LAUGHING, and SINGING. The lungs, when debilitated, derive equal benefit
with the limbs, or other parts of the body, from moderate exercise.
I have mentioned, in another place[28], several facts which support
this opinion. But too much pains cannot be taken to inculcate upon our
patients to avoid all _excess_ in the use of the lungs, by _long_, or
_loud_ reading, speaking, or singing, or by sudden and violent _bursts_
of laughter. I shall long lament the death of a female patient, who had
discovered many hopeful signs of a recovery from a consumption, who
relapsed, and died, in consequence of bursting a blood-vessel in her
lungs, by a sudden fit of laughter.
[28] An Account of the Effects of Common Salt in the Cure of
Hæmoptysis.
12. Are there any advantages to be derived from the excitement of
certain PASSIONS in the treatment of consumptions? Dr. Blane tells us,
that many consumptive persons were relieved, and that some recovered, in
consequence of the terror which was excited by a hurricane in Barbadoes,
in the year 1780. It will be difficult to imitate, by artificial
means, the accidental cures which are recorded by Dr. Blane; but we
learn enough from them to inspire the invigorating passions of hope
and confidence in the minds of our patients, and to recommend to them
such exercises as produce exertions of body and mind analogous to those
which are produced by terror. Van Sweiten and Smollet relate cures of
consumptions, by patients falling into streams of cold water. Perhaps,
in both instances, the cures were performed only by the fright and
consequent exertion produced by the fall. This is only one instance out
of many which might be mentioned, of partial and unequal action being
suddenly changed into general and equal excitement in every part of the
system. The cures of consumptions which have been performed by a camp
life[29], have probably been much assisted by the commotions in the
passions which were excited by the various and changing events of war.
[29] Vol. I. p. 204.
13. A SALIVATION has lately been prescribed in this disease with
success. An accident first suggested its advantages, in the Pennsylvania
hospital, in the year 1800[30]. Since that time, it has performed many
cures in different parts of the United States. It is to be lamented,
that in a majority of the cases in which the mercury has been given,
it has failed of exciting a salivation. Where it affects the mouth, it
generally succeeds in recent cases, which is more than can be said of
any, or of all other remedies in this disease. In its hectic state, a
salivation frequently cures, and even in its typhus and last stage, I
have more than once prescribed it with success. The same regard to the
pulse should regulate the use of this new remedy in consumption, that
has been recommended in other febrile diseases. It should never be
advised until the inflammatory diathesis of the system has been in a
great degree reduced, by the depleting remedies formerly mentioned.
[30] Medical Repository of New-York. Vol. V.
During the use of the above remedies, great care should be taken to
relieve the patient from the influence of all those debilitating and
irritating causes which induced the disease. I shall say elsewhere that
decayed teeth are one of them. These should be extracted where there is
reason to suspect they have produced, or that they increase the disease.
I have hitherto said nothing of the digitalis as a palliative remedy in
pulmonary consumption. I am sorry to acknowledge that, in many cases in
which I have prescribed it, it has done no good, and in some it has done
harm. From the opposite accounts of physicians of the most respectable
characters of the effects of this medicine, I have been inclined to
ascribe its different issues, to a difference in the soil in which it
has been cultivated, or in the times of gathering, or in the manner
of preparing it, all of which we know influence the qualities of many
other vegetables. If the theory of consumption which I have endeavoured
to establish be admitted, that uncertain and unsafe medicine will be
rendered unnecessary by the remedies that have been enumerated, provided
they are administered at the times, and in the manner that has been
recommended.
Before I proceed to speak of the radical cure of the consumption, it
will be necessary to observe, that by means of the palliative remedies
which have been mentioned, many persons have been recovered, and some
have had their lives prolonged by them for many years; but in most of
these cases I have found, upon inquiry, that the disease recurred as
soon as the patient left off the use of his remedies, unless they were
followed by necessary or voluntary exercise.
It is truly surprising to observe how long some persons have lived
who have been affected by a consumptive diathesis, and by frequent
attacks of many of the most troublesome symptoms of this disease. Van
Sweiten mentions the case of a man, who had lived thirty years in this
state. Morton relates the history of a man, in whom the symptoms of
consumption appeared with but little variation or abatement from his
early youth till the 70th year of his age. The widow of the celebrated
Senac lived to be 84 years of age, thirty of which she passed in a
pulmonary consumption. Dr. Nicols was subject to occasional attacks of
this disease during his whole life, and he lived to be above eighty
years of age. Bennet says he knew an instance in which it continued
above sixty years. I prescribed for my first pupil, Dr. Edwards, in a
consumption in the year 1769. He lived until 1802, and seldom passed a
year without spitting blood, nor a week without a cough, during that
long interval of time. The fatal tendency of his disease was constantly
opposed by occasional blood-letting, rural exercises, a cordial, but
temperate diet, the Peruvian bark, two sea voyages, and travelling in
foreign countries. There are besides these instances of long protracted
consumptions, cases of it which appear in childhood, and continue for
many years. I have seldom known them prove fatal under puberty.
I am led here to mention another instance of the analogy between
pneumony and the pulmonary consumption. We often see the same frequency
of recurrence of both diseases in habits which are predisposed to them.
I have attended a German citizen of Philadelphia, in several fits of the
pneumony, who has been confined to his bed eight-and-twenty times, by
the same disease, in the course of the same number of years. He has, for
the most part, enjoyed good health in the intervals of those attacks,
and always appeared, till lately, to possess a good constitution. In the
cases of the frequent recurrence of pneumony, no one has suspected the
disease to have originated exclusively in a morbid state of the lungs;
on the contrary, it appears evidently to be produced by the _sudden_
influence of the same causes, which, by acting with less force, and
for a _longer_ time, produce the pulmonary consumption. The name of
pneumony is taken from the principal symptom of this disease, but it as
certainly belongs to the whole arterial system as the consumption; and
I add further, that it is as certainly produced by general predisposing
debility. The hardness and fulness of the pulse do not militate against
this assertion, for they are altogether the effects of a morbid
and convulsive excitement of the sanguiferous system. The strength
manifested by the pulse is moreover partial, for every other part of the
body discovers, at the same time, signs of extreme debility.
It would be easy, by pursuing this subject a little further, to mention
a number of facts which, by the aid of principles in physiology and
pathology, which are universally admitted, would open to us a new theory
of fevers, but this would lead us too far from the subject before us.
I shall only remark, that all that has been said of the influence of
_general_ debilitating causes upon the lungs, both in pneumony and
consumption, and of the alternation of the consumption with other
general diseases, will receive great support from considering the lungs
only as a part of the whole external surface of the body, upon which
most of the remote and exciting causes of both diseases produce their
first effects. This extent of the surface of the body, not only to the
lungs, but to the alimentary canal, was first taken notice of by Dr.
Boerhaave; but was unhappily neglected by him in his theories of the
diseases of the lungs and bowels. Dr. Keil supposes that the lungs,
from the peculiar structure of the bronchial vessels, and air vesicles,
expose a surface to the action of the air, equal to the extent of the
whole external and visible surface of the body.
Thus have I mentioned the usual palliative remedies for the
consumption. Many of these remedies, under certain circumstances, I have
said have cured the disease, but I suspect that most of these cures have
taken place only when the disease has partaken of an intermediate nature
between a pneumony and a true pulmonary consumption. Such connecting
shades, appear between the extreme points of many other diseases. In a
former essay[31], I endeavoured to account for the transmutation (if I
may be allowed the expression) of the pneumony into the consumption,
by ascribing it to the increase of the debilitating refinements of
civilized life. This opinion has derived constant support from every
observation I have made connected with this subject, since its first
publication, in the year 1772.
[31] Inquiry into the Diseases and Remedies of the Indians of
North-America; and a comparative view of their diseases and
remedies with those of civilized nations. Vol. I.
I come now to treat of the RADICAL REMEDIES for the pulmonary
consumption.
In an essay formerly alluded to[32], I mentioned the effects of labour,
and the hardships of a camp or naval life, upon this disease. As there
must frequently occur such objections to each of those remedies, as to
forbid their being recommended or adopted, it will be necessary to seek
for substitutes for them in the different species of exercise. These
are, _active_, _passive_, and _mixed_. The _active_ includes walking,
and the exercise of the hands and feet in working or dancing. The
_passive_ includes rocking in a cradle, swinging, sailing, and riding in
carriages of different kinds. The _mixed_ is confined chiefly to riding
on horseback.
[32] Thoughts on the Pulmonary Consumption. Vol. I.
I have mentioned all the different species of exercise, not because
I think they all belong to the class of radical remedies for the
consumption, but because it is often necessary to use those which are
passive, before we recommend those of a mixed or active nature. That
physician does not err more who advises a patient to take physic,
without specifying its qualities and doses, than the physician does
who advises a patient, in a consumption, to use exercise, without
specifying its species and degrees. From the neglect of this direction,
we often find consumptive patients injured instead of being relieved by
exercises, which, if used with judgment, might have been attended with
the happiest effects.
I have before suggested that the stimulus of every medicine, which
is intended to excite action in the system, should always be in an
exact ratio to its excitability. The same rule should be applied to
the stimulus of exercise. I have heard a well-attested case of a young
lady, upon whose consumption the first salutary impression was made by
rocking her in a cradle; and I know another case in which a young lady,
in the lowest state of that debility which precedes an affection of the
lungs, was prepared for the use of the mixed and active exercises, by
being first moved gently backwards and forwards in a chariot without
horses, for an hour every day. Swinging appears to act in the same
gentle manner. In the case of a gardener, who was far advanced in
a consumption, in the Pennsylvania hospital, I had the pleasure of
observing its good effects, in an eminent degree. It so far restored
him, as to enable him to complete his recovery by working at his former
occupation.
In cases of extreme debility, the following order should be recommended
in the use of the different species of exercise.
1. Rocking in a cradle, or riding on an elastic board, commonly called a
chamber-horse.
2. Swinging.
3. Sailing.
4. Riding in a carriage.
5. Riding on horseback.
6. Walking.
7. Running and dancing.
In the use of each of those species of exercise great attention should
be paid to the _degree_ or _force_ of action with which they are applied
to the body. For example, in riding in a carriage, the exercise will be
less in a four-wheel carriage than in a single horse chair, and less
when the horses move in a walking, than a trotting gait. In riding on
horseback, the exercise will be less or greater according as the horse
walks, paces, canters, or trots, in passing over the ground.
I have good reason to believe, that an English sea-captain, who was
on the verge of the grave with the consumption, in the spring of the
year 1790, owed his perfect recovery to nothing but the above gradual
manner, in which, by my advice, he made use of the exercises of riding
in a carriage and on horseback. I have seen many other cases of the
good effects of thus accommodating exercise to debility; and I am sorry
to add, that I have seen many cases in which, from the neglect of this
manner of using exercise, most of the species and degrees of it, have
either been useless, or done harm. However carelessly this observation
may be read by physicians, or attended to by patients, I conceive no
direction to be more necessary in the cure of consumptions. I have been
thus particular in detailing it, not only because I believe it to be
important, but that I might atone to society for that portion of evil
which I might have prevented by a more strict attention to it in the
first years of my practice.
The more the arms are used in exercise the better. One of the
proprietary governors of Pennsylvania, who laboured for many years under
consumptive diathesis, derived great benefit from frequently rowing
himself in a small boat, a few miles up and down the river Schuylkill.
Two young men, who were predisposed to a consumption, were perfectly
cured by working steadily at a printing press in this city. A French
physician in Martinique cured this disease, by simply rubbing the arms
between the shoulders and the elbows, until they inflamed. The remedy is
strongly recommended, by the recoveries from pulmonary consumption which
have followed abscesses in the arm-pits. Perhaps the superior advantages
of riding on horseback, in this disease, may arise in part from the
constant and gentle use of the arms in the management of the bridle and
the whip.
Much has been said in favour of sea voyages in consumptions. In the
mild degrees of the disease they certainly have done service, but I
suspect the relief given, or the cures performed by them, should be
confined chiefly to seafaring people, who add to the benefits of a
constant change of pure air, a share of the invigorating exercises of
navigating the ship. I have frequently heard of consumptive patients
reviving at sea, probably from the transient effects of sea sickness
upon the whole system, and growing worse as soon as they came near
the end of their voyage. It would seem as if the mixture of land and
sea airs was hurtful to the lungs, in every situation and condition
in which it could be applied to them. Nor are the peculiar and morbid
effects of the first operation of land and sea airs upon the human body,
in sea voyages, confined only to consumptive people. I crossed the
Atlantic ocean, in the year 1766, with a sea captain, who announced to
his passengers the agreeable news that we were near the British coast,
before any discovery had been made of our situation by sounding, or by a
change in the colour of the water. Upon asking him upon what he founded
his opinion, he said, that he had been sneezing, which, he added, was
the sign of an approaching cold, and that, in the course of upwards of
twenty years, he had never made the land (to use the seaman's phrase)
without being affected in a similar manner. I have visited many sick
people in Philadelphia, soon after their arrival from sea, who have
informed me, that they had enjoyed good health during the greatest part
of their voyage, and that they had contracted their indispositions after
they came within sight of the land. I mention these facts only to show
the necessity of advising consumptive patients, who undertake a sea
voyage for the recovery of their health, not to expose themselves upon
deck in the morning and at night, after they arrive within the region in
which the mixture of the land and sea airs may be supposed to take place.
I subscribe, from what I have observed, to the bold declaration of Dr.
Sydenham, in favour of the efficacy of riding on horseback, in the cure
of consumption. I do not think the existence of an abscess, when broken,
or even tubercles in the lungs, when recent, or of a moderate size,
the least objection to the use of this excellent remedy. An abscess in
the lungs is not necessarily fatal, and tubercles have no malignity in
them which should render their removal impracticable by this species of
exercise. The first question, therefore, to be asked by a physician who
visits a patient in this disease should be, not what is the state of his
lungs, but, is he able to ride on horseback.
There are two methods of riding for health in this disease. The first
is by short excursions; the second is by long journies. In slight
consumptive affections, and after a recovery from an acute illness,
short excursions are sufficient to remove the existing debility; but in
the more advanced stages of consumption, they are seldom effectual, and
frequently do harm, by exciting an occasional appetite without adding
to the digestive powers. They, moreover, keep the system constantly
vibrating by their unavoidable inconstancy, between distant points
of tone and debility[33], and they are unhappily accompanied at all
times, from the want of a succession of fresh objects to divert the
mind, by the melancholy reflection that they are the sad, but necessary
conditions of life.
[33] The bad effects of _inconstant_ exercise have been taken notice of
in the gout. Dr. Sydenham says, when it is used only by fits and
starts in this disease, it does harm.
In a consumption of long continuance or of great danger, long journies
on horseback are the most effectual modes of exercise. They afford a
constant succession of fresh objects and company, which divert the
mind from dwelling upon the danger of the existing malady; they are
moreover attended by a constant change of air, and they are not liable
to be interrupted by company, or transient changes in the weather, by
which means appetite and digestion, action and power, all keep pace
with each other. It is to be lamented that the use of this excellent
remedy is frequently opposed by indolence and narrow circumstances
in both sexes, and by the peculiarity of situation and temper in the
female sex. Women are attached to their families by stronger ties than
men. They cannot travel alone. Their delicacy, which is increased by
sickness, is liable to be offended at every stage; and, lastly, they
sooner relax in their exertions to prolong their lives than men. Of
the truth of the last observation, sir William Hamilton has furnished
us with a striking illustration. He tells us, that in digging into
the ruins produced by the late earthquake in Calabria, the women who
perished in it, were all found with their arms folded, as if they had
abandoned themselves immediately to despair and death; whereas, the men
were found with their arms extended, as if they had resisted their fate
to the last moment of their lives. It would seem, from this fact, and
many others of a similar nature which might be related, that a capacity
of bearing pain and distress with fortitude and resignation, was the
distinguishing characteristic of the female mind; while a disposition to
resist and overcome evil, belonged in a more peculiar manner to the mind
of man. I have mentioned this peculiarity of circumstances and temper
in female patients, only for the sake of convincing physicians that it
will be necessary for them to add all the force of eloquence to their
advice, when they recommend journies to women in preference to all other
remedies, for the recovery of their health.
Persons, moreover, who pursue active employments, frequently object to
undertaking journies, from an opinion that their daily occupations are
sufficient to produce all the salutary effects we expect from artificial
exercise. It will be highly necessary to correct this mistake, by
assuring such persons that, however useful the habitual exercise of an
active, or even a laborious employment may be to _preserve_ health, it
must always be exchanged for one which excites new impressions, both
upon the mind and body, in every attempt to _restore_ the system from
that debility which is connected with pulmonary consumption.
As travelling is often rendered useless, and even hurtful in this
disease, from being pursued in an improper manner, it will be necessary
to furnish our patients with such directions as will enable them to
derive the greatest benefit from their journies. I shall, therefore, in
this place, mention the substance of the directions which I have given
in writing for many years to such consumptive patients as undertake
journies by my advice.
1. To avoid fatigue. Too much cannot be said to enforce this direction.
It is the hinge on which the recovery or death of a consumptive patient
frequently turns. I repeat it again, therefore, that patients should be
charged over and over when they set off on a journey, as well as when
they use exercise of any kind, to avoid fatigue. For this purpose they
should begin by travelling only a few miles in a day, and increase the
distance of their stages, as they increase their strength. By neglecting
this practice, many persons have returned from journies much worse than
when they left home, and many have died in taverns, or at the houses of
their friends on the road. Travelling in stage-coaches is seldom safe
for a consumptive patient. They are often crowded; they give too much
motion; and they afford by their short delays and distant stages, too
little time for rest, or for taking the frequent refreshment which was
formerly recommended.
2. To avoid travelling too soon in the morning, and after the going
down of the sun in the evening, and, if the weather be hot, never to
travel in the middle of the day. The sooner a patient breakfasts after
he leaves his bed the better; and in no case should he leave his morning
stage with an empty stomach.
3. If it should be necessary for a patient to lie down, or to sleep in
the day time, he should be advised to undress himself, and to cover his
body between sheets or blankets. The usual ligatures of garters, stocks,
knee-bands, waistcoats, and shoes, are very unfriendly to sound sleep;
hence persons who lie down with their clothes on, often awake from an
afternoon's nap in terror from dreams, or in a profuse sweat, or with
a head-ach or sick stomach; and generally out of humour. The surveyors
are so sensible of the truth of this remark, that they always undress
themselves when they sleep in the woods. An intelligent gentleman of
this profession informed me, that he had frequently seen young woodsmen,
who had refused to conform to this practice, so much indisposed in the
morning, that, after the experience of a few nights, they were forced to
adopt it.
Great care should be taken in sleeping, whether in the day time or at
night, never to lie down in damp sheets. Dr. Sydenham excepts the danger
from this quarter, when he speaks of the efficacy of travelling on
horseback in curing the consumption.
4. Patients who travel for health in this disease should avoid all
large companies, more especially evening and night parties. The air
of a contaminated room, phlogisticated by the breath of fifteen or
twenty persons, and by the same number of burning candles, is poison
to a consumptive patient. To avoid impure air from every other source,
he should likewise avoid sleeping in a crowded room, or with curtains
around his bed, and even with a bed-fellow.