Volume 1 — THOUGHTS UPON THE CAUSE AND CURE OF THE PULMONARY CONSUMPTION.

The ancient Jews used to say, that a man does not fulfil his duties in life, who passes through it, without building a house, planting a tree, and leaving a child behind him. A physician, in like manner, should consider his obligations to his profession and society as undischarged, who has not attempted to lessen the number of incurable diseases. This is my apology for presuming to make the consumption the object of a medical inquiry.

Perhaps I may suggest an idea, or fact, that may awaken the ideas and facts which now lie useless in the memories or common-place books of other physicians; or I may direct their attention to some useful experiments upon this subject.

I shall begin my observations upon the consumption, by remarking,

1. That it is unknown among the Indians in North-America.

2. It is scarcely known by those citizens of the United States, who live in the first stage of civilized life, and who have lately obtained the title of the first settlers.

The principal occupations of the Indian consist in war, fishing, and hunting. Those of the first settler, are fishing, hunting, and the laborious employments of subduing the earth, cutting down forests, building a house and barn, and distant excursions, in all kinds of weather, to mills and courts, all of which tend to excite and preserve in the system, something like the Indian vigour of constitution.

3. It is less common in country places than in cities, and increases in both, with intemperance and sedentary modes of life.

4. Ship and house carpenters, smiths, and all those artificers whose business requires great exertions of strength in the open air, in all seasons of the year, are less subject to this disease, than men who work under cover, and at occupations which do not require the constant action of their limbs.

5. Women, who sit more than men, and whose work is connected with less exertion, are most subject to the consumption.

From these facts it would seem, that the most probable method of curing the consumption, is to revive in the constitution, by means of exercise or labour, that vigour which belongs to the Indians, or to mankind in their first stage of civilization.

The efficacy of these means of curing consumption will appear, when we inquire into the relative merit of the several remedies which have been used by physicians in this disease.

I shall not produce among these remedies the numerous receipts for syrups, boluses, electuaries, decoctions, infusions, pills, medicated waters, powders, draughts, mixtures, and diet-drinks, which have so long and so steadily been used in this disease; nor shall I mention as a remedy, the best accommodated diet, submitted to with the most patient self-denial; for not one of them all, without the aid of exercise, has ever, I believe, cured a single consumption.

1. Sea-voyages have cured consumptions; but it has been only when they have been so long, or so frequent, as to substitute the long continuance of gentle, to violent degrees of exercise of a shorter duration, or where they have been accompanied by some degree of the labour and care of navigating the ship.

2. A change of climate has often been prescribed for the cure of consumptions, but I do not recollect an instance of its having succeeded, except when it has been accompanied by exercise, as in travelling, or by some active laborious pursuit.

Doctor Gordon of Madeira, ascribes the inefficacy of the air of Madeira in the consumption, in part to the difficulty patients find of using exercise in carriages, or even on horseback, from the badness of the roads in that island.

3. Journies have often performed cures in the consumption, but it has been chiefly when they have been long, and accompanied by difficulties which have roused and invigorated the powers of the mind and body.

4. Vomits and NAUSEATING MEDICINES have been much celebrated for the cure of consumptions. These, by procuring a temporary determination to the surface of the body, so far lessen the pain and cough, as to enable patients to use profitable exercise. Where this has not accompanied or succeeded the exhibition of vomits, I believe they have seldom afforded any permanent relief.

5. Blood-letting has often relieved consumptions; but it has been only by removing the troublesome symptoms of inflammatory diathesis, and thereby enabling the patients to use exercise, or labour, with advantage.

6. Vegetable bitters and some of the STIMULATING GUMS have in some instances afforded relief in consumptions; but they have done so only in those cases where there was great debility, accompanied by a total absence of inflammatory diathesis. They have most probably acted by their tonic qualities, as substitutes for labour and exercise.

7. A Plentiful and REGULAR PERSPIRATION, excited by means of a flannel shirt, worn next to the skin, or by means of a stove-room, or by a warm climate, has in many instances prolonged life in consumptive habits; but all these remedies have acted as palliatives only, and thereby have enabled the consumptive patients to enjoy the more beneficial effects of exercise.

8. Blisters, SETONS, and ISSUES, by determining the perspirable matter from the lungs to the surface of the body, lessen pain and cough, and thereby prepare the system for the more salutary effects of exercise.

9. The effects of SWINGING upon the pulse and respiration, leave us no room to doubt of its being a tonic remedy, and therefore a safe and agreeable substitute for exercise.

From all these facts it is evident, that the remedies for consumptions must be sought for in those exercises and employments which give the greatest vigour to the constitution. And here I am happy in being able to produce several facts which demonstrate the safety and certainty of this method of cure.

During the late war, I saw three instances of persons in confirmed consumptions, who were perfectly cured by the hardships of a military life. They had been my patients previously to their entering into the army. Besides these, I have heard of four well-attested cases of similar recoveries from nearly the same remedies. One of these was the son of a farmer in New-Jersey, who was sent to sea as the last resource for a consumption. Soon after he left the American shore, he was taken by a British cruiser, and compelled to share in all the duties and hardships of a common sailor. After serving in this capacity for twenty-two months, he made his escape, and landed at Boston, from whence he travelled on foot to his father's house (nearly four hundred miles), where he arrived in perfect health.

Doctor Way of Wilmington informed me, that a certain Abner Cloud, who was reduced so low by a pulmonary consumption as to be beyond all relief from medicine, was so much relieved by sleeping in the open air, and by the usual toils of building a hut, and improving a farm, in the unsettled parts of a new country in Pennsylvania, that he thought him in a fair way of a perfect recovery.

Doctor Latimer of Wilmington had been long afflicted with a cough and an occasional hæmoptysis. He entered into the American army as a surgeon, and served in that capacity till near the end of the war; during which time he was perfectly free from all pulmonary disease. The spitting of blood returned soon after he settled in private practice. To remedy this complaint, he had recourse to a low diet, but finding it ineffectual, he partook liberally of the usual diet of healthy men, and he now enjoys a perfect exemption from it.

It would be very easy to add many other cases, in which labour, the employments of agriculture, and a life of hardship by sea and land, have prevented, relieved, or cured, not only the consumption, but pulmonary diseases of all kinds.

To the cases that have been mentioned, I shall add only one more, which was communicated to me by the venerable Doctor Franklin, whose conversation at all times conveyed instruction, and not less in medicine than upon other subjects. In travelling, many years ago, through New-England, the doctor overtook the post-rider; and after some inquiries into the history of his life, he informed him that he was bred a shoe-maker; that his confinement, and other circumstances, had brought on a consumption, for which he was ordered by a physician to ride on horseback. Finding this mode of exercise too expensive, he made interest, upon the death of an old post-rider, to succeed to his appointment, in which he perfectly recovered his health in two years. After this he returned to his old trade, upon which his consumption returned. He again mounted his horse, and rode post in all seasons and weathers, between New-York and Connecticut river (about 140 miles), in which employment he continued upwards of thirty years, in perfect health.

These facts, I hope, are sufficient to establish the advantages of restoring the original vigour of the constitution, in every attempt to effect a radical cure of consumption.

But how shall these remedies be applied in the time of peace, or in a country where the want of woods, and brooks without bridges, forbid the attainment of the laborious pleasures of the Indian mode of hunting; or where the universal extent of civilization does not admit of our advising the toils of a new settlement, and improvements upon bare creation? Under these circumstances, I conceive substitutes may be obtained for each of them, nearly of equal efficacy, and attainable with much less trouble.

1. Doctor Sydenham pronounced riding on horseback, to be as certain a cure for consumptions as bark is for an intermitting fever. I have no more doubt of the truth of this assertion, than I have that inflammatory fevers are now less frequent in London than they were in the time of Doctor Sydenham. If riding on horseback in consumptions has ceased to be a remedy in Britain, the fault is in the patient, and not in the remedy. “It is a sign that the stomach requires milk (says Doctor Cadogan), when it cannot bear it.” In like manner, the inability of the patient to bear this manly and wholesome exercise, serves only to demonstrate the necessity and advantages of it. I suspect the same objections to this exercise which have been made in Britain, will not occur in the United States of America; for the Americans, with respect to the symptoms and degrees of epidemic and chronic diseases, appear to be nearly in the same state that the inhabitants of England were in the seventeenth century. We find, in proportion to the decline of the vigour of the body, that many occasional causes produce fever and inflammation, which would not have done it a hundred years ago.

2. The laborious employments of agriculture, if steadily pursued, and accompanied at the same time by the simple, but wholesome diet of a farmhouse, and a hard bed, would probably afford a good substitute for the toils of a savage or military life.

3. Such occupations or professions as require constant labour or exercise in the open air, in all kinds of weather, may easily be chosen for a young man who, either from hereditary predisposition, or an accidental affection of the lungs, is in danger of falling into a consumption. In this we should imitate the advice given by some wise men, always to prefer those professions for our sons, which are the least favourable to the corrupt inclinations of their hearts. For example, where an undue passion for money, or a crafty disposition, discover themselves in early life, we are directed to oppose them by the less profitable and more disinterested professions of divinity or physic, rather than cherish them by trade, or the practice of the law. Agreeably to this analogy, weakly children should be trained to the laborious, and the robust, to the sedentary occupations. From a neglect of this practice, many hundred apprentices to taylors, shoemakers, conveyancers, watchmakers, silversmiths, and mantua-makers, perish every year by consumptions.

4. There is a case recorded by Dr. Smollet, of the efficacy of the cold bath in a consumption; and I have heard of its having been used with success, in the case of a negro man, in one of the West-India islands. To render this remedy useful, or even safe, it will be necessary to join it with labour, or to use it in degrees that shall prevent the alternation of the system with vigour and debility; for I take the cure of consumption ultimately to depend upon the simple and constant action of tonic remedies. It is to be lamented that it often requires so much time, or such remedies to remove the inflammatory diathesis, which attends the first stage of consumption, as to reduce the patient too low to make use of those tonic remedies afterwards, which would effect a radical cure.

If it were possible to graduate the tone of the system by means of a scale, I would add, that to cure consumption, the system should be raised to the highest degree of this scale. Nothing short of an equilibrium of tone, or a free and vigorous action of every muscle and viscus in the body, will fully come up to a radical cure of this disease.

In regulating the diet of consumptive patients, I conceive it to be as necessary to feel the pulse, as it is in determining when and in what quantity to draw blood. Where inflammatory diathesis prevails, a vegetable diet is certainly proper; but where the patient has escaped, or passed this stage of the disease, I believe a vegetable diet alone to be injurious; and am sure a moderate quantity of animal food may be taken with advantage.

The presence or absence of this inflammatory diathesis, furnishes the indications for administering or refraining from the use of the bark and balsamic medicines. With all the testimonies of their having done mischief, many of which I could produce, I have known several cases in which they have been given with obvious advantage; but it was only when there was a total absence of inflammatory diathesis.

Perhaps the remedies I have recommended, and the opinions I have delivered, may derive some support from attending to the analogy of ulcers on the legs, and in other parts of the body. The first of these occur chiefly in habits debilitated by spiritous liquors, and the last frequently in habits debilitated by the scrophula. In curing these diseases, it is in vain to depend upon internal or external medicines. The whole system must be strengthened, or we do nothing; and this is to be effected only by exercise and a generous diet.

In relating the facts that are contained in this inquiry, I wish I could have avoided reasoning upon them; especially as I am confident of the certainty of the facts, and somewhat doubtful of the truth of my reasonings.

I shall only add, that if the cure of consumptions should at last be effected by remedies in every respect the opposites of those palliatives which are now fashionable and universal, no more will happen than what we have already seen in the tetanus, the small-pox, and the management of fractured limbs.

Should this be the case, we shall not be surprised to hear of physicians, instead of prescribing any one, or all of the medicines formerly enumerated for consumptions, ordering their patients to exchange the amusements, or indolence of a city, for the toils of a country life; of their advising farmers to exchange their plentiful tables, and comfortable fire-sides, for the scanty but solid subsistence, and midnight exposure of the herdsman; or of their recommending, not so much the exercise of a passive sea voyage, as the active labours and dangers of a common sailor. Nor should it surprise us, after what we have seen, to hear patients relate the pleasant adventures of their excursions or labours, in quest of their recovery from this disease, any more than it does now to see a strong or well-shaped limb that has been broken; or to hear a man talk of his studies, or pleasures, during the time of his being inoculated and attended for the small-pox.

I will not venture to assert, that there does not exist a medicine which shall supply, at least in some degree, the place of the labour or exercises, whose usefulness in consumptions has been established by the facts that have been mentioned. Many instances of the analogous effects of medicines, and of exercise upon the human body, forbid the supposition. If there does exist in nature such a medicine, I am disposed to believe it will be found in the class of TONICS. If this should be the case, I conceive its strength, or its dose, must far exceed the present state of our knowledge or practice, with respect to the efficacy or dose of tonic medicines.

I except the disease, which arises from recent abscesses in the lungs, from the general observation which has been made, respecting the inefficacy of the remedies that were formerly enumerated for the cure of consumptions without labour or exercise. These abscesses often occur without being preceded by general debility, or accompanied by a consumptive diathesis, and are frequently cured by nature, or by very simple medicines.