Pulmonary Consumption, Its Causes, Symptoms and Treatment

Annual Oration 1843

By Charles W. Wilder, M.D.

Mr. President, and Gentlemen of the Society,

In compliance with the appointment made by the choice of the Counsellors of this Society last year, I appear before you this day, neither insensible of the honor conferred upon me, nor of the disproportion of my limited knowledge and capacity, under the most favorable auspices, to the acceptable discharge of this responsible duty; and more especially do I feel that I am justly chargeable with presumption, in attempting to interest you under the circumstances in which, by the allotments of Providence, I have been obliged to prepare for this hour. Afflicted with typhous fever and its consequences for more than two months, with inflammation and disease of my eyes at least four months, with bronchitis and pulmonary catarrh for more than two months, in quick succession, — these are the circumstances to which I allude. I had contemplated the selection of a historical subject, requiring much time and labor, had my health permitted. More than once, within the last five months, have I decided that I ought to and must resign the office assigned me into the hands of those who appointed me to it; and I should have done it, but for the early day in February on which the last stated meeting of the Counsellors happened, to which when my attention was called, I found the time too short to get my resignation before them at that, their last stated meeting. I have therefore selected, as the subject of this discourse, Pulmonary Consumption.

Phthisis is of so frequent occurrence among us, that the inquiry, Can nothing further be done to check its prevalence? is one of deep interest to our entire community. When it invades the family circle, and selects as its victims, as it most commonly does, its fairest and best specimens of moral and intellectual promise, the all-absorbing question, Can nothing be done to stay its onward progress to a fatal termination? is propounded with intense solicitude.

The former inquiry naturally invites attention to, and an investigation of, its causes, that they may be removed, or more cautiously avoided; the latter, to a consideration of its phenomena and specific nature, that some philosophical and useful practical deductions may be made, relative to its cure.

Before entering upon the consideration of the causes of phthisis, allow me, by way of digression, to remark, that it seems exceedingly difficult so to train our minds, as not to be influenced much by the speculations and excitements of the age in which we may happen to live. Ultraism invades every department of science, medical by no means excepted, and often, in an unguarded moment, throws from its track the patient, noiseless observer of its fundamental laws, by a skilful exercise of its hallucinating power over the intellect, dazzling, bewildering and confounding the mind, till its fancy dethrones its legitimate sovereign, reason, and weak credulity or cold skepticism takes the place of careful observation of facts, and of sound logical deductions therefrom. Both of these states of mind must of necessity be fatal to true scientific progress, or the success of art based upon scientific laws; but their practical results may be quite similar, in obedience to the rule, that “the two extremes meet.” Doing every thing and doing nothing with medicines, are fancy's follies, equally absurd. The credulously hallucinated mind seizes upon the former as a principle of action, with enthusiasm, and in too many instances, perhaps, accelerates his patient's progress to the tomb; while the skeptically hallucinated adopts the latter as his polar star, folds up his hands, in reliance upon the expectant plan, and coolly witnesses, to its fatal termination, the daily ravages of a curable disease; and thus the two extremes meet in death. The middle course, although steep, and rugged, and laborious to pursue, is the only road to high practical eminence in the application of the science of medicine to the art of healing. Let us not, henceforth, leave to arbitrary empiricism the appropriate work of science, but, by patient anatomical and pathological investigation, follow truth from cause to effect, and from effect to cause, till the diseases of man shall be understood and controlled, as far as the capacity of human intelligence and human skill shall be allowed to approximate.

Causes of Phthisis.

Dr. Marshall Hall enumerates the causes of a tuberculous diathesis under eight distinct heads:

1. Hereditary disposition.

2. Cold and damp soil or air.

3. Insufficient food.

4. Insufficient clothing.

5. Insufficient exercise, air or light.

6. The depressing passions.

7. Attacks of fever, inflammation, dyspepsia, &c.

8. The abuse of remedies.

These causes, taken in their broadest sense, include much, but I think not all, that predisposes to or excites the disease under consideration, in our own country. He has left out of the catalogue excessive eating and drinking, to which are justly referable many cases of genuine phthisis, and in subjects, too, having no constitutional disposition thereto. He has added a remark, so general in its import,—viz., “that whatever impairs the strength and tone of the system, favors the formation of tubercle,”—as to include the cause, perhaps, which I have mentioned. These causes are stated, by Dr. Hall, under general heads, and in classes, the details of which are sufficiently understood, perhaps, by the faculty; and if physicians would do their duty, as the guardians of the health of those with whom they are connected by professional and social intercourse, and reduce the generals to their particulars, as individual cases might require, it would be superfluous to detail to an audience of physicians any of the causes of consumption. But as the object of this discourse is usefulness, at the risk even of being justly chargeable with repetition, I shall contemplate briefly in detail some of the prominent causes of this destructive malady.

The limits of a single discourse will not allow of a minute consideration of all the circumstances operating as remote or immediate causes, expressed and implied under the eight general heads arranged by Dr. Hall; but only such as the writer may deem the most important, and more particularly applicable to the conditions, habits, customs, avocations and notions of our own immediate community, with a view to call a more general attention to a subject inferior to few others in importance, — having, also, an influential connection with intellectual power and moral beauty. The physical condition of the writer has been such, for the last eight months, as to allow him to think and write but for a very brief period at once; hence, exact systematic arrangement of ideas, expressed by a choice selection of words, without improper ellipses or redundancies, will not be attempted. But if he shall be able, in any manner, to state some facts, and make some speculative suggestions, in relation to his subject, that shall result in any good to mankind, he will be satisfied.

Hereditary Disposition.—This is placed at the head of the causes of a tuberculous diathesis, by Dr. Hall. Constitutional tendency to a disease must have had a cause and an origin. The abstract question of the origin of physical evil and suffering, I shall not stop to discuss. It would be foreign to my present purpose. That constitutional tendencies to certain diseases, among which is pulmonary consumption, do exist, is a fact of observation, which I think no intelligent physician will deny. That these tendencies, however first induced, are susceptible of modification, extenuation, and even complete eradication, most physicians will probably admit. Who will deny that the constitution of man is capable of almost indefinite improvement? If susceptible of deterioration, to the lowest state of vitiation, by analogy, it is also capable of the highest state of perfection consistent with the law of natural decay. If this be so, are not health and disease set before us, based upon the same immutable law as human freedom in morals? Intelligent and well-directed human effort, then, is what is wanted to improve the physical as well as the moral condition of man. Should not the physician be the pioneer in this important and philanthropic enterprise?

Insufficient Food.—Whatever the facts may be with regard to the insufficiency of the food of the poor on the island of Great Britain, or on the continent, there cannot be much suffering felt or many diseases caused in our own country for the want of substantial food. The materials for wholesome and substantial living are here produced in such abundance, and so accessible to all who are disposed to make but a moderate effort to obtain them, that even the poorest classes among us need not physically suffer by insufficient nutriment, unless through incapacity or a defective education in the preparation of the raw material for digestibility and nutrition; and our paupers are certainly well supplied with suitable and sufficient food, and many of the luxuries of life. In our country towns, the poorest class of our citizens are usually served with animal food once or more every day; and most of the families, called poor, eat more animal food, and potatoes well moistened with melted animal fat, than the independent yeomanry and mechanics that are familiarly called “well off.”

Insufficient food, therefore, as it seems to me, cannot with justice be ranked among the causes of a tuberculous diathesis, in New England; while excessive eating, improper food, and stimulating drinks might with much propriety be substituted therefor. Cases of consumption and of a cachexia, induced by the habitual use of spiritous liquors, are too familiar to need proof; while no statistical table will be required by the experienced physician, to show the fact that gluttony, and even a less free indulgence at the table, produce more cases of acute and chronic dyspepsia, with the sombre catalogue of neuralgic symptoms usually attendant,—inflammation, ephemeral fevers, and functional diseases,—than any other and all other causes combined. These local and constitutional disturbances directly tend to weakness of the system, and to break up its healthy balance, and thus to lay the foundation for some grave organic disease. Would there were more poetry than truth in the ancient lines,

The temptations to excess in the quantity of food, consist chiefly in the variety with which the appetite is excited; hence the danger and the evil of a great variety of rich food at any one meal. The true meaning of a simple diet is but poorly understood. It should be illustrated by every physician's table. The example will have a good influence, and our advice to others will then be thought to be sincere. I deem it almost impossible properly to regulate the diet of children and youth, in the midst of a great variety of rich food. Temptations to overload the stomach are much too common for their safety. The variety with which the tables of our public houses are furnished, is a temptation too powerful for the resistance of a keen appetite, unless it has been under the habitual control of caution and self-denial. Private tables are often more enticing and ensnaring than those of our public hotels. The family tables, generally, and almost universally, are quite too often loaded with savory and stimulating meats, made more so by condiments of more or less pungency, with a considerable variety of vegetables at certain seasons of the year, and potatoes at all seasons,—but not always of the best quality, or properly cooked to be easily digested,—with warm or hot new bread, to be eaten with butter and cheese, as a kind of superstructure upon a heavy and solid base, for the health and best good of the community; while milk, with light, old bread crummed into it, is almost out of date, even among children. I do not say there has been no improvement, within the last twenty years, in the families of physicians and others, in simplifying the diet, and more especially the breakfast and supper. Unseasonable, great dinners, too, I rejoice to believe, are falling into disrepute in our cities. There is yet room for further and greater improvements, both in the quantity and simplicity of our food. Adopt the latter, and it will do much to regulate the former. “No man,” said the sage Franklin, “was ever sorry for eating too little.”

Insufficient Clothing.—This cause is as often, perhaps, found affecting the fashionables, who possess the means of self-protection by suitable and sufficient clothing, as the very squalid poor. If fashion but speak the word, the coat and vest must be thrown open, to display to the best advantage a fine and beautiful linen bosom, which alone,—although it may be adorned by a costly diamond, set in the most precious metal,—is wholly inadequate to the safe protection of the chest from the rude and cold blasts of a fickle New England atmosphere, during the inclement seasons of the year. The feet, too, must submit to fashion's power, however extravagant and arbitrary she may be in her exactions. If she so direct, the toes and feet must be so compressed as to impede or wholly suspend the circulation of the blood, in the minute vessels of the skin; or they must be protected from cold and dampness by nothing more substantial than the most delicate calf or kid leather, with soles, perhaps, from the sixteenth to an eighth of an inch in thickness, although the mercury may stand at 10° below zero, or the water and snow may be from four to twelve inches deep. The female, too (I speak of her always with sincere respect), is no less exposed to the effects of this cause than the male, and often more. If the goddess, fashion, but so decree (and who is able to resist her mandate?), on extraordinary occasions at least, she must be decked with the mere externals, composed it may be of the most delicate and thin fabrics, with arm and neck unprotected, the beauty and delicacy of which may be exposed, not only to the admiring gaze of her social circle, but also to the chilling winds of winter. How often are the glands of the neck, or the mucous membrane of the nose, throat and lungs, thrown into a state of irritation or inflammation, by such unwise exposures! Is it said there is no necessary connection between inflammation and tubercle or true phthisis? Allow this question to be unsettled, I would inquire if any of the inflammatory affections of the respiratory organs are beneficial to the general health? When often repeated, do they not always impair, more or less, the mucous texture of those organs, and thus interfere with their healthy operations? Thickening or other lesions of this membrane are often of lasting and serious consequence, undermining and breaking down the constitution. Thus common colds, bronchitis, pulmonary catarrh, &c., are always liable to act as the remote, and too often prove to be the exciting, cause of pulmonary consumption. The habitually intemperate, with their families, may, and often do, suffer from insufficient clothing; but most of the evils resulting from it must be voluntary, or through ignorance of the wants of the body, during the inclement seasons, and the vicissitudes of our climate, for which prudent forecast should always provide. This cause, efficient and operative, as it seems to me it certainly is, can and ought to be removed. Fashions can be changed, and every person, of comfortable health and ordinary capacity, in our abundant and liberal country, can be fully supplied with sufficient clothing from the proceeds of moderate labor; and in cases of honest inability so to provide, the deficiency is generally, and always should be, cheerfully supplied from public or private charities.

Insufficient Exercise, Air or Light.—That my remarks upon this general head may be the better understood, I wish, first, to state, that what has been generally believed to be true, viz., that more females die of consumption than males, is now established by statistical facts. The result of the research of the indefatigable M. Louis upon this point, is, that the proportion of deaths by consumption of men and women, is as 55 to 72. Although I know of no data by which to settle this question of proportion for our own Commonwealth, from the best information I have been able to obtain from others, with my own observations and notes, I am constrained to believe that three females, at least, die of phthisis, to two males. The cause of this difference has not, to my knowledge, yet been satisfactorily explained. The fact is melancholy, and the highest interest of mankind demands deep and earnest inquiry into its cause, or causes, that they may be removed or shunned; and should I make some plain remarks, and state some homely or unwelcome truths, touching the subject, I hope to be forgiven by the reflecting and candid portion of our sensible and better halves, who are lovers of truth, and always alive to duty and the best interests of our race. Let not the following remarks upon exercise be understood to recommend female slavery in domestic labor, to the neglect of the cultivation of the intellectual and moral sciences; no such meaning is intended, but a suitable economical and healthy systematic division of time, for the culture of the mind and the proper development of the physical system. Both are indispensable.

A neglect of suitable exercise disposes to a tuberculous diathesis. The invigorating effects of proper exercise soon pass away; hence it must be daily taken, if we would avail ourselves of its benefits. It is the same to the health, strength and firmness of the system, as food is to its life. We are made for activity. We see this innate principle illustrated in the unrestrained child, who is constantly active, if health attend him, during his waking hours. We witness the rapid development of his physical powers from year to year, under this wholesome provision of the God of nature. Herein we are furnished with the true key, by which to unlock the store-house of knowledge in relation to this branch of physical training, as a preventive of the diathesis so favorable to the formation of tubercle. It is action, unimpeded and unshackled action, that gives strength and firmness to organized matter. It promotes the healthy secretions, invigorates absorption, and balances the circulating fluids of the system. It is absolutely indispensable, to preserve the natural appetite for simple food, the perfect digestion, assimilation and animalization of the natural nutriment of the system. We can therefore no more habitually disobey this law of our natures with impunity, than we can assume the functions and powers of the amphibia. It should be cheerfully complied with, to its full extent. How absurd, then, is it, to bind down the elasticity of God's workmanship by artificial, mechanical appliances, in obedience to vain fashion or arbitrary tastes in dress! How often do mothers violate or counteract this established law, in the early management of their children, more especially their female children, by improperly adapted clothing. How much such restraints and confinement of the muscles and joints contribute to the early formation of tubercle, who can tell? Who shall declare how long the seeds of disease, thus early sown, shall remain inactive, or when they will act “like thorns in the flesh?”

May not children very early receive physical as well as moral impressions, which can never be eradicated? Let this idea have its proper practical influence. Why is it that so many more females die of consumption than males? Are not both sexes exposed alike to its hereditary tendencies? If so, we must seek for other causes to account for the difference. May not their different early management be plausibly suggested as one probable cause? In the school-room they may suffer alike by confinement, or insufficient air; but at home, their conditions are often widely different. While the male is let loose, to play and sport in the free and pure air, the female is confined to her seat, and that, too, perhaps in the close and heated room. It may be said, that many of the female duties are best performed in a sitting position. Grant it, but children and youth must never be confined to that position but a short time at once. The injury to health and constitution is too disproportionate to the temporary, pecuniary profit it may afford. The constitutional perfection of the female is of paramount importance, inasmuch as the mother, probably, imparts more influences for weal or for wo to her offspring than the father. Whether we contemplate this truth in a physical, moral or intellectual point of view, its vast importance must be seen, and it calls for serious, practical attention.

As the female advances in age, her habits of exercise often vary according to outward circumstances,—wealth, poverty, education, fashion. How widely different is the exercise of our female population, the unmarried in particular, from what it was during the first century of the settlement of this western world! Our pilgrim mothers, and their immediate female descendants, acted no inferior part in subduing the then wilderness, and in changing it into orchards and gardens, and planting with their own hands the young trees and twigs that now constitute our stately, rugged, yet beautiful elms, that so much adorn our front yards and road sides, and afford so much delight during the summer's heat; ay, and who, from the raw material, green in the field, and from the fleecy race, manufactured the firm and substantial fabrics that so effectually protected from “summer's heat and winter's cold” the lords of creation, as well as themselves, and their mutual pledges of love and future hope? Their necessities wrought out for them constitutions almost invulnerable, and insusceptible of tuberculous disease; and if there is any truth in tradition, pulmonary consumption was a very rare disease among them. I have been informed by some aged people, that, when they were young, “a person sick with the consumption” was an object of much curiosity, insomuch that it was not uncommon for people to travel forty or fifty miles, to see a subject of it. A writer in the Medical and Agricultural Register, printed in Boston, in Sept., 1806, in answer to this question, “Whence is it that consumption is so much more prevalent in both sexes now, than in the days of our forefathers? “says, “that this is fact, I presume will not be denied. Consumptions are not only more frequent, according to the testimony of aged people, but also much more rapid in their progress than they were in their early days.” He then makes the inquiry, “Must this be charged to change in our climate? or mode of living and dress? or to some other cause or causes?” Again he says: “If we attend to the mode of living, we shall find a far greater change between that of our hardy ancestors and the present generation, than was ever known in any climate in ten centuries. The mode of living and dress is now as different from what it was in the days of our grandfathers, as simplicity and luxury.”

The above quotations apply more particularly, or, in fact, wholly, to eating, drinking and dress, and to both sexes. How changed the exercise, now, when the inventions of men, aided by the laws of the mechanical forces, have driven from the domestic fire-side the wheel, the distaff and the loom, while fashion has substituted for them the toilet, the mirror and the piano. Not that I complain of or decry neatness and good taste in dress, or musical skill, as a female accomplishment, — but of the devotion of too much time, to the neglect of higher and superior duties; exalting the ornamental far above its proper place, to the injury of health, above the substantial and indispensable practical knowledge in the management of domestic affairs, so necessary to health and fire-side enjoyment. May we not fairly infer, from the changes in the habits of exercise of females, one plausible cause of their constitutional deterioration and present effeminacy, so favorable to the production of tuberculous disease?

Notwithstanding almost every kind of clothing is now made principally by the use of machinery, with the assistance, comparatively, of but a very few females (who, so far as my own observation goes, seem to enjoy an immunity from consumption over the sedentary and inactive), yet there is no want of opportunity for every female in our Commonwealth to enjoy (if she will) suitable, useful and sufficient exercise. What physician, of any considerable experience in country practice, does not know something of the waste and loss, to say nothing of the unpalatable, indigestible, sour or hepatized bread, the “staff of life,” with crude and half-cooked vegetables, with burnt or half-cooked meat, immersed two inches deep in melted animal fat, with eggs fried or boiled to petrifaction, — as well as the domestic unhappiness, and sometimes utter family ruin, directly occasioned by the unpardonable ignorance of females, in the prudent and skilful management of domestic concerns. The acute diseases, and morbid habits of body, produced in children and adults, by living on such crude, unpalatable, unwholesome and indigestible food, made so by unskilful hands, are charged in the account to family misfortune by the overruling hand of Providence, which should excite the tenderest human sympathy. How many industrious and hard-laboring young men have been disheartened, and have had their spirits sunk in silence within them, by the irretrievable misfortune of joining hands with a female of idle, gossiping habits, educated to grace the ballroom, ride for her health, and thump the keys of her piano, but wholly ignorant of the practical details of good and prudent housewifery, and of the management of children, should the solemn dispensation of issue (too common, alas!) be superadded to his bitter cup of wo. Sedentary or idle habits wholly disqualify the physical system for active and laborious endurance, until gradually inured to it; hence it is that we so often hear from the lips of sedentary or idle females, “I can't stand it to do house-work.”

Nor is this all. The degradation of character attached to domestic service, and the hard hands, so made by a diligent use of the kitchen utensils, are abhorrent to the feelings of the falsely refined; hence, the health and strength communicated to the living solids by practical house-work can never be fully realized, while such unworthy notions are entertained. Tender mothers, through ignorance of the physical laws, and the wants of their already, perhaps, half-ruined daughters, by a mistaken and misplaced indulgence on account of supposed delicacy or weakness of constitution, suffer them to pass year after year, without taking the necessary exercise to prevent and ward off the very disease they so fearfully apprehend, and thus they hasten to an early tomb the idols of their hearts, by the very course adopted to secure to them health and long life.

Here the faithful physician may do much, by his knowledge and influence, by imparting better notions, and by enjoining a practical observance of the laws of health. Let truth and duty here guide us, unawed by popular prejudice or the fear of pecuniary loss. The best good of our whole community requires plain dealing, to change the false maxims and erroneous ideas of physical training and proper living, wherever they may be found, into the true and fixed principles so clearly established by the Author of nature.

Healthy, honorable, indispensable, should be stamped upon all the domestic duties, by the sanctions of the highest female influence and of general popular acclamation. Then, none would presume or even dare to disregard their claims; and ignorance of the principles and even of the minute practical details of housewifery should and would cause the capillaries of the face to redden with shame. I have spoken thus strongly in favor of a practical knowledge of housework, because it is not only the appropriate business of the female, but on account of its prophylactic power; and because it is an indispensable requisite, as a female accomplishment, if she would enjoy health and cheerfulness, contentment and pure happiness, in herself, and be the organ of communication of these heavenly blessings to her husband and her family. Yet how few, compared with the whole of our female population, more especially between the ages of fifteen and thirty (the very period in which more die of consumption than at any prior or ulterior time of life), are willing cheerfully to take upon themselves the care and exercise necessary to preserve or restore health, and more fully develop physical strength, and to obtain a thorough practical knowledge of domestic economy, and thus qualify themselves for lovely and useful wives, healthy and good mothers, and so raise the average length of human existence, lessen materially the present number of hereditary dispositions to tuberculous disease, and take the most important step in restoring our race to their primeval strength and longevity.

The amount of exercise for good health is, I fear, generally estimated much too low. I repeat, that it must be daily used, from two to ten hours each day, according to the wants and circumstances of individual cases. To have its happiest influence, it should be so varied as to call into action alternately the greatest number of muscles, and should be of such a character, if possible, as to interest the mind, and produce cheerfulness and contentment, or it will be likely to fail of its object. Sedentary ladies should regard the kitchen utensils as their ministering angels; while the axe, the saw, the scythe, the rake, the spade and the hoe daily invite sedentary gentlemen to a participation in the health, strength and cheerfulness their use imparts. Any kind of exercise is better than none; but, as a general rule, for adults and all persons of reflection, useful exercise,—by which I mean some kind of business which has an object to be obtained, and which requires activity, forecast and attention to accomplish, and promises a reasonable reward,—is decidedly the most beneficial. We meet with cases, however, in which the business of the world or usefulness has no charms; and in such cases, excitement is found, perhaps, only in games and sports, riding in parties, in excursions of pleasure, in swinging, sea voyages, and the like, all of which must be resorted to, as individual cases may seem to require, or insufficient exercise must still stand out in bold relief, as an effective cause of phthisis.

Insufficient Air.—We should never forget for a moment that we are breathing animals, and that a full, fresh and constant supply of pure atmospheric air is indispensable to health and even life. We all well know that an all-important change in the blood is effected by the agency of the common air. Whether the blood is oxygenated, decarbonized, or both, or neither of them, its color and properties are changed by the air, and this change is essential to life.

Whatever decomposes or vitiates the air in which we may happen to be, or lessens the quantity below the requirements of the system, is fraught with mischief, and may be justly ranked among the causes of phthisis. Hence, may we not fairly infer, that the average of life of cordwainers, clerks, students, machinists, tin-workers, and artizans generally, is reduced by insufficient air? By the returns of 273 cities and towns in this Commonwealth, made by the clerks of the several towns, of the marriages, births and deaths, in obedience to an Act passed by our Legislature, March 3d, 1843, and from which an approximation to the true average longevity of adults pursuing different occupations is attempted, we learn the startling fact, that the average difference of life between those I have named and the cultivators of the soil, is about twenty years. Have insufficient pure air and insufficient exercise nothing to do as causes of this tremendous difference? The rarefaction of the air in heated rooms, the carbonic acid, incident to respiration, in small or close rooms, or when the number of occupants is too great for the size of the room, the dust, and the many other ways by which the air we breathe is vitiated, are fruitful sources of constitutional deterioration, or pulmonary lesions, favorable to the production of true phthisis.

Although these returns are very imperfect, yet in the attempt I have named, the calculation there made probably approximated pretty closely the truth. These classes of men need light upon this subject; and whose duty is it to impart it? Surely the physician's. When the subject is once understood, and its importance duly appreciated, ways and means will be soon found out, to remedy these evils. But little ingenuity is required to contrive better, if not the best, methods of ventilating work-shops and studies, so that a sufficient quantity of pure, fresh air will be supplied to their occupants. The subject should be so presented to their minds, if possible, as to make them feel its importance, and the remedy will be certain to follow.

Insufficient air is allowed the lungs, by unwise fashions in dress, too generally adopted by females. Mothers sometimes commence the mechanical compression of the chests of their female offspring in their very infancy. But if this tender age is suffered to go free, youth seldom, if ever, escapes the iron grasp of the tight waist or stays. These are applied with more or less force, according to the necessity of the case, to shape the being into the beau ideal of fashion's fancy, even should it require the lower part of the chest to be contracted to one half of its natural dimensions. The lungs, thus compressed, are denied their natural expansion, and, of course, the necessary quantity of air for the perfect performance of their highly important functions. The sternum and ribs, subjected to the mechanical power of boards and whalebone, made fast with cords that might have defied the strength of the giant of Israel, unshorn of his locks, cannot be moved by the soft and yielding net-work of the lungs, and, thus encased, the whole weight of the atmosphere is insufficient fully to expand the air cells of the inferior lobes; consequently, a portion of the lungs is doomed to perform the work of the whole, respiration is shortened and quickened, and, while their superior portions are probably injured by over-action, the lower waste for the want of the exercise designed them by the God of nature. Nor is this all. The blood, which should here meet the air, and, by a wise and beautiful process, be arterialized, is but partially purified and fitted for the high purpose of life, by this limited action of the lungs; and thus this vital fluid, loaded with impurities, perhaps, is destined to perform its accustomed round of circulation, imparting, it may be, to the various secreting organs the sedative of disease and death, instead of the proper stimulus of health and life. This foolish if not wicked custom is often adopted so early, that the muscles and bones become reconciled, to a considerable extent, to its mischievous pressure, so that, before the child arrives to years of discretion and reflection, habit has established a seeming although a deceitful necessity for its continuance, and thus its evils are disbelieved, and its often sad results perpetuated. The sternum depressed, the ribs protruded forward, if not dislocated at their cartilaginous junctions, the natural cavity of the chest diminished, the shoulder blades thrown from their proper positions, the spine crooked, the lungs tuberculated, are probably among the bitter consequences of lacing. Nor is this all. Compressed and bound down, the passive stomach must severely suffer in the performance of its appropriate function; digestion, unable, by its too close confinement, to give to its heterogeneous contents the necessary undulating or churning motion, so essential in blending them thoroughly with the gastric juice. Should not this unwise fashion, when reason and argument are insufficient, be held up to supreme contempt, till its folly is abandoned?

Phenomena of Phthisis.

The premonitory symptoms are,—slight, chilly sensations, or a kind of instinctive shrinking from every current of cool air; the color of the face frequently changing, in a very peculiar manner, better imagined than described; a general dryness of the skin; a diminished appetite, or satisfaction of appetite by a considerable less quantity of food; slight, transient heat in the afternoon or evening, with a burning sensation in the palms of the hands and soles of the feet; the pulse more or less accelerated, the twenty-four hours round, whether asleep or awake,—generally increased in force, frequency and fulness after eating a considerable meal, especially if meat compose a considerable part of it; often a dry, hacking cough, or a disposition to cough; sometimes a sense of tightness or stricture across the upper portion of the chest; respiration always more or less hurried by even moderate exertion; frequently some hoarseness or change in the voice, in the afternoon and evening; a diminution of physical power, but sometimes an increase of mental perception, clearness and energy. These are the common symptoms which characterize the first stage of consumption, more or less of which are usually present, and apparent, in every genuine case.

In this stage of consumption, but little information worthy of confidence can be obtained, by direct exploration of the chest. I would by no means undervalue percussion and auscultation, as of high importance, and generally to be relied on in settling once difficult questions in relation to the diseases of the respiratory organs and the heart; and I mean to be understood, by the above remark, that the peculiar sounds described by the able writers upon direct exploration, are not generally cognizable sufficiently early, in incipient phthisis, to be unequivocally available in determining the question of tubercles in the lungs, by physicians of only ordinary opportunities and experience, like myself. In this opinion I am sustained by Dr. Hall, who says, “the physical signs in the most early stage of tubercular formation are inappreciable.” When I have not been able, by percussion or auscultation, to perceive any certain sound, indicative of any disease of the lungs, the resonance and respiratory murmur in every part of the chest, so far as I could detect, being perfectly natural, I have been led to suspect, by the pulse, and the presence of some of the other symptoms I have named, and by the history of the patient's ancestry, that tuberculous formations had already commenced; and the sequel of the case has too often verified my suspicions.

The second stage is marked by distinct physical signs of tubercular formations and extensions; an increased frequency of the pulse; often a hard, distressing cough, with expectoration of mucus, sometimes tinged with blood, and often mixed with small quantities of pus; daily hectic paroxysms; respiration more hurried, and bronchial at the upper part of the chest; percussion over the affected part decidedly dull; the crackling sound, mentioned by writers, may often be heard, when the ear is placed in the right position, after a fit of coughing, indicating the commencement of tuberculous softening, or ulceration, more generally cognizable at the top of the lungs; bronchophony, and the peculiar thrill, not only distinctly audible, but communicating a trembling sensation to the hand, when laid immediately over the affected part, when the patient speaks; the mucous and subcrepitous rales are, occasionally, perceived in different parts of the chest, which, with other physical symptoms, too familiarly known to need repetition, tell the morbid actions and structural changes in the lungs, too plainly to be mistaken, and remind us that our best efforts to give relief, arrest the progress of diseased action, and restore to health the injured organs, will probably be unavailing.

The third and last stage may be known by the hurried and difficult respiration; the great frequency of the pulse; the expectoration of mucus, pus, and cheesy or curdy matter; the cavities that are plainly cognizable in various parts of the lungs; the tuberculous infiltrations and extensions, so obvious as to leave no longer any doubt in the mind, that the disease has now proceeded far beyond the reach of any known remedy, except by way of palliation; while the peculiar fetor of the breath, the fiery redness of the tongue, the aphtha in the mouth, the glassy eye, the high shoulders, the prominent cheek bones, the hectic, crimson flush, followed by a deathly pallidity, the dingy appearance of the hair, split at the ends, the blanched skin, the œdematous feet, the colliquative diarrhœa, the cold and partial sweat, announce the near approach of the king of terrors.

Such is the progress of consumption, when not arrested in its course; which sweeps off so many young men of high promise in usefulness, and still more of our beautiful, amiable and virtuous females, to an early grave. From one-fourth to one-eighth of all the deaths in Massachusetts are probably occasioned by this fell disease. Can nothing further be done, to stay its ravages?

I am aware, that by the statistics recently published by Dr. Hayward, in the New England Quarterly Journal of Medicine and Surgery, the ratio of deaths by consumption, to all other diseases and accidents, for thirty years, from 1811 to 1840, inclusive, has decreased in the cities of Boston, New York and Philadelphia. I rejoice that it is so, but doubt, very much, the decrease of consumption throughout our Commonwealth, or New England. Much has been done to diffuse among the inhabitants of these cities a correct knowledge of the physical laws, and enforce reasonable living, by popular lectures upon diet and physical education; and improvements have been, or ought to have been, made among all classes, by the removal of many of the causes of this formidable disease. But in the country towns, the opinion of physicians and others is, that the ratio of deaths by consumption, to all other diseases and accidents, is now, and has been for a series of years past, gradually increasing. Registration, in several towns in Worcester County, kept by physicians, clergymen and grave-diggers, make the ratio from one-third to one-sixth; but these are not sufficiently exact or extensive to establish the fact; and Dr. Hayward admits that the registrations from which he made his tables are too inexact to warrant a certain conclusion, but only an approximation to the truth. The tables are made with care, and shed the best light we have on this important subject, and for which, I think, Dr. Hayward is entitled to the thanks of the faculty. It is to be hoped, as the subject is now before the community, that its importance will be duly appreciated, and that some future friend of the medical profession and of man will have more extensive and exact data, from which to ascertain and fix the true ratio of deaths by consumption, of males and females, to all other diseases, not only in our cities, but throughout each State of the Union.

Specific Nature of Phthisis.

I am aware that the faculty is divided in opinion upon this topic of my discourse, and it is not surprising that it is so. The subject is replete with difficulties as well as interest. The pathological anatomy of the lungs, from the commencement to the close, in consumption, will probably never be exactly known. We cannot open the chest, like a book, and read from its vital page. Much, of necessity, must be left to inference. Deductions are sometimes made to sustain pre-conceived opinions, or some favorite theory, and may not always be legitimate; and the facts themselves have all the different colors of the rainbow, when viewed through seven different pairs of eyes. Personal idiosyncrasies and education should always be taken into the account, in our estimate of the value of recorded facts, and the deductions therefrom. One quite learned man may see truly wonderful things wrought out by animal magnetism, while another, equally wise and learned, can discover nothing in it to astonish. Physicians have no established medical creed, and each claims for himself the right to observe and think. This broad-cast liberty must of necessity produce variety of opinion, especially upon abstruse and unsettled questions, among which is the specific nature or essence of tubercle; and this state of things is probably the most favorable for the discovery of the truth. If we admit that the specific nature of tuberculous phthisis is not only unknown, but may be inscrutable, it only places it on the same ground with that of many other diseases, whose fatal tendencies are generally successfully obviated.

When we say a disorder is inflammation, what do we mean by it? Nothing more than that the malady has the characteristics which have been duly recognized by that name. When we begin to speculate upon its nature, and the vital actions every way concerned in producing it, we are as much in the dark as we are concerning the essence of tubercle. We can observe its intensity, and lessen its violence by a prompt and diligent use of the means which experience and the general principles of medical science have established, by which we can often, nay, generally, conduct it to a safe resolution; and this is the most important, because it is the most useful, knowledge we can possess in relation to it.

We hear much, and, indeed, feel much, of the uncertainty of the healing art. But is the science of medicine, or the healing art, based on more uncertain principles than other sciences? How deep is our knowledge of the natural sciences? We can observe something of what is done by what are called the laws of nature; but how it is done, who can tell? We can say the same of healthy vital action and of morbid action. Said the immortal poet, in answer to the question, “What is it to be wise?”

So consumption is well known by its bitter fruits, if not by its specific nature; and by its effects we may follow it back to many of its causes. We can observe its phenomena and pathological ruins after death, from which we may infer something of its essence.

By an investigation and knowledge of its causes we may do much by way of prevention; and, by a thorough acquaintance with its phenomena and lesions, we may perhaps do something by way of remedy. By a strict attention to the rational and physical signs of phthisis, and by many inspections of the lungs of those who have died of it, I am satisfied of its inflammatory nature, sometimes more, sometimes less acute. That the inflammation attendant upon the formation, extension and softening of tubercles, is different from adhesive inflammation, to me, is quite evident. That it is analagous to ulcerative and suppurative inflammation (if the terms are allowable), to me, is almost certain. That it has its commencement in the true capillaries of the lungs, I think, admits of very little doubt. That there is a partial or total loss of vital action in the absorbents and minute veins of the lungs; and an increased action in the minute arteries, to my mind, is highly probable. That a certain condition, state or habit of the general system, produced by hereditary, or other causes, precedes this peculiar, specific inflammation, ulceration and suppuration of the lungs, I have not the slightest doubt. Here I must pause, as the limits of a single discourse will not allow me to pursue the subject farther into the region of speculation, nor would it be of any practical utility, perhaps, if I should state at length, the reasons for the opinions I have now advanced. I am aware there is but little or nothing new in them; but their practical bearing, if true, is highly important.

Means of Prevention.

I have considered somewhat in detail, what I believe to be some of the ordinary causes of phthisis, in our immediate community; and, if true, it will be best prevented by avoiding all of them, so far, as it may be practicable to do it. Persons predisposed to consumption, or having the peculiar forms or temperament favorable to be acted upon by the remote and exciting causes of it, should make it their first and principal study to understand, as far as they may be able, the physical laws, the influences that the external world has upon their own constitution, and the proper adaptation of those influences to their personal wants, and, when these natural laws and influences are understood, they should be scrupulously respected. Our young men and boys should be directed in their selection of an avocation, as the business of life, with care,—and our children and youth, of both sexes, should be physically trained, with direct reference to their constitutional tendencies. It is a great mistake in parents and others, having the care of children and youth, to deny them habits of industry, and even exposure to many of the hardships and rough influences of the world around them;—not recklessly, or without suitable preparation successfully to meet and resist their otherwise, perhaps, unhappy consequences, because they are delicate and weakly. These are the constitutions, of all others, that most need daily active employment and healthy excitement. All mankind are benefited by constant employment and labor, but the sickly and weakly cannot live without them. I do not mean sudden or violent action, but constant, steady, active employment in which the body and mind perfectly harmonize. It is as essential to the female as to the male. I have witnessed instances in which females of a delicate organization, having no disease (unless the debility and languid state of the system consequent upon inaction can be called disease), were absolutely and imperatively denied any participation in the light and active duties of domestic affairs, or to join in any active amusement, through the mistaken notions of tender mothers, lest they should get fatigued and “overdone.” Too often are the wan or slightly yellowed countenance, the faltering step, and feeble powers of injuriously indulged children and pets, attributed to “overdoing,” when, in fact, irregular habits of living, and want of suitable exercise, are the true causes of their unhealthy and sad condition. Employment, active, constant, agreeable and useful, is the true panacea for invalids.

The diet of the delicate and predisposed to consumption, should be simple, nutritious, and easy of digestion; a large proportion of it should be light, good bread, with milk, always taken with exact regularity as to time; eating slowly and masticating thoroughly, before it is allowed to pass into the stomach, always adapting the quantity to the amount of exercise performed. Activity and rest nicely balanced; labor and food proportionally regulated; clothing and temperature rightly adjusted; a full supply of pure, fresh air; cheerful and exhilarating light; and contentment of mind, are among the best means of invigorating a weak and lax constitution, and of removing that sort of cachexia so favorable to the formation of tubercle, and thus of warding off consumption, and of staying its ravages. Sponging the whole surface of the body and the extremities with water, occasionally made more stimulant and tonic, by the addition of common salt, at a temperature suited to the season of the year, and the feelings of the individual, followed immediately by active friction with a dry, coarse cloth or brush, every night and morning; wearing flannel next the skin, during the changeable and inclement seasons of the year, have proved highly serviceable to persons of strong hereditary tuberculous tendencies, and, in conjunction with the means already named, have prolonged many valuable lives, to a ripe old age. Some medical writers lay much stress upon the wearing of flannel next the skin, by persons of consumptive tendencies (and very justly, too, if my own experience can add any thing to the weight of their testimony), on account of the reciprocal consent between the capillary system of the skin and that of the lungs. That a strong sympathy and reciprocity of action do exist between the capillaries of the skin, and those of the lungs, I think no physician will be disposed to deny. Does not this fact make in favor of the suggestion of the loss of vital action, and the commencement of tubercular formation in the capillaries of the lungs? Dr. Barlow, of Bath, England, has given the true reasons for wearing flannel next the skin, and the proper way of wearing it, to be the most serviceable to persons generally, as well as invalids and those more particularly predisposed to consumption. He recommends to lay aside the flannel at bed time, and substitute therefor, a cotton night-dress. He says:—“The chief advantage resulting from a flannel dress next the skin is not the actual warmth imparted or retained, an effect that might be obtained to an equal extent, by an increase of outward clothing,—but from the uniformity of temperature thus insured to so large a portion of the surface of the body, and the tendency which this has to keep the highly important, but too much neglected functions of the skin in an active and healthy condition. During the day, the frequent and oftentimes sudden vicissitudes of our climate are such as to render the effects of flannel, in preserving an equality of temperature, most valuable. But at night and during sleep, we are subject to no such vicissitudes, consequently, no such necessity for the use of it does then exist. But while the use of flannel at night appears to be unnecessary, there are several considerations which show it to be injurious. These considerations regard both the condition of the body and the flannel itself. Whatever the wants of the body during the night, for warmth, may be, they are generally fully supplied by the bed-clothes in ordinary use. The body requires no extraordinary warmth during sleep, but on the contrary, there is at such times even a tendency to an increase of the natural warmth. When to this natural tendency, the heat caused by flannel worn next the skin is superadded, the effect is to keep the skin in a state of considerable excitement, and to induce perspiration, more or less profuse. These effects are not calculated to prepare the body for enduring the vicissitudes of the ensuing day; but rather to render it more susceptible of injury. The property which renders woollen cloth so eminently suited to the purposes in view, is that of its being a slow conductor of heat. A flannel dress that is worn next the skin throughout the night, becomes so charged with perspiration, that its power of conducting heat is thereby greatly increased, and its preservative effects proportionally diminished. A two-fold injury results, then, from the practice of continuing the flannel dress during sleep, viz., a diminution of the preservative powers of the flannel, and an increased susceptibility of the skin. By laying aside the flannel on going to bed, and substituting for it a cotton nightdress, the body is kept in that temperature during the night, which fits it for encountering the vicissitudes of the ensuing day; while the flannel itself is preserved from the deteriorating influences of the nightly perspiration, and it will be resumed in the morning in a dry and clean state, which contributes both to comfort and protection.”

I would here remark, that taking off the flannel at night, after the labors and fatigues of the day, and putting on a cotton night-dress without warming it, makes an impression upon the skin, followed by an agreeable glow, worth all the trouble of the exchange. The plan is worthy of attention, by all who practise wearing flannel next the skin, during the inclement seasons, and will much more effectually protect the system from colds, than when it is worn during the night as well as the day, as I believe it generally is by most persons. It may, perhaps, be thought trivial and too much trouble; but those who may so think, I would ask, What is the value of life without a comfortable degree of health? Is any trouble or sacrifice too great to restore it, when wanting, or preserve it, when enjoyed?

The feet of the consumptive should be protected with particular care. The warm and fleecy hose, with good substantial boots or shoes, should never be despised so long as they keep the feet dry and warm. The soles of the feet closely sympathize with the mucous membrane of the nose, throat and lungs. The feet, therefore, should never be suffered to remain cold or damp for a moment of time, when it is possible to prevent it. They are much inclined to be uncomfortably cold, which can often be remedied or much improved by sudden immersions in cold water, for a few seconds at a time, immediately followed by active friction with a warm, coarse cloth, and when these means prove insufficient to restore the circulation in the minute blood-vessels, and consequently warmth, common salt may be added to the bath, or a cloth may be used for the friction that has been dipped in salt-water and dried.

I have now mentioned some of the means of lessening the ratio of deaths by consumption, to which, as I am fully persuaded, the old adage,—“an ounce of preventive is worth a pound of remedy,”—is eminently pertinent.

Treatment.

With regard to the best method of treating consumption, my own experience is, that if any success is to be reasonably expected, it must be treated on general principles, according to the rational and physical symptoms present when we are called upon to prescribe, having regard to the constitutional and outward circumstances of the patient. No disease, as it seems to me, to which man is liable, requires a closer investigation or a nicer discrimination in forming an opinion of the course of treatment to be adopted, than the first stage of phthisis, under its ordinary insidious development. When the case is understood, and the course to be pursued is decided upon, watchfulness on the part of the physician is absolutely indispensable to ascertain the effects of his remedies, and if the object aimed at has been obtained or approximated. If nothing has been gained, he should institute a more searching inquiry into all the minutiae of the case, carefully review the symptoms, and ascertain, if possible, the cause of failure. Some internal obstacle, or outward influence, may, perhaps, have been overlooked, which is keeping up and aggravating the excitement, and must first be dislodged or removed, to insure success. The nurse is to be watched as well as the patient, to know that our remedies have been properly and faithfully administered and applied, or whether our directions have been only half complied with, or wholly neglected, and our medicines laid aside, and some patent specific substituted for it, or given at the same time. Constant vigilance is absolutely necessary, as all sorts of notions now prevail, relative to the treatment of diseases, as well as to law and morals, among nurses, and consequential, meddlesome advisers, whose moral sense is in no way shocked, or even ruffled, by taking upon themselves the awful responsibility in which the life of a fellow being is involved. How often has the unsuspecting and conscientious physician lost his confidence in his plan of treatment, or in his own judgment, through the infidelity or incapacity of nurses, in its exact execution! “I take the responsibility” is now too fashionable for the safety and best good of the constitutions of patients, as well as for the safety of the constitution, laws and institutions of our body politic. Arbitrary experiments are fraught with too much uncertainty and danger, to be hastily adopted by medical executives, although their effects may be secretly deposited, with the relics, in the tomb.

Specifics for consumption, too, are out of the question. The complicated nature of the disease ridicules the very idea. None of the hobbies of the present or the past should be relied upon for a single day, while there is any reasonable prospect of a radical cure. This disease must be met as it is; and vanquished, if possible, in the shortest practicable time. It is often necessary to make a decided impression upon the system at once, to break out a link in the chain of diseased action.

The best method of doing this must, necessarily, be left to the discretion, skill and judgment of him who may be called upon to prescribe the course to be pursued, after a close, personal inspection, and a full and careful investigation of all the symptoms and external circumstances of his patient,—and after weighing the case in “reason's comparing balance.” Effective means are not wanting, when the principle of action is once established. The lancet, the leech, the cupping-glass, the Spanish fly, Croton oil, tartarized antimony, ipecacuanha and mercury, are instruments of power and of great utility, when skilfully used. Much, however, depends on the time and the manner of their use. Acuteness in discrimination, and exactness in perception, will rightly adapt them to the object to be obtained.

It would be difficult, perhaps impossible, to point out in detail the best means suited to the removal or mitigation of all the various symptoms and bad feelings incident to this disease; yet their incidental attendants should not be overlooked, or treated with entire neglect, especially when the real disease is unhappily influenced by them. But the eye must be steadily kept upon the disease itself, and the attention fixed upon the progress it is making, rather than on its incidentals; and that physician who enters the field of action, armed only with a set of recipes, supposed to be suited to all the various symptoms, will find himself but poorly prepared (“if he have never read and reasoned”) to contend the ground, inch by inch, with death’s prime minister. He must have other resources about him, or his enemy will elude his grasp. A thorough knowledge of the principles of medical science; clear, common sense; a sound and discriminating judgment; a minute and exact knowledge of the powers, actions, functions and sympathies of the animated body, while in a state of perfect health; the ordinary influences of mind over and upon the functions of life; its exceptions, and extraordinary influences in certain morbid physical conditions; in a word, an exact acquaintance with all the minutiæ of physical and mental philosophy, — their nice connection and reciprocal influences, as far as can be learned, are among, and a part of, the necessary medical furniture for successful practice.

I am sure that consumption, during its first stage, has been suspended, yes, cured, and can again be, as often as many other grave and formidable diseases, with which we so often successfully contend. Under early proper treatment, it will often yield in a short time; but too often, alas, it exhibits an obstinacy which calls for firmness, patience and perseverance to successfully overcome it. I do not mean to say that every case, even if put under proper treatment in due season, is curable. I believe no such thing; but only that not every case is incurable, and necessarily fatal. Much can be done with medicines, if done at the right time, and in the right way. The lancet may be altogether ineffectual, and even prejudicial, in cases, even in which its use is absolutely indispensable, if we govern its use by the number of ounces of blood abstracted, instead of the impression made upon the patient. No rule, therefore, should ever be prescribed for the abstraction of blood, by weight or measure. Some patients tolerate its loss to an extent almost incredible, before the right effect is produced, to wit, an essential change in the pulse, the skin and the face, and sometimes complete syncope. The effects produced by the administration of tartarized antimony, in nauseating doses, and of emetics, should be the governing rule. Not that I am the advocate of rashness or recklessness in the use of powerful remedies, in this or any other disease,—but of acute discrimination in settling the principle of action, and of firmness of purpose that dares to do right, under a watchful care of the modus operandi of what is done,—and of always stopping in the right time and at the right place.

I would repeat, that the remedial agents to be relied on are venesection, having strict regard to the effects produced, instead of the quantity of blood abstracted; leeching; cupping; blistering and irritating the surface of the chest with tartar emetic ointment, Croton oil and sinapisms, while the pulse and other circumstances of the patient will tolerate them; at the same time we should call to our aid, when the disease is obstinate, tartarized antimony, and give it in sufficient doses, in solution in water, to keep up more or less nausea for hours, or even days, as the case may require; giving a gentle emetic, every evening, of ipecacuanha, when no peculiarity of the patient contradicts its use,—to be continued for a longer or shorter period of time, according to the effects produced, or the necessities of the case; keeping the skin in a soft and moderately moist state; confining the patient to a moderately warm but large and airy room; enjoining rest, while there is any considerable febrile action, and even confinement to the bed may sometimes be requisite, till the force and frequency of the pulse are essentially moderated. Abstinence from all solid food, for a while, may be requisite, but cooling and demulcent drinks should be freely taken, and some liquid nourishment may be allowed. Mild mercurials, when the digestive and hepatic systems are deranged, will be serviceable, keeping the bowels open, when necessary, with gentle laxatives.

This plan of treatment is to be adopted, in whole or in part, pursued longer or shorter, modified or changed, according to the sudden or slow access, violence or mildness of the disease, and the constitutional circumstances of the patient, obviating incidental symptoms by their appropriate remedies, till the force of the disease is broken; when the confirmation of the cure may be left to a milk and vegetable diet, suitable exercise, a change of climate, expectorants, and friction upon the skin, or effected by a diligent use of the means recommended for the prevention of phthisis. The common expectorants are too well known to require enumeration; but I would here remark, that the eupatorium perfoliatum seems to me to be entitled to a higher rank in the catalogue of remedies, and especially as an useful adjuvant in lessening inflammatory action in the first, and as an expectorant in the second, stage of consumption. A strong infusion of the leaves and blossoms, timely gathered and carefully dried and preserved, taken in doses of from two to four ounces, every six or eight hours, generally slightly affects the stomach at first, promotes perspiration, and acts gently upon the bowels, without a reduction of the strength, promotes expectoration, and lessens the frequency of the pulse. By its use in my own case, while afflicted with bronchial inflammation last March, my pulse was twice reduced from eighty-four beats in a minute to sixty, sitting up in my chair during the time. This infusion may be made more palatable by the addition of refined sugar, or honey, to suit the taste. I have used it in this form, as I think, with considerable benefit, in pulmonary and bronchial disease. It is worthy of a more extensive trial.

The general views which I have now stated in relation to the treatment of the first stage of consumption, I do not pretend have even the charm of novelty to recommend them; still, I do believe them to be important, and that their fitness is too often lost sight of, in the desire to find something, which will probably never be discovered, to act specifically as an antidote to this obstinate and, too often, intractable disease. I feel much confidence in this plan of treatment, under favorable opportunities for carrying it out, and firmly believe that it will prove successful in a majority of cases of incipient phthisis, if early adopted and skilfully executed.

The faithful physician, however, will meet with obstacles and discouragements, in carrying forward to a successful issue so rigid a plan of treatment, which may require all the address he can command to overcome, and which, too often, he may expect will be insufficient to retain his patient's confidence and submission, while a certain cure is unconditionally and very dogmatically promised on much easier and more agreeable terms, by ignorant and self-complacent empirics and patentees. However well some men may think and reason on subjects generally, they often seem to lose their reason and common sense in relation to the treatment of disease. On this subject the mysterious and marvellous, aided perhaps by the honest but fatally mischievous interference and advice of meddlesome neighbors, successfully addresses their infirmities, and overpowers their better judgment. They could not be so cajoled and befooled on any other subject. How often, indeed, do we see consumptive patients, as well as dyspeptics, fly from one physician to another, and from the latter to the ignorant quack, incapable of reading or reasoning, for the cure of this complicated and grave disease! Why is it thus? Is it because

What would these otherwise sensible men say of the pretending mechanic, without even a knowledge of the laws of motion, and who had never seen the inside of a watch, but who, nevertheless, should offer to repair and regulate its delicate machinery by a wise look and a random shake? They would at once pronounce him a vile impostor, unworthy of patronage or notice. And can they not see any similarity between this mechanic and that renowned son of Apollo, who, with the same look of wisdom, prescribes pills and bitters or syrups in every stage of this, and for all other diseases, always composed of the same materials? Alas! for boasted human reason! Who that knows that man must die — who that knows the uncertainty of the healing art, as well as all things earthly—would not be surprised, yes, astounded, to read the encomiums so lavishly bestowed upon a host of patent or secret medicines, from the never-failing “botanical cough-drops,” to the “resurrection pills” as safe and infallible remedies for consumption, in any stage of it, as well as for all other diseases, as dissimilar in their character as light and darkness, or as knowledge and ignorance, or honesty and dishonesty, yet published to the world for truth, accompanied with certificates, manufactured for the market, of their wonderful virtues and miraculous cures? What is the effect on common minds of such bold and positive assurance, and such transcendent recommendations? I answer, that many (I might almost have said all) do and will try them, and that, too, perhaps, in the only stage which affords any reasonable chance of a radical cure, and which, when once wasted, can never be redeemed. Indeed, this obstacle in the way of success so often meets us at the door, that our energies are paralyzed. I here assert, that I have never seen a single case of consumption permanently relieved by any of these secret medicines. Those having any influence, except as a placebo to the mind, generally contain some opiate preparation, which often soothes some of the more noticeable symptoms,—as the cough, for example,—but which return upon the deluded sufferer, with a force proportionate to the suspension, in a short period of time. The hope inspired by this deceitful mitigation, furnishes to the limited comprehension of the patient and his friends a reason for further trial of these medicines; and thus this treacherous disease, and these still more perfidious remedies, are making the victory sure.

These deceivers (and I know not but they deceive themselves as well as others) well know the common prejudices against all medicines, not selected from the vegetable kingdom. They are careful, of course, to use the qualifying word, “vegetable,” written in huge capitals, often and generally before the bombastic name of their potent cure-all, when, at the same time, it is well known to you, that many, and probably most of these patent compounds, having any physical effects, contain some of the very Samsons of the mineral kingdom, combined with some form of opium. Then it is, strange as it may seem, that opium, mercury, antimony and arsenic, against which there is such a general prejudice in the community, excited and kept up by these vegetable standards of moral purity, under the cloak of secrecy, and the essence of checkerberry, are swallowed with avidity. Surely opium has a vegetable origin, and so have many other deadly poisons that may be beneficially effective in skilful and careful hands, in the treatment of diseases; but the deception is none the less on that account. But is the daily use of opium always safe and harmless, in every stage of consumption? This is not in accordance with the best modern medical opinion. The stimulating property of opium must be prejudicial in its influence upon an already too much excited and an inflamed system, and my experience induces me to believe its daily use, in the first stage of consumption, quite as objectionable as a moderate daily use of spiritous liquor or wine. I have never known a successful termination of genuine phthisis, where this drug has been admitted into its early daily treatment. Certain symptoms or incidental occurrences may call for a single moderate dose of some opiate preparation, but when the object is obtained, for which it may have been proper to administer it, I would recommend to dismiss it at once.

These secret medicines promise altogether too much. Their extravagant and bloated commendations make probability blush. This fact, alone, it would seem, should be sufficient to excite universal distrust, if not disgust. But it is not so, and I verily believe that thousands of valuable lives have been lost by the faith and confidence inspired by these fulsome recommendations, in their safety and infallibility as remedial agents. If the patient waver, the gratuitous cant is, “it can't do any hurt to try it.” This short argument is often conclusive, and the medicine is tried. Do these medical advisers realize the responsibility they take upon themselves? They are probably honest in their advice, having read in their newspaper that they are not only “safe,” but “certain cures.” Who is responsible for all this deception? Some good people seem to believe (and is it not creditable to their hearts?) all that is printed, and when these secret, deceitful, and oftentimes dangerous compounds are puffed off in the most fascinating terms which the ingenuity of man can employ to foster popular errors in their favor, and strengthen and heighten popular prejudice against what are vaguely termed “apothecary medicines,” and all coolly set forth as sober truth, in the family newspaper; is it surprising that they try them? The heaviest sin in this business does not lie at the door of this class of people. There is another class of persons, for whom I can think of no apology, and who, as it would seem, can have but a single object in view, a single purpose to effect. Let us take our leave of this class of impostors, in the language of the good old patriarch; “O, my soul, come not thou into their secret; unto their assembly, mine honor, be not thou united.”

The treatment of the second and third stages of consumption should be mild and soothing. Mucilages and gently exciting expectorants may be given to allay irritation, and to aid in throwing off the loose secretions in the throat and bronchial tubes; sinapisms and emollient poultices; stimulating liniments or plasters; a dry hot cloth, which is often more grateful than any other external application, may be applied to the chest, to relieve local pain or distress. The temperature of the patient’s apartments should be kept as even as possible, day and night, at the degree of warmth most agreeable to the patient; the air is to be kept pure and sweet, by gentle, constant circulation, with strict attention to cleanliness; the diet is to be adapted to the condition and habits of the patient; the bowels to be kept regularly open; and gentle exercise should be taken, daily, out or in doors, according to the state of the weather, so long as the patient can bear it. All medicines should be omitted when the patient is comfortable without them. Light exercise of the mind, upon subjects suited to the taste and habits of the patient, should be encouraged. Deception and quackery should not and cannot be resorted to, by the conscientious and scientific physician. If the patient or his friends are not satisfied with truth and reason, it is better to retire than wound the moral sense, or the dignity of professional science.

I am aware that some of the various forms of opium are almost universally resorted to, by physicians, to alleviate the sufferings of patients in the second and third stages of consumption. My experience is, that the daily administration of opium, in any of its preparations, even in the last stage of phthisis, is of doubtful utility as a palliative. Every dose seems to create a necessity for another, which often increases in proportion to the time it is used, till its constant influence is deemed indispensable, by the patient, to make existence tolerable. Therefore, I would recommend to withhold opiate preparations, as long as possible, except occasional moderate doses, to check diarrhœa, with pain in the bowels, when it cannot be effected by the use of other remedies. I object to the daily use of opium, because it lessens or wholly destroys the appetite for simple food, increases the heat and febrile symptoms, and consequently facilitates and accelerates tuberculous ulceration in the lungs; and because it seems only to smooth the pillow of suffering at the expense of an accelerated waste of the sands of life,—of a clouded intellect,—and of an increased susceptibility of the system to pain and suffering when not under its deadening influence. It agrees with some constitutions better than with others,—but it flatters, only to deceive, and charms, only to destroy.

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