in such a manner as that a patient may escape the extremes of heat
and cold. For this purpose he should pass the winter, and part of the
spring, in Georgia or South-Carolina, and the summer in New-Hampshire,
Massachusetts, or Vermont, or, if he pleases, he may still more
effectually shun the summer heats, by crossing the lakes, and travelling
along the shores of the St. Laurence to the city of Quebec. He will
thus escape the extremes of heat and cold, particularly the less
avoidable one of heat; for I have constantly found the hot month of
July to be as unfriendly to consumptive patients in Pennsylvania, as
the variable month of March. By these means too he will enjoy nearly an
equable temperature of air in every month of the year; and his system
will be free from the inconvenience of the alternate action of heat
and cold upon it. The autumnal months should be spent in New-Jersey or
Pennsylvania.
In these journies from north to south, or from south to north, he
should be careful, for reasons before mentioned, to keep at as great
a distance as possible from the sea coast. Should this inquiry fall
into the hands of a British physician, I would beg leave to suggest
to him, whether more advantages would not accrue to his consumptive
patients from advising them to cross the Atlantic ocean, and afterwards
to pursue the tour which I have recommended, than by sending them
to Portugal, France, or Italy. Here they will arrive with such a
mitigation of the violence of the disease, in consequence of the length
of their sea voyage, as will enable them immediately to begin their
journies on horseback. Here they will be exposed to fewer temptations
to intemperance, or to unhealthy amusements, than in old European
countries. And, lastly, in the whole course of this tour, they will
travel among a people related to them by a sameness of language and
manners, and by ancient or modern ties of citizenship. Long journies
for the recovery of health, under circumstances so agreeable, should
certainly be preferred to travelling among strangers of different
nations, languages, and manners, on the continent of Europe.
6. To render travelling on horseback effectual in a consumption, it
should be continued with moderate intervals from _six to twelve months_.
But the cure should not be rested upon a single journey. It should be
repeated every _two_ or _three years_, till our patient has passed
the consumptive stages of life. Nay, he must do more; he must acquire
a _habit_ of riding constantly, both at home and abroad; or, to use
the words of Dr. Fuller, "he must, like a Tartar, learn to live on
horseback, by which means he will acquire in time the constitution of a
Tartar[34]."
[34] Medicina Gymnastica, p. 116.
Where benefit is expected from a change of climate, as well as from
travelling, patients should reside at least two years in the place
which is chosen for that purpose. I have seldom known a residence for a
shorter time in a foreign climate do much service.
To secure a perfect obedience to medical advice, it would be extremely
useful if consumptive patients could always be accompanied by a
physician. Celsus says, he found it more easy to cure the dropsy in
slaves than in freemen, because they more readily submitted to the
restraints he imposed upon their appetites. Madness has become a curable
disease in England, since the physicians of that country have opened
private mad-houses, and have taken the entire and constant direction
of their patients into their own hands. The same successful practice
would probably follow the treatment of consumptions, if patients were
constantly kept under the eye and authority of their physicians. The
keenness of appetite, and great stock of animal spirits, which those
persons frequently possess, hurry them into many excesses which defeat
the best concerted plans of a recovery; or, if they escape these
irregularities, they are frequently seduced from our directions by every
quack remedy which is recommended to them. Unfortunately the cough
becomes a signal of their disease, at every stage of their journey,
and the easy or pleasant prescriptions of even hostlers and ferrymen,
are often substituted to the self-denial and exertion which have been
imposed by physicians. The love of life in these cases seems to level
all capacities; for I have observed persons of the most cultivated
understandings to yield in common with the vulgar, to the use of these
prescriptions.
In a former volume I mentioned the good effects of accidental LABOUR in
pulmonary consumptions. The reader will find a particular account in the
first volume of Dr. Coxe's Medical Museum, of a clergyman and his wife,
in Virginia, being cured by the voluntary use of that remedy.
The following circumstances and symptoms, indicate the longer or shorter
duration of this disease, and its issue in life and death:
The consumption from gout, rheumatism, and scrophula, is generally of
long duration. It is more rapid in its progress to death, when it arises
from a half cured pleurisy, or neglected colds, measles, and influenza.
It is of shorter duration in persons under thirty, than in those who are
more advanced in life.
It is always dangerous in proportion to the length of time, in which
the debilitating causes, that predisposed to it, have acted upon the
body.
It is more dangerous when a predisposition to it has been derived from
ancestors, than when it has been acquired.
It is generally fatal when accompanied with a bad conformation of the
breast.
Chilly fits occurring in the forenoon, are more favourable than when
they occur in the evening. They indicate the disease to partake a little
of the nature of an intermittent, and are a call for the use of the
remedies proper in that disease.
Rheumatic pains, attended with an abatement of the cough, or pains in
the breast, are always favourable; so are
Eruptions, or an abscess on the external parts of the body, if they
occur before the last stage of the disease.
A spitting of blood, in the early, or forming stage of the disease, is
favourable, but after the lungs become much obstructed, or ulcerated, it
is most commonly fatal.
A pleurisy, occurring in the low state of the disease, generally kills,
but I have seen a case in which it suddenly removed the cough and hectic
fever, and thus became the means of prolonging the patient's life for
several years.
The discharge of calculi from the lungs by coughing and spitting, and
of a thin watery liquid, with a small portion of pus swimming on its
surface, are commonly signs of an incurable consumption.
No prediction unfavourable to life can be drawn from pus being
discharged from the lungs. We see many recoveries after it has taken
place, and many deaths where that symptom has been absent. Large
quantities of pus are discharged in consumptions attended with
abscesses, and yet few die of them, where they have not been preceded
by long continued debility of the whole system. No pus is expectorated
from tubercles, and how generally fatal is the disease, after they are
formed in the lungs! It is only after they ulcerate that they discharge
pus, and it is only after ulcers are thus formed, that the consumption
probably becomes uniformly fatal. I suspect these ulcers are sometimes
of a cancerous nature.
A sudden cessation of the cough, without a supervening diarrh[oe]a,
indicates death to be at hand.
A constant vomiting in a consumption, is generally a bad sign.
Feet obstinately cold, also a swelling of the feet during the day, and
of the face in the night, commonly indicate a speedy and fatal issue of
the disease.
Lice, and the falling off of the hair, often precede death.
A hoarseness, in the beginning of the disease, is always alarming, but
it is more so in its last stage.
A change of the eyes from a blue, or dark, to a light colour, similar
to that which takes place in very old people, is a sign of speedy
dissolution.
I have never seen a recovery after an apthous sore throat took place.
Death from the consumption comes on in some or more than one, of the
following ways:
1. With a diarrh[oe]a. In its absence,
2. With wasting night sweats.
3. A rupture of an abscess.
4. A rupture of a large blood-vessel in the lungs, attended with
external or internal hæmorrhage. _Sudden_ and _unexpected_ death in a
consumption is generally induced by this, or the preceding cause.
5. Madness. The cough and expectoration cease with this disease. It
generally carries off the patient in a week or ten days.
6. A pleurisy, brought on by exposure to cold.
7. A typhus fever, attended with tremors, twitchings of the tendons, and
a dry tongue.
8. Swelled hands, feet, legs, thighs, and face.
9. An apthous sore throat.
10. Great and tormenting pains, sometimes of a spasmodic nature in the
limbs.
In a majority of the fatal cases of consumption, which I have seen, the
passage out of life has been attended with pain; but I have seen many
persons die with it, in whom all the above symptoms were so lenient,
or so completely mitigated by opium, that death resembled a quiet
transition from a waking, to a sleeping state.
I cannot conclude this inquiry without adding, that the author of it
derived from his paternal ancestors a predisposition to the pulmonary
consumption, and that between the 18th and 43d years of his age, he has
occasionally been afflicted with many of the symptoms of that disease
which he has described. By the constant and faithful use of many of the
remedies which he has recommended, he now, in the 61st year of his age,
enjoys nearly an uninterrupted exemption from pulmonary complaints.
In humble gratitude, therefore, to that BEING, who condescends to be
called the preserver of men, he thus publicly devotes this result of his
experience and inquiries to the benefit of such of his fellow-creatures
as may be afflicted with the same disease, sincerely wishing that they
may be as useful to them, as they have been to the author.
OBSERVATIONS
ON
THE SYMPTOMS AND CURE
OF
_DROPSIES_.
Whether we admit the exhaling and absorbing vessels to be affected in
general dropsies by preternatural debility, palsy, or rupture, or by a
retrograde motion of their fluids, it is certain that their exhaling and
absorbing power is materially affected by too much, or too little action
in the arterial system. That too little action in the arteries should
favour dropsical effusions, has been long observed; but it has been
less obvious, that the same effusions are sometimes promoted, and their
absorption prevented, by too much action in these vessels. That this
fact should have escaped our notice is the more remarkable, considering
how long we have been accustomed to seeing serous swellings in the
joints in the acute rheumatism, and copious, but partial effusions of
water in the form of sweat, in every species of inflammatory fever.
It is nothing new that the healthy action of one part, should depend
upon the healthy action of another part of the system. We see it in
many of the diseases of the nerves and brain. The tetanus is cured by
exciting a tone in the arterial system; madness is cured by lessening
the action of the arteries by copious blood-letting; and epilepsy and
hysteria are often mitigated by the moderate use of the same remedy.
By too much action in the arterial system, I mean a certain morbid
excitement in the arteries, accompanied by preternatural force, which is
obvious to the sense of touch. It differs from the morbid excitement of
the arteries, which takes place in common inflammatory fevers, in being
attended by less febrile heat, and with little or no pain in the head
or limbs. The thirst is nearly the same in this state of dropsy, as in
inflammatory fevers. I include here those dropsies only in which the
whole system is affected by what is called a hydropic diathesis.
That debility should, under certain circumstances, dispose to excessive
action, and that excessive action should occur in one part of the body,
at the same time that debility prevailed in every other, are abundantly
evident from the history and phenomena of many diseases. Inflammatory
fever, active hæmorrhages, tonic gout, asthma, apoplexy, and palsy,
however much they are accompanied by excessive action in the arterial
system, are always preceded by original debility, and are always
accompanied by obvious debility in every other part of the system.
But it has been less observed by physicians that an undue force or
excess of action occurs in the arterial system in certain dropsies, and
that the same theory which explains the union of predisposing and nearly
general debility, with a partial excitement and preternatural action in
the arterial system, in the diseases before-mentioned, will explain the
symptoms and cure of certain dropsies.
That debility predisposes to every state of dropsy, is evident from
the history of all the remote and occasional causes which produce them.
It will be unnecessary to mention these causes, as they are to be found
in all our systems of physic. Nor will it be necessary to mention any
proofs of the existence of debility in nearly every part of the body.
It is too plain to be denied. I shall only mention the symptoms which
indicate a morbid excitement and preternatural action of the arterial
system. These are,
1. A _hard_, _full_, and _quick_ pulse. This symptom, I believe, is more
common in dropsies than is generally supposed, for many physicians visit
and examine patients in these diseases, without feeling the pulse. Dr.
Home mentions the _frequency_ of the pulse, in the patients whose cures
he has recorded[35], but he takes no notice of its force except in two
cases. Dr. Zimmerman, in his account of the dropsy which terminated
the life of Frederick II, of Prussia, tells us that he found his pulse
_hard_ and _full_. I have repeatedly found it full and hard in every
form of dropsy, and more especially in the first stage of the disease.
Indeed I have seldom found it otherwise in the beginning of the dropsy
of the breast.
[35] Medical Facts.
2. _Sizy blood._ This has been taken notice of by many practical
writers, and has very justly been ascribed, under certain circumstances
of blood-letting, to an excessive action of the vessels upon the blood.
3. _Alternation of dropsies with certain diseases which were evidently
accompanied by excess of action in the arterial system._ I have seen
anasarca alternate with vertigo, and both ascites and anasarca alternate
with tonic madness. A case of nearly the same kind is related by Dr.
Mead. Dr. Grimes, of Georgia, informed me that he had seen a tertian
fever, in which the intermissions were attended with dropsical swellings
all over the body, which suddenly disappeared in every accession of a
paroxysm of the fever.
4. _The occasional connection of certain dropsies with diseases
evidently of an inflammatory nature_, particularly pneumony, rheumatism,
and gout.
5. Spontaneous _hæmorrhages_ from the lungs, hæmorrhodial vessels, and
nose, cases of which shall be mentioned hereafter, when we come to treat
of the cure of dropsies.
6. _The appearance of dropsies in the winter and spring, in habits
previously affected by the intermitting fever._ The debility produced by
this state of fever, frequently disposes to inflammatory diathesis, as
soon as the body is exposed to the alternate action of heat and cold,
nor is this inflammatory diathesis always laid aside, by the transition
of the intermitting fever into a dropsy, in the succeeding cold weather.
7. _The injurious effects of stimulating medicines in certain dropsies_,
prove that there exists in them, at times, too much action in the
blood-vessels. Dr. Tissot, in a letter to Dr. Haller, "De Variolis,
apoplexia, et hydrope," condemns, in strong terms, the use of opium
in the dropsy. Now the bad effects of this medicine in dropsies, must
have arisen from its having been given in cases of too much action in
the arterial system; for opium, we know, increases, by its stimulating
qualities, the action and tone of the blood-vessels, and hence we find,
it has been prescribed with success in dropsies of too little action in
the system.
8. _The termination of certain fevers in dropsies in which
blood-letting was not used._ This has been ascertained by many
observations. Dr. Wilkes relates[36], that after "an epidemical fever,
which began in Kidderminster, in 1728, and soon afterwards spread, not
only over Great Britain, but all Europe, more people died dropsical
in three years, than did perhaps in twenty or thirty years before,"
probably from the neglect of bleeding in the fever.
[36] Historical Essay on the Dropsy, p. 326.
But the existence of too much action in the arterial system in certain
dropsies, will appear more fully from the history of the effects of the
remedies which have been employed either by design or accident in the
cure of these diseases. I shall first mention the remedies which have
been used with success in tonic or inflammatory dropsies; and afterwards
mention those which have been given with success in dropsies of a weak
action in the arteries. I have constantly proposed to treat only of the
theory and cure of dropsies in general, without specifying any of the
numerous names it derives from the different parts of the body in which
they may be seated; but in speaking of the remedies which have been used
with advantage in both the tonic and atonic states, I shall occasionally
mention the name or seat of the dropsy in which the remedy has done
service.
The first remedy that I shall mention for dropsies is _blood-letting_.
Dr. Hoffman and Dr. Home both cured dropsies accompanied by pulmonic
congestion by means of this remedy. Dr. Monroe quotes a case of dropsy
from Sponius, in which bleeding succeeded, but not till after it had
been used twenty times[37]. Mr. Cruikshank relates a case[38] of
accidental bleeding, which confirms the efficacy of blood-letting in
these diseases. He tells us that he attended a patient with dropsical
swellings in his legs, who had had a hoarseness for two years. One
morning, in stooping to buckle his shoes, he bursted a blood-vessel
in his lungs, from which he lost a quart of blood; in consequence of
which, both the swellings and the hoarseness went off gradually, and
he continued well two years afterwards. I have known one case in which
spontaneous hæmorrhages from the hæmorrhodial vessels, and from the
nose, suddenly reduced universal dropsical swellings. In this patient
there had been an uncommon tension and fulness in the pulse.
[37] Treatise on the Dropsy.
[38] Treatise on the Lymphatics.
I could add the histories of many cures of anasarca and ascites,
performed by means of blood-letting, not only by myself, but by a number
of respectable physicians in the United States. Indeed I conceive this
remedy to be as much indicated by a tense and full pulse in those forms
of dropsy, as it is in a pleurisy, or in any other common inflammatory
disease.
In those deplorable cases of hydrothorax, which do not admit of a
radical cure, I have given temporary relief, and thereby protracted
life, by taking away occasionally a few ounces of blood. Had Dr.
Zimmerman used this remedy in the case of the king of Prussia, I cannot
help thinking from the account which the doctor gives us of the diet and
pulse of his royal patient, that he would have lessened his sufferings
much more than by plentiful doses of dandelion; for I take it for
granted, from the candour and integrity which the doctor discovered in
all his visits to the king, that he did not expect that dandelion, or
any other medicine, would cure him.
Although a _full_ and _tense_ pulse is always an indication of the
necessity of bleeding; yet I can easily conceive there may be such
congestions, and such a degree of stimulus to the arterial system, as to
produce a depressed, or a _low_ or _weak_ pulse. Two cases of this kind
are related by Dr. Monroe, one of which was cured by bleeding. The same
symptom of a low and weak pulse is often met with in the _first_ stage
of pneumony, and apoplexy, and is only to be removed by the plentiful
use of the same remedy.
II. _Vomits_ have often been given with advantage in dropsies. Dr. Home
says, that squills were useful in these diseases only when they produced
a vomiting. By abstracting excitement and action from the arterial
system, it disposes the lymphatics to absorb and discharge large
quantities of water. The efficacy of vomits in promoting the absorption
of stagnating fluids is not confined to dropsies. Mr. Hunter was once
called to visit a patient in whom he found a bubo in such a state that
he purposed to open it the next day. In the mean while, the patient went
on board of a vessel, where he was severely affected by sea-sickness and
vomiting; in consequence of which the bubo disappeared, and the patient
recovered without the use of the knife.
Mr. Cruikshank further mentions a case[39] of a swelling in the knee
being nearly cured by a patient vomiting eight and forty hours, in
consequence of his taking a large dose of the salt of tartar instead of
soluble tartar.
[39] Letter to Mr. Clare, p. 166.
III. _Purges._ The efficacy of this remedy, in the cure of dropsies,
has been acknowledged by physicians in all ages and countries. Jalap,
calomel, scammony, and gamboge, are often preferred for this purpose;
but I have heard of two cases of ascites being cured by a table
spoonful of sweet oil taken every day. It probably acted only as a
gentle laxative. The cream of tartar, so highly commended by Dr. Home,
seems to act _chiefly_ in the same way. Gherlius, from whom Dr. Home
learned the use of this medicine, says, that all the persons whom he
cured by it were in the vigour of life, and that their diseases had
been only of a few months continuance. From these two circumstances,
it is most probable they were dropsies of great morbid action in the
arterial system. He adds further, that the persons who were cured by
this medicine, were reduced very low by the use of it. Dr. Home says
that it produced the same effect upon the patients whom he cured by it,
in the infirmary of Edinburgh. Dr. Sydenham prefers gentle to drastic
purges, and recommends the exhibition of them every day. Both drastic
and gentle purges act by diminishing the action of the arterial system,
and thereby promote the absorption and discharge of water. That purges
promote absorption, we learn not only from their effects in dropsies,
but from an experiment related by Mr. Cruikshank[40], of a man who
acquired several ounces of weight after the operation of a purge. The
absorption in this case was from the atmosphere. So great is the effect
of purges in promoting absorption, that Mr. Hunter supposes the matter
of a gonorrh[oe]a, or of topical venereal ulcers to be conveyed by them
in some instances into every part of the body.
[40] Letter to Mr. Clare, p. 117.
IV. _Certain medicines_, which, by lessening the _action of the
arterial system_, favour the absorption and evacuation of water. The
only medicines of this class which I shall name are _nitre_, _cream of
tartar_, and _foxglove_.
1. Two ounces of nitre dissolved in a pint of water, and a wine-glass
full of it taken three times a-day have performed perfect cures, in two
cases of ascites, which have come under my notice. I think I have cured
two persons of anasarca, by giving one scruple of the same medicine
three times a-day for several weeks. The two last cures were evidently
dropsies of violent action in the arterial system. Where nitre has been
given in atonic dropsies it has generally been useless, and sometimes
done harm. I have seen one instance of an incurable diarrh[oe]a after
tapping, which I suspected arose from the destruction of the tone of the
stomach and bowels, by large and long continued doses of nitre, which
the patient had previously taken by the advice of a person who had been
cured by that remedy. To avoid this, or any other inconvenience from the
use of nitre in dropsies, it should be given at first in small doses,
and should always be laid aside, if it should prove ineffectual after
having been given two or three weeks.