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To the Medicat Society in London.
had entertained respecting the use of balsamicmedicines, strictly so called, in the cure os consumptions, and offered some conjectures in re gard to their fit si introduction into internat Use, and their application to pulmonary diseases in particular. Upon the whole, I am stili os opinion, that their usefui essicacy in these di sordersis much to be suspected, and that an indiscrimi nate use of medicaments of this classi, has rathera tendency to increasse than mitigate the symp- toms attending a genuine phthisis pulmonalis. Whilst I am endeavouring to excite suspicions against What appear to me the laedentia in this
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distemper, I mould thinti myself fortunate,
could the review of severat years experien Ce af ford any usesul hinis to those whom I missi toaid, and lo Whom these remarks are particularly addi essed, the young praetitionerS. When we consider the structure of the lungs, the tendernesse of their fabric, the multitude ofvesteis of whicli they consist, the importance of their use, the many accidenis they are UnaVoid- ably exposed to, and , in comparison os many other paris, their insensibility to immediate te ston, we mali be much more surprised there areso sem persons die os consumptions, great as thenum ber may seem ingly appear', than that somany peristi by this distemper.
To enumerate ali the causes that are cap ableos producing Ihthisis pulmonalis, is not my intention ; but to potnt out the necessi ty of attend-ing to iis commen cement, in Order to Preventiis progressi. The measses, and other inflammatory distases of the breas , to whicli children, asWeli as others, are exposed, osten lay the founda-
tion os consumptions: so likewise Will colds, the suppression of some salutary discli arge, scro-
In this city the weehly bilis are supposed to exhibit a tolerably exact account of those who die of the respective distases mentioned in that list. But I am informed, that thearticle of Consumptions includes generalty ali itiose who die of any lingering disease, and are much emacialed; bywhicli the list is vastly enlarge d beyond what it ought to be, to the reproach of our country; foreigners imagining that this distase is much more frequent amongst ua, than it is in reality.
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phulo is and venereat affections, and many other causes, ait which will operate more certainly and
clusion, in proportion as a certain tendernes Sin the fabric of the lungs, an hereditary tabes, and other circumstances, conchar : sor, to those who are ac quainted with the animal oeconomy, it is rather a matter of wonder how the strongand robust escape affections of the lungs, sur- unded as we are With so many catlses CaPZble of producing these asseections, than that per- sons of a certain malle, and particular delicacy
os constitution, are so subject to pulmonary dis
Wo Cannot, I thin k, be too industrious in propagating the sol lowing doctrine: That theti me at whicli a physician casa be of most u se in
the Cure os consumptions, is at their first be ginning. The sightest catarrhal defluxion ought not to be neglected, is it does not go olf in asew dayS. The beginning of most consumptions is a Cough, more or lessi violent. This Cough is produced ei ther by a thin saltisa defluXion, irritat-ing the membrane that lines the trachea, so as tobring on a generat spasm os ali the paris, in or der to disto ige and discli arge the irritating mat-ter; or et se, by an inflammation os sonae part of the lungs or bronchiae, produced by one or other of the generat causes of inflammation. Is the catarrhat cough is neglee ted, or is re
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duced it, this mill be sum cient to bring on an inflammation, Whicli, is not remove J, terminateSin the usual manner of inflammations ; either byresolution, in Whicli case the lungs receive butii ille harm; or by suppuration, in Whicli theinis clites, however sim ali at present, does notnil to be productive o flasting and injurious Consequences, proportioned to the extent of the injury, and the Condition of the sufferer, in respectio predisponent caUses. Is the inflammation terminates laeither by resolution nor suppuration, it osten leaves a schirrhous har iness, Where by this particular part of the lungs, ho ever smali and confined, becomes of litile or no Use in the oeconomy of this organ; but by occasioning an obs ruction of circulation and respiration in one single potnt, subjects the found paris of the lungs to greater la
of this disse ase. The mos trifling cough, is it continUCS, may ei ther adVance gradu atly till iten is in immediate mischi ef, or may leave such impressioris as may subject the patient to perpetuat returns: a cohagh theres ore in chil iren, or yoUng persons, or in persons of a certain malle at any time of lise, ought spee lily to be
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means of do ing this most fasely: but there is onepart of management necessary to be observed by those who are abolit child reia thus affected,
that cannot be too strongly insisted on by the physician, and that is, the necessity of properdiet, proper likeWise in respeet to quantity. Is
CVer an extreme attention to regimen is neces
fary, it most certain ly is so to persons affected with coughs, as wili perhaps be more fully mentione d ; but to clitidi en it is stili more so, bothas they are greater scisterers by improper diei,
and have lessi command over their own appetite and inclination S.
For is a large quantity of the best chyle adiis spee lily to the present stock of blood, as alimust passe through the lungs, this temporary in- crease of quantity will ad I to their irritation, the quantity itself being a simulus. But is thechyle thus increassed has not been properly digested, ei ther ori accolant of the quantity or hin dos sood, the mischies Will be greater. And this position will, I belleve, be soland uniformi y truethrough e very stage of pulmonary diseases, and will evince the neces ity of giving very explicitanti peremptory orders in relation to diei, and the cluty of those who attend the sicli in this disia
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Iga Remaris on the Cure of Consumptions.would many of the most in curabie consumptive cases haVe been prevented, or cured, at their first commen cement Θ A person whose emacialed
figure strii es one with horror, his sorehe ad Co- vered with drops of s Aeat, his cheelis patia ted with a livid crimson, his eyes sunk, ali the litile set that raised them in their orbiis, and e very
Where et se, being was ted; his pulse quick and
tremulous, his natis bending over the en is of
ostensive, qui ch, and laborious ; his Cough in cessant, scarce allowing him time to teli ias, that me monilis ago he Lot a cold, but he knew not, perhaps, hoW he got it; he negleeted it for this Very re ason, and neglected every means os assit ance, tili the mischies was become in curable, and scarcely a hope test os palliation. You se emultitudes of such objecis dat ly, and see theni With a mixture of anger and compastion sor their negleet and their sufferings. Excuse me sori res passing in this manner on your time and youi humani ty. Though it is not in your power topi event ali these sacrifices to ignorance and inattention ; yet, is the faciat ty combine in prompt-ing their sellom citi Zens to nece flary Care, and
prompt them to suffer no stight beginnings to PasS Unregat ded, hoWeVer they may be adtingagainst their own interest, they will have the satisfaction os contributing to the preservation ofmany a useful lik; sor, perhaps, among those Rho perissa by consumptions, there are many
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Remaris on the Cure of Consumptions. 133Who, in respect to the excellencies both of bodyand mirid, have given indications of becomingconspicuoUS Ornaments of humanity. When a cough begitas, is the patient is VeryyoUng, let the quantity of diet, especialty solids, be lesiened; let the deficiency be made up With Warm thin suppings; barley-water, milli and Water, thin gruet, the lightes broths, such things of this kind as the age and condition of the Patient admit. Is there be much heat, or any patia in thebre asst, blee ling will be indispensably necessary. The quantity to be talien aWay, and how of tenrepeated, musto be determined by the symptorias, the patient's age, habit, pulse, and other circum
In respect to medicines, the mos demulcentand cooling are indicated ; and when the symp- tonas of inflammation are ab aled, gentie anOdynes will be useful. Every thing of a heating, irritating nature, such as the balsams, should beavoided; and even the expressed olis of almondsand olives are osten to be suspected, and used with caution, as they are seldom totalty free froin s me degree of rancidity, than whichscarcely any thing is more irritating and dis gust fui. I have known the common doses of the saline mixture, and other cooling salis, in- creasse a cough by irritation ; so that even thesessiould be administered, when neces ry, ratheria simali doses, and frequently. The common
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13 Remaris on the Cure of Consumptions.
emulsion made with good fresa sweet almonds, is a very proper Vehicle sor the severat remedies indicated in this complaint; but is the almondsare nor frella, Or are intermiXed with the bitter,as is too frequently the case, they are injuri OUs.' Fressi whi te poppy-seeds, in the proportion Ofhais an ounce to a pint of Bristol or PUre mater,make an excellent emulsion and Unexception-
able ; and these may be raised in any quantityboth at home and in oUr own Colonies. I f the thin copious defluxion lessens, and theliquid grows thic er, and yet comes V p Without dissicut ty, the cough Will ab ate, and gradu allycease entirely. It must depend upon the judg-ment of the prescriber to know when and towhat extent anodynes are to be used. I beli evethey are never sa se ad the beginning of a Cough, till by proper methods tiae tendency to inflammation is first ab aled, except where the Cough is altogether of the spasmodic kind, as in s me hysteric cases, or When it proce eds fi Om acri mony heretofore discli arged by an issiae, an ulcet, or erosions on the si in , and imprudent ly sup presssed; or frona gouty affections; in Whichcases anodynes are tando ubtedly os use : but in coughs arising from suppressed perspiration, oran inflammatory diathesis, as in the meastes and epidemic constitutions, in such cases, anodynesare seldom to be allo ed, unless it be to obtain
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Remaris on the Cure of Consumptions. 13
norance, are scarCely to be enumerate i.
When by a proper cooling regimen, and eVacuations, the inflammation accompanying the cough is abaled, then sinali doses of anodynesioined with the medicines above mentioned, to sicli a quantity as to mitigate a fruitiess, incesissent cough, a re very beneficiat. I f this fir9 pe- riod has passed over without any attention patitto the disorder, the Cough becomes more harshand dry; si glit lancinating patras are noW and then seli, dat ling, as it were, through the sub stance of the lungs, frona sonae central potiat in the cavi ty of the tborax; commonly frona underone of the breasts, s metimes exactly in them id ille. A forenes s is complained of that is almos continualty felt: this is augmented much by the cough, but not to such a degree as thepleuritic stitches. It is not unus ual, Under thesecircumstances, to see the thin frothy phlegm,
blood; somelimes a smali spoonsul or two, Ormore, are Coughed Up at sonae certain time of the day. It is not osten that much larger quan tities are thrown up in this state of the dis easse, hinless the patient is very plethoric, or the fabricos the lungs extreme ly tender, or the cough is incessant. The sanae indications potiat out a similar processi, in res pedi: to cure. To withdraw as much nou ristament as can be done, Without the risc of suf-
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136 Remaris on the Cure of Consumptions.sering Dona inanition; to supply the most cool-ing nourishment, and the most eastly digested, in moderate quantities, and the more frequently;to bieed in Dali quantities repeatedly; judgingos this necesiity not from the appearance of theblood alone, for this Will osten continue si Zy, tili more is talien away than is compati ble withthe patient's siluation in other res pedis . For is we lessen the vires vitae by inanition too much, a
disease then talies place, Whicli probably Will in- . creasse our difficulty, that is, debility of the solids,
and the consequent vitiation of the fluids. The pulse, the heat, the Palia, Cough, respiration, strength and age of the patient, mouid ali betaken into Consideration. Many persons live Dee from complainis With si Zy blood. The condition the resore of the blood singly ought not to determine Us ; we should examine ali the
very generalty injuriotis; flem meat, or indeed animal sood of any kinii, scenas Under these Cir cumstances improper. Spices of ali hinds in any quantity, and indeed every thing possessedos much piquancy. Whey, either frona goatsor cows, milli, butter-milli, milli and water, light broths, and ali the farinaceoUS preparations, are to be recommended, but stili rememberin E