Other formats

    Adobe Portable Document Format file (facsimile images)   TEI XML file   ePub eBook file  

Connect

    mail icontwitter iconBlogspot iconrss icon

The Pamphlet Collection of Sir Robert Stout: Volume 28

Chapter VI. — Cough in Consumption

page break

Chapter VI.

Cough in Consumption.

Of all diseases in which cough is a symptom, there is none so fatal to the English as consumption. And, until within the last fifteen years there was no disease of which the cure was deemed so hopeless. It was formerly considered that to pronounce a person consumptive was equivalent to a sentence of death, for that if tubercle were once formed in the lungs it could never be absorbed or removed, and must necessarily prove fatal in the end.

But an improved pathology, and improved methods of treatment have changed all that. We now know that even in the last stages of consumption, when the lung is eaten into cavities, and the patient is emaciated almost to a skeleton, not only may amendment take place, but even recovery and restoration to a state of comparative health, and that in the earlier stages, recovery is as frequent as in any other chronic disease, provided proper means are adopted.

The symptoms of consumption are, unfortunately, almost too well known to require description. The most prominent are,—cough, slight at first, so slight as often not to attract the patient's attention, weakness, shown by inability to follow the usual employment, or endure even the most moderate exertion without fatigue, expectoration, of at first a light frothy mucus, sometimes streaked with blood, afterwards of denser and darker coloured mucus, lastly, of pus and mucus mixed, with occasional attacks of blood spitting or hœmoptysis, pains in the chest, attacks of inflammation of the bronchi, or air passages, of the lung itself, or of the pleura, and emaciation of the body progressively increasing until the patient at last becomes apparently a mere bag of bones, just covered with skin. During the later stages of the disease, there is hectic fever marked by flushes of heat and profuse perspirations, the bowels frequently become the seat of tubercle, and there is inflammation and ulceration of them, accompanied by uncontrollable diarrhœa, and at length the patient dies completely worn out.

All these dreadful symptoms are occasioned by the presence of "tubercles" in the lungs, and other parts of the body. Tubercles are bodies of a low form of organization, possessing a tendency to degeneration and ulceration, and exciting around them a low form of inflammation, in the course of which more tubercular matter is deposited. Ultimately, when masses of tubercle are agglomerated, and ulceration has taken place, cavities are formed, varying in size, but often as large as an egg, and sometimes larger.

page 26

In the treatment of consumption, it must always be remembered that tubercles are never formed in a healthy body. Whether the disease be hereditary, the patients parent or parents having suffered from tubercular disease, or whether it has arisen spontaneously in the child of healthy parents, it is absolutely impossible that the patient can have been healthy and strong when tubercle first began to be deposited. The most frequent causes of consumption are, impure air, insufficient or unwholesome food, dirt, drunkenness, and other vices tending to weaken the body, prolonged dyspepsia or indigestion, or long continued over-exertion either of mind or body.

It would be of course utterly out of the question to attempt in this little pamphlet, a treatise on consumption. All that can be done is to indicate most briefly and very imperfectly the main points to be observed in the treatment.

First, if it be possible the cause must be removed. Of course, if the patient inherit from his parents a predisposition to the disease, this cannot be removed, but it may be combatted. The means of doing this will be pointed out presently. If the disease arises from the other causes named, they should be removed. In all cases, pure air, good and sufficient food, perfect cleanliness, abstinence from any severe exertion of mind and body, exercise proportioned to the strength of the patient, and a sound state of the digestive organs, are of the first importance.

Of these, pure air is the most essential. No one was ever cured of consumption by being shut up in close hot rooms, loaded with clothes, and excluded from every breath of fresh air, for fear of draughts. It is particularly necessary to enforce this in England, as the English generally have a perfect mania for burying consumptive people alive in such places.

Next, we would place plenty of good wholesome food, with a proper quantity of stimulants. The old plan of putting consumptive patients on a low diet, and using frequent local bleedings with the view of avoiding or curing inflammations, was a most pernicious one, and was no doubt the cause of the frightful mortality of this disease formerly. On the other hand, it is of on use cramming people with food for which they have no appetite or digestion, or giving very large quantities of wine or brandy. Nothing requires more skill or care than the adjustment of the proper supply of nutriment.

Next, cleanliness. The whole body should be rapidly washed once a day, and the back and front of the chest scrubbed with a hard towel till they glow. If the patient is not strong enough to do this himself, somebody should do it for him.

Exercise, proportioned to the strength, but never allowed to become a source of exhaustion,—and freedom from all severe labour are absolutely essential. Without exercise there cannot be a good appetite or a healthy digestion : with too much of it, or with excessive labour of any kind, the patient will take more out of his system than he puts in, his weakness will increase, and the tubercle will increase in proportion.

To obtain these advantages, it is often advisable to give the patient change of air; the sea-coast, especially that of South Devon, and the page 27 Undercliffe in the Isle of Wight, are admirably adapted to this purpose by their warm and equable climate, unequalled elsewhere in Great Britain.

The purely medical treatment of consumption consists mainly in the administration of tonics and cod liver oil, and of medicines for the relief of cough, spitting of blood, diarrhœa, or other urgent symptoms.

Tonics are always required, and should if possible be administered from the very onset. Of these the various preparations of peruvian bark, and iron, in some of its many forms, I have found the best. Iodine is also very useful in some cases, and may be advantageously combined with iron in the form of the syrup or the iodide of iron. Quinine or some other preparation of bark should be given freely. The mineral acids, especially the sulphuric, are also useful, and are supposed to prevent or alleviate the very distressing night sweats. I have found the oxyde of zinc more beneficial in this respect.

Cod liver oil is, however, the one medicine on which the most reliance must be placed in the treatment of consumption. It should always at first be combined with tonics, but after the disease has been brought into a quiescent state and the patient is fattening, it may generally be trusted to alone, and should be continued for months after all bad symptoms have vanished. It is disagreeable to taste at first, but this is generally overcome, and patients soon get to take it without any effort To some persons it is most repugnant, and disguise it how we may, they cannot bear it I have never seen one of these persons recover, although they may sometimes temporarily improve under other treatment. It may be taken on water, wine, coffee, milk, and a variety of other fluids. Some people chew a bit of orange or lemon peel before taking it, and another bit afterwards; others put a pinch of salt and pepper to it, and try to imagine they are eating sardines. In general it is best to leave the vehicle in which it is to be taken to the patient's own taste.

When it is absolutely impossible to overcome the patient's repugnance, or when the oil destroys the appetite and injures the digestion, other fatty substances should be taken, such as cream and butter.

But the reader may say what about the cough? How is it to be treated. To this I would reply that unless it is very severe and destroys the patient's rest; the very best treatment for it is—to let it alone. The less taken in the shape of cough mixtures and pills, the better. All the nauseating compounds of antimony, ipecacuanha, squills, et hoc genus omne, should be left aside. They do no good, they never touch the real root of the disease, and they do an immensity of harm by injuring the appetite and digestion. If the cough keeps the patient awake, a sedative draught of morphia, laudanum, or hydrocyanic acid should be given. If there is any bronchitis or local pneumonia or pleurisy, these should be treated of course, and hot fomentations or poultices applied to the affected part. Occasionally a small blister, or the croton oil liniment may be of service, but there should be no succession of blisters applied to weaken the patient. Severe pleuritic pain I have relieved by the application of two or three leeches, after fomentations had been found unavailing, but care should be taken that the leech bites are not allowed to bleed too long.

page 28

Diarrhœa must be treated by astringents,—hot fomentations or mustard plasters to the bowels,—opium, and careful regulation of the diet.

Under the plan of treatment thus roughly marked out, I have seen patients recover with surprising and most gratifying rapidity. A few cases will show this better than any argument.

Case 1.—In 1852, while taking charge of a practice of a since deceased relative of mine at Stafford, I was called in to a young man who was suffering from cough, weakness, emaciation, and other symptoms of consumption. Astethoscopic examination showed the presence of tubercle at the apex of one lung. He was put on the treatment above recommended (tonics and cod liver oil), had change of air, and perfectly recovered in a few weeks, all traces of tubercle having disappeared. Eight or nine years after he remained well.

Case 2.—I attended in her first confinement, a young married woman, who was the last survivor of a family of six—all the others having died of consumption. I told her that probably suckling would develop the disease, although she was then, as I ascertained, quite free from any tubercular deposit in the lungs. I warned her of the early symptoms, and told her to apply at once. A few months afterwards she came to me, suffering from the usual symptoms. There was distinct evidence of tubercle then. I ordered her to wean the child at once, and commence with tonics and cod liver oil. In a short time she got quite well. This was in 1856. She is, now, I believe, alive and well; I know she was, not very long ago.

Case 3.—I received a letter for a young woman who was a patient of the Royal Kent Dispensary, to which I was surgeon. I found her in a dirty miserable house, in a wretched street in one of the most unhealthy neighbourhoods of London. She was lying on a bed formed of three chairs. Everything gave indications of the most abject poverty. She was in the third stage of phthisis, there being cavities in both lungs. She was dreadfully weak, and was dropsical in both legs, and in the hands, I believe solely from debility. She was also very dirty. I persuaded her relatives to wash her—rather a difficult matter. I got her an allowance of a little meat from the parish, and put her on the usual treatment, although without any hopes of her recovery. To my surprise she rapidly improved; and two years afterwards when I went to the same house, I saw a stout healthy looking young woman, whom I could scarcely believe to be my former patient.

Case 4.—Miss D., a young lady aged 8, had been suffering for some time from debility, and had been gradually getting thinner, until when I saw her she was extremely emaciated. There was a patch of red in the cheeks; the eye was of that peculiar bright appearance so often seen in this disease. There was a quick pulse, and slight hectic every night, with night sweats. The cough was very severe and distressing, and attended with much spitting. On examination of the chest there were found distinct signs of tubercle in both lungs, but more marked in the right, where there was great dulness down to the nipple, with indications of a cavity, namely, pectoriloquy, &c. This young lady had every advantage as regards diet, fresh air and clothing, but one of her sisters had already gone off in consumption, and she had been page 29 kept much too closely at her studies to suit the health of one so young. I ordered all studies to be given up at once, and as she had previously to my seeing her, been under a very improper system of treatment, nearly everything that had been done was reversed. Instead of confinement to the house to avoid cold, daily exercise was ordered, instead of nauseating expectorants to cure the cough, tonics were given, with plenty of wine and beef tea. Cod liver oil was given immediately. Under this system she improved very fast, and in a few weeks she was able to discontinue all treatment except the use of the cod liver oil, with which she persevered for nearly a year. Three years after I first saw her she was perfectly well, and had grown tall and stout.

Case 5.—April 17th, 1863. Mr. L., a young man of 22, came to me; he complained of debility so great as completely to disable him from following his employment. Severe cough and profuse night sweats. Had been getting thinner. On examination, found the upper part of right lung solidified by tubercle; put him on the usual treatment; found the profuse night sweats weakened him very much; gave him the oxyde of zinc, with great benefit, and ordered him the most nutritious diet he could take. The symptoms gradually disappeared; he gained strength and flesh; the night sweats left him altogether; and on May 30th, he was discharged quite well, the stethoscope revealing nothing more than the faintest traces of the deposit in the lung. Nothing was given in this case for the cough.

Case 6.—Mrs. D., aged about 40. Found her lying down on a couch in such a state of exhaustion and debility, that I was not able to make on the first visit a full examination of the lungs. She had persisted in going about until utterly unable to stand any longer. The emaciation was extreme; the pulse about 120; the cough most severe and distressing; in fact there were all the symptoms of the third stage of consumption The stethoscope showed the existence of extensive disease of both lungs, and in one there was a cavity as large as a small apple. As the cough in this case was so severe as to deprive the patient of rest, and by its violence to interfere with her recovery, I was obliged for the first few days to prescribe almost exclusively for it. I gave morphia and hydrocyanic acid, throwing in however a small dose of the inspissated liquor cinchonæ of Battley. After a few days she was so much improved that I was able to give her quinine and iron, and cod liver oil.

The improvement in this case was more rapid than in any other I have treated. I examined the chest at intervals of about a week, and at the end of exactly one month from the time I first saw her, all traces of a cavity had disappeared; the place was filled up and cicatrized, all active disease had ceased, and there was nothing remained but such slight indications of former tubercular deposit, as would hardly have been noticed by any new observer. Her health and strength had improved, pari passu (as indeed is always the case), and about five weeks after I first saw her, she was able to walk from the Newcastle road, Shelton, up to Hanley Market.

The above are a few cases selected with the view of showing how consumption may be cured by a rational plan of treatment. Quack remedies are of no avail; there is no specific for the disease, nor is it page 30 possible to cure it after a certain stage has been reached, simply because all methods of cure demand some time for their operation. If the bowels have become ulcerated, and frequent diarrhoea is one of the symptoms, there is hardly any hope; nevertheless, even in this case it is worth while to try.

The greatest difficulty medical men experience is in inducing patients to persevere with the oil for a sufficient time, and to take regular exercise. Women especially will not take exercise. I believe that the majority of the female sex would not take an hour's walk every day for a month to save their lives.