Medical inquiries and observations. By Benjamin Rush, M.D. professor of chemistry in the University of Pennsylvania.
Rush, Benjamin, 1746-1813., Redman, John, 1722-1808, dedicatee., Rush, Benjamin, 1746-1813. Appendix: containing, the new method of inoculating for the small pox.
Page  137

FREE 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 leav|ing 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 les|sen the number of incurable diseases. This is my apo|logy for presuming to make the consumption the sub|ject 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 experi|ments upon this subject.

I SHALL begin my observations upon the consump|tion, by remarking,

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

Page  138 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 set|tler, are fishing, hunting, and the laborious employ|ments of subduing the earth, cutting down forests, building a house and barn, and by distant excursions in all kinds of weather, to mills and courts. All of which tend to excite and preserve in the system, some|thing like the Indian vigor of constitution.

3. IT is less common in country places than in ci|ties, 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 disorder, than men who work un|der 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 sub|ject to the consumption.

FROM these facts it would seem, that the most pro|bable method of curing the consumption, is to revive in the constitution, by means of exercise or labor, that vigor which belongs to the Indians, or to mankind in their first stage of civilization.

Page  139 THE efficacy of these means of curing consumpti|on will appear, when we inquire into the relative merit of the several remedies which have been used by physicians in this disorder.

I SHALL not produce among these remedies the nu|merous receipts for syrups, bolusses, electuaries, de|coctions, 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 accomodated 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 fre|quent, as to substitute the long continuance of gentle, to violent degrees of exercise of a shorter duration.

2. A CHANGE of CLIMATE has often been pre|scribed for the cure of consumptions, but I do not re|collect an instance of its having succeeded, except when it has been accompanied by exercise, as in tra|velling, 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 carria|ges, 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 Page  140 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 consump|tions; but it has been only by removing the trouble|some symptoms of inflammatory diathesis, and there|by enabling the patients to use exercise, or labor, with advantage.

6. VEGETABLE BITTERS and some of the STI|MULATING GUMS have in some instances afforded relief in consumptions; but they have done so only in those cases where there was great debility, accompani|ed by a total absence of inflammatory diathesis. They have most probably acted by their tonic qualities as substitutes for labor 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 cli|mate, has in many instances prolonged life in consump|tive habits; but all these remedies have acted as palli|atives only, and thereby have enabled the consump|tive patients to enjoy the more beneficial effects of exercise.

Page  141 8. BLISTERS, SETONS, and ISSUES, by determin|ing the perspirable matter from the lungs to the sur|face 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 sub|stitute for exercise.

FORM all these facts it is evident that the remedies for consumptions must be sought for in those exercises and employments which give the greatest vigor 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 attest|ed cases of similar recoveries from nearly the same re|medies. 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 compel|led 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.

Page  142 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 coun|ty 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 haemoptysis. 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 pul|monic complaints. 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 (as he lately inform|ed me) enjoys a good share of health.

IT would be very easy to add many other cases, in which labor, the employments of agriculture, and a life of hardship by sea and land, have prevented, re|lieved, or cured not only the consumption, but pul|monary diseases of all kinds.

TO the cases that have been mentioned, I shall add only one more, which was lately communicated to me by the venerable Doctor Franklin, whose conversation at all times conveys instruction, and not less in medi|cine than upon other subjects. In travelling, many years ago, through New-England, the doctor overtook the post-rider; and after some inquiries into the his|tory of his life, he informed him that he was bred a Page  143 shoemaker; that his confinement, and other circum|stances, 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 upward of thirty years, in perfect health.

THESE facts, I hope, are sufficient to establish the advantages of restoring the original vigor of the con|stitution, 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 hunt|ing; 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 attain|able with much less trouble.

1. DOCTOR Sydenham pronounced riding on horse|back, 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 inflamma|tory fevers are now less frequent in London, than they were in the time of Doctor Sydenham. If riding on Page  144 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 Cadogar,) when it cannot bear it.
In like manner, the inability of the patient to bear this manly and wholesome exercise, serves only to demon|strate 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 symp|toms and degrees of epidemic and chronic diseases, appear to be nearly in the same state that the inhabi|tants of England were in the seventeenth century. I can easily conceive the vigor of the human constitu|tion to have been such in Doctor Sydenham's time, as that a defluxion or ulcer in the lungs should have had no more effect in increasing the action of the arterial system, than a moderate inflammation of the eyes has at present in exciting an inflammatory fever in a good constitution: hence the safety and advantage formerly of riding on horseback in pulmonic complaints. We find, in proportion to the decline of the vigor of the body, that many occasional causes produce fever and inflammation, which would not have done it an hun|dred 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 farm-house, 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 con|stant labor or exercise in the open air, in all kinds of weather, may easily be chosen for a young man who, Page  145 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 pro|fessions 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 disposi|tion discover themselves in early life, we are directed to oppose them by the less profitable and more disinte|rested professions of divinity, or physic, rather than cherish them by trade, or the practice of the law*.

4. THERE is a case recorded by Doctor Smollet, of the efficacy of the cold bath in a consumption; and I have heard of its having been used with success in a negro man in one of the West-India islands. To ren|der this remedy useful, or even safe, it will be neces|sary to join it with labor, or to use it in degrees that shall prevent the alternation of the system with vigor and debility: for I take the cure of consumption to depend upon the simple action of tonic, without the least mix|ture of debilitating powers. Indeed, I conceive it to be easier to palliate the symptoms, and prolong life, by the use of the powers which are simply debilitating, than by a mixture of both of them. This is not a solitary fact in the human body. We often see a stiff neck and spasms, brought on by a person's being expo|sed, at the same time, to a stream of air from a door or Page  146 window, and to the heat of a warm room, where neither would have been injurious, if it had acted singly upon the system. There are many extremes in physic, as in other things, which meet in a point. There is an inflammatory diathesis connected with debility, as cer|tainly as with an excess of tone in the arterial system. And I think I have seen greater degrees of this inflam|matory diathesis in the male inhabitants of cities, than of the country, and more in women, than in men. I have moreover seen the most acute inflammatory disea|ses where the system had been previously debilitated by a long continuance of warm weather, or of an obstinate intermitting fever, and in too many instances by the use of spirituous liquors. This species of inflammato|ry diathesis appears to arise, therefore, from what has been called, and perhaps not improperly, indirect de|bility. Is it the presence of this species of inflammato|ry diathesis which renders consumptions so much more difficult to cure than formerly? Is it this which often ren|ders riding on horseback so ineffectual, or so injurious in this disorder? I suspect it is; and it is to be lamen|ted that it often requires so much time, or such reme|dies to remove this species of inflammatory diathesis, as to reduce the patient too low to make use of those re|medies afterwards which would effect a radical cure.

IF it were possible to graduate the tone of the sys|tem by means of a scale, I would add, that to cure consumptions, the system should be raised to the high|est degree of this scale. Nothing short of an equili|brium of tone, or a free and vigorous action of every muscle and viscus in the body, will fully come up to a radical cure for consumptions.

Page  147 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 indirect inflammatory diathesis pre|vails, a vegetable diet is certainly proper; but where the patient has escaped, or passed this stage of the dis|order, I believe a vegetable diet alone to be injurious; and am sure a moderate quantity of animal food may be taken with advantage. In both cases, the diet should consist, as much as possible, of one kind of ali|ment.

THE presence or absence of this inflammatory dia|thesis, furnishes the indications for administering or re|fraining from the use of the bark and balsamic medi|cines. 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 sup|port 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 spirituous liquors, and the last frequently in habits debilitated by the scrophula. In curing these disorders, 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 gene|rous diet.

Page  148 IN relating the facts that are contained in this essay, 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 rea|sonings.

I SHALL only add, that if the cure of consumpti|ons should at last be effected by remedies in every re|spect 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 in 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 con|sumptions, 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 expo|sure of the herdsman; or of their recommending, not so much the exercise of a passive sea-voyage, as the active labors 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 ex|cursions, or labors, in quest of their recovery from this disorder, 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.

Page  149 FROM a review of the facts and observations which have been mentioned, I cannot help thinking that the words of the philosopher, "Quod petis in te est," ap|ply not more to the means of obtaining happiness, than they do to the means of obtaining a radical cure for the consumption.

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 labor or exercises, whose use|fulness in consumptions has been established by the facts that have been mentioned. Many instances of the analogous effects of medicines, and of exercise up|on the human body, forbid the supposition. I shall only add, that if there does exist in nature such a me|dicine, I am disposed to believe it will be found in the class of TONICS. If this should be the case, I con|ceive its strength, or its dose, must far exceed the pre|sent state of our knowledge or practice, with respect to the efficacy or dose of tonic medicines.

I EXCEPT the disorder, 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 labor or exercise. These abscesses often occur without being accompanied by a consumptive diathesis, and are frequently cured by nature, or by very simple medicines.