, it might, in many oases, be eradicated; but, from the carelessness or inattention of the attending physician it is allowed to pass stealthily on to disorganization of the lungs before its true nature is discovered. It then becomes doubly important that persons should become alarmed when they find themselves gradually growing thinner and weaker, with imperfect diges- tion and irregular bowels, and at once have their lungs carefully examined; not trusting to the judgement of the physician who attributes the symptoms in all these cases to the liver complaint, dyspepsia, or indigestion. CHAPTER XII. CONSUMPTION IN INFANCY AND CHILDHOOD. It cannot fail to attract the attention of every reader of mortality bills, to notice the very largo percentage of deaths among infants and children. From the most reliable statistics it is found that one-half of all the children born die within the first four years of their existence; and that nearly forty per-cent of them die before they have attained the age of two years. This must be surprising to those who consider that these occur at that time of life when the recuperative powers of the system are the most active; yet it will be observed how rare an occurrance it is to find a death of a child attributed to coiisnmption. Why is this ? Is it because consumption is a rare occurance in children ? No. — In the great majority of instances it is because the medical attendant has neglected to examine the lungs for the indications of disease in them, but has contented him- self with examining and prescribing for the symptoms which are more noticeable. Consumption is much more common among children than is generally believed : — Dr. Guersent, one of the physicians to the Hopital des Enfans Malades of Paris, an institution appropriated to the treatment of patients between the ages of one and sixteen years, states as the result of his observations, "ih&t fvc-sixths of those who die in that establishment are more or less tuberculous." The observations ?f MM. Lombard and Papavoine go to substantiate the same fact. Dr. Allison of Edmburgh estimates that one-third of all the deaths of children in that city are from consump- tion. A very large percentage can be proven by any medical man who will take the trouble to examine the lungs of those children who may die under his care. The symptoms which mark the presence of the disease in children are not very manifest; there is no spitting of blood, no expectoration to examine, for it is swallowed immediately on being raised from the lungs;— the cough, when present, is m paroxysms and sometimes very nearly resembles hooping-cough, — there is generally some fever in the afternoons, but it is usually attributed to worms; — at night there is a slight perspiration on the child's forehead, but rarely well-marked night-sweats; tlieie 18 irequentiy aiarrna3a, out ii ;.k atiriuuicu tu x/tttxt/csttv.-r, .-, •• -■- - complaint; and in a very large majority of cases, there is continued and steady i :i^ 11 38 • casting of the flesh. Yet none of ^^^^^^^^:'^t^ child has consumption. It is or^y ^yj^^ ^^^a too many physicians never apply can be diagnosed with any degree of ^e^t^^^^ themselves with prescribing some- it to the chest of the young ^'^f ;;;'^^'^^;'^::h^^^^^ thinking (if we may judge thing for the more prominent ^y^V^'^f'\^^ ^^ the lungs, from'their actions) that there may be f^^l'l^Z behind the ears, pustules on the If a child suffer from eruptions ^f «^* ^^J'.'/the upper lip, soreness of, and dis- edges of the eye-lids, swelling or -"Jf^f;^^^^^^^^ ^f theTeck, and gradual wastmg of charges from the nose, swelling of ^^ S^^' ^,^e the lungs carefully exammed the strength and flesh, it is always ^^v^f JfXgly to consumption; but they all by the stethescope. None of these P?^'^* ^^XcW^ predisposes to it, if tu- in^dicate a bad state of tl^« g-^^^.Sl and Ltgl^lxLinaLn o^ bercles be not already dep?sited A caretul a^a fe ^ ^^^^^^ ^ ,^ la by a well experienced medical man ^^ fj'f^^^^ w^ l need not inform the reader never be neglected. If disease be found ^^ ^^^^^^^^^^ eteck the dianhcea for that "chalk mixtures" o\"P^JfS""'V,l* tre fungs It^.an only be removed by the time, cannot remove ^he diseje from t^^^^^^^ .^ ^ ^^^se- carefuUv attending to those principles ot practice quent chapter on the treatment of consumption. CHAPTER XIII. COMPLICATIONS OF CONSUMPTION. Before proceeding to speak of «- -SrVt^rs^hTve^^^^^^^^^^ general remarks on the vaneties of the disease it mu ^^^^^^ -^ different ^y non-professional readers to ^^^^^ ^^^ r' iS^ f ^^^^^^^^ and that the symptoms cases, produced by the one cause : viz. *"t)e7les in ^ne m ^ , ^^^^ ^ j^ are no? precisely the same in every c^e flll^^'^l^-,Z.\ro so widely difter- is because the constitutional peculiarities ot the ^^verai p ^^. ^^ j^ It. These differences ^^^^^^iJ^^^^X^s JZ ^r^e.iM probably suffer nervous temperament be attacked by tuberces^^^^^^ g ^^ ^^J^ ^, i,,^ much more from pain in the ^^^f.^^^^^^f, ™^^^^^ disease' will probably be temperament; if he be ^^ ^ '^''fl''''!'^^^'^^ and prominent symptoms; and when forming his opinion. Complications of Consumption. From what I have said in the P^f "|^,tConl^^^^^^^^ .^jn^ fvoPA the connection between the circulation o^ impure ^ ^^^^^^^ ^^ ^^^ S. jro'J?r:£^" i^ -thL *f Uwf S anothev the WeU, eto. 39 to show that the i that the disease cians never apply prescribing some- (if we may judge s, pustules on the mess of, and dis-^ ;radual wasting of irefuUy examined (tion; but they all sposes to it, if tu- lation of the lungs doubt, and should inform the reader t the diarrhoea for nly be removed by sceibe in a subse- )n I will offer a few appeared strange to mptoms in different I that the symptoms y are they not? It arc so widely dift'er- ; If a person of high will probably suffer inphatic, or sanguine se will probably be inent symptoms; and Tcraents of the liver, osyncrntiies also exert ay lead to some error* ,d bear them in mind 3 work the reader will we highly carbonized — «tV,/»%. ortfnna fiT the ,e weakest at the time: jr the bowels, etc. The Stomach may be inflamed or ulcerated, diminished in size or enlarged to twoortherSesitLriginalsize. The i.^^,er may be studded with tubercles, or more or less changed- into a substance resembling fat m appearance. The 5oi.e& may be inflamed or ulcerated, either in the mucous Immg of them or m the sma SaLs found beneath it. — In the latter case there will be obstmate diarrhoea as a Result of it The Kidneys may be affected as a complication of the disease; m which case there will be pain in the back or derangement in the secretion of urme. The foregoing complications are all situated at a distance from the disease in the lunes- but there are others more closely connected with it; as ulceration of the epiglot- r which generally occurs late in the disease, and when extensive, causes fluida to be e urned bl the nostrils when the patient attempts te swallow them; 2. ulceration of tTlarvnl and Trachea, when there will be more or less hoarseness according to Ihe fxtent and situation of the ulceration; in some cases amounting to complete loss of the vote These all appear to be caused by the corroding effects of the matter exnectorated from the lungs, in it« passage along the mucous membrane of the air- Zage 3. Affections of the pleura are of various grades from simple congestion to uceration and perforation of it. When it is simply congested or slightly inflamed the^e is rnore or less pain in the chest, which appears to be the principal inconvenience SusedTy Tt; but ^hen it passes on to inflammation we may have water and pus form outside of the lung in the cavity of the pleura, which, by its presence^ inter- es maSally wilh the 'process of respViou : or we may have the fura perforated bv outward ulceration of a tubercle situated near the surfa<;e of the lung, thus aUoSg al^ and matter to escape into the cavity of the pleura, and causing pam and a sense of great suffocation. . These are u^uallv associated with the latter stages of consumption when present at all during its course, and are exceedingly distressing symptoms. T nped not inform my readers that these all tend to complicate the disease and render its dfa^oss much more difficult; requiring careful investigation to discover tSue causeSm. It is too often the case that physicians, through inadvertance neglect tr^^^^^ and treat the complications alone, a course which cannot fail to lead to unsatisfactory results. CHAPTER XIV. DURATION OF CONSUMPTION. Consumption has almost universally been thpught to be a lin^^^^^^^^^^^^^ persons who have been attacked by it thought to have had aj^^f^^^^^^^^^ veara at least — True, it extends over a lengthend period m some instances, Dui noi Lv ily so," for from' the researches of eSiinent authorities on th« subject ^ ha been calculated that the average duration of the disease is twenty-three months, but that the larger proportion of them (^iemZmapor, directly ,o the organ atfecttxl, instead of dosing the stomach. 1 his peculiar system of inhalation has beerV followed by most grat- ifying results duiiii^ the pafet few years-many Of the mo:e oost-inate cases undtirthe old treatment— in fact, pronounced incurable-VicMing to a (;ourse of inhalation in a most renriarkaiile manner. The letters we have Geen and shall continue to publish will be found to contain a full exposition of Dr. liuntcV pecuHai tiiedical views, and we doubt not will be pe. used with mterest and profit by our renders. Of course, not being learned in medical matters We are unable to express an opinion for ourselves on thi able, while he advantage of inhaling the remedies into the lungs instead of fiUine the Stomach with nauseating drugs, the afflicted will know well how to appreciate.' iig drugs, Fkom the 'New Youk TumiJsE.* To such AS are not absolutely. impervious to new ideas, wc would comraetid the fecries of letters by Dr. Hubert Iluntdf, which have from time to time appeared in our colurtius, with regard to thfe nature, symptoltis. and curability of consumption. The act, that iheir author is a regular and thoroughly educated physician, does not r'- «- '.hose letters their value-that is founded on their combination of medical knoWled-e and learning, with practical cdoimon sense-'a quality which commends itself to thd judgement of all who possess it. We solicit the especial attention of those interested, to the letter in this paper, proving that consumption, though a dangerous, is a curcblc disease, yie.dmg to skilful and judicious treatment, like most if not all others. We think^ lew can rtiad this and resist the conWctiOn that tht, author speaks from knowl- Sentiments of similar purport to the above haVe bcdtt expressed by many membera o! the press , but limited bpace prevents mo giving more than the names of them, The fcllowinor are the names of a few of them. -— • The 'New Fork Time»; The 'Detroit free Pres»; The New York Herald; The 'Hiome Journal; The 'New York Express; The *New York Evening Mirror; The 'New York Journal of Commerce; The 'New York Commercial Advertiser; The 'New York World; The 'New Orleans Bee; The 'Eichnumd Whig,' The .Lynchbura RpmihUcan; The Louinnlle JnumvV Ki'.. Thft 'Pitu^ bvrcj bpsprjfrhy The '^hcumrifi. G'lzrffe: Ohio, 'VhG'WiImwgfonJonrnai;NC., '''■" ' WUmimjhn Dd, Onritttt; ilr. ^i;c, b The Vi The author of this treatise devotes his attention to the treatment of diseases of the Throat, Lungs, and Heart, exclusively. He can be consulted personally, or by letter, at No. 70 Bay Street, TORONTO. Office Hours, from 9 A. M. to 4 P. M.