THE 
NERVOUS SYSTEM 
IN THE 
TREATMENT OF CONSUMPTION. 
BY 
THOMAS J. MAYS, M.D. 
REPRINTED FROM TRANSACTIONS OF 
THE PHILADELPHIA COUNTY MEDICAL SOCIETY. [Reprinted from the Transactions of the Philadelphia County Medical Society, 1891.] 
THE NERVOUS SYSTEM IN THE TREATMENT OF 
CONSUMPTION. 
By THOMAS J. MAYS, M.D. 
[Read January 28, 1891.] 
If one fact is more evident than another, it is that pulmonary con- 
sumption is not a disease of the lungs exclusively. It is not seldom 
that we meet patients who complain of fatigue, of anorexia, of wasting, 
of cough, of dyspnoea, of rise in temperature, of shooting pains in the 
trunk or extremities, and who present all the symptomatic appearances 
of phthisis, and yet show no active outbreak of pulmonary disease. 
The cautious practitioner observes in these manifestations a foreboding 
tyf what is sure to follow, sooner or later. He knows that for practical 
purposes such persons are as much sufferers from consumption as if 
they showed the active physical signs of the disease in their lungs 
already, and treats them accordingly. 
If pulmonary consumption is not essentially a disease of the lungs, 
what particular tissue or texture does it primarily invade ? From a 
careful study of a large number of cases, I have become firmly con- 
vinced that con^^ntion is fundamentally a disease of the nervous 
system, but it is not; my intention or province this evening to dwell 
on the evidence which supports this theory, but to consider the rela- 
tion which the nerve element in this disease bears to its treatment, 
and to refer only to this pathological association in so far as it assists 
in showing the latter in its proper light. 
Now, in order to bring the salient points of my subject before you, 
I shall briefly, in the first place, consider the frequent association of 
consumption with diseases of the nervous system; and, in the second 
place, discuss the nerve-degenerations which, so far as I know, are 
probably constantly present in this disease. 
Dr. Maudsley says (fPaihology of Mind, p. 233) that when a family 
decays, the last member not unusually dies either from phthisis or 2 
MAYS, 
insanity ; that phthisis alternates with insanity, and the reverse ; and 
that one-fourth of the deaths in asylums for the insane are caused by 
phthisis. Dr. Clouston, an equally good authority, states that phthisis 
occurs about twice: as frequently in the insane as in the sane. The 
post-mortem researches of Dr. J. Crichton-Browne also confirm these 
opinions. 
Dr. Stevens, of New York, in his work on Functional Nervous 
Diseases (p. 139), records the family history of one hundred of his 
patients who suffered from various nervous diseases and in whom 
marked errors of refraction had been found. The collective members 
of these patients' families, including parents, sisters, and brothers only, 
were five hundred and ten in number. Of these, one hundred and 
four suffered and died from pulmonary consumption; one hundred 
and fourteen from cerebro-spinal meningitis, epilepsy, chorea, insanity, 
apoplexy, and other nervous disorders; seventeen from Bright's dis- 
ease, and twenty-two from rheumatism and heart disease. In other 
words, consumption and nervous diseases prevailed to the extent of 
40 pei' cent, (about 20 per cent, of each), while Bright's disease, 
rheumatism, and cardiac disorder to the extent of 8 per cent. 
Professor Grasset has also shown (" On the Relations of Hysteria 
with the Scrofulous and Tubercular Diathesis " : Brain, vols. vi. and 
vii.) that a similarly close relationship exists between hysteria and 
consumption. He cites a large number of cases of hysteria, in nearly 
all of which there existed a strong family history of phthisis, and- in 
many of these hysteria was transmuted into consumption, and vice 
versa. 
Moreover, pulmonary consumption is also closely affiliated with 
other diseases in the pathology of which nerve degeneration plays a 
most prominent role. This is true of leprosy, of beri-beri, of pel- 
lagra, of alcoholism, of syphilis, of herpes zoster, of mercurialism, of 
plumbism, etc. 
Then, when we come to study the nerve degenerations which are so 
intimately associated with pulmonary consumption, the neurotic ele- 
ment in this disease becomes still more conspicuous. Thus, it is a 
well-recognized fact that section of the vagi or injury to the medulla 
is followed by oedema, haemoptysis, and inflammation of the lungs. 
Equally well is it demonstrated that compression of these nerves by 
tumors in the neck, or by aneurisms within the thorax, etc., leads to 
pulmonary consumption. During a recent ^research on this question 
I found the records of nearly one hundred cases of phthisis in which 
the vagi were disintegrated through the pressure of aneurisms, of TREATMENT OF PHTHISIS PULMONALIS. 
3 
enlarged bronchial glands, or tumors, or became diseased from other 
causes. Beside these, I found the reports of six cases of paralysis of 
respiration ; seven of pulmonary oedema ; four of pulmonary infarcts ; 
seven of bronchitis; and twenty-seven cases of pneumonia in which 
the vagi were diseased. Dr. F. L. Hahn, in a post-mortem investiga- 
tion of a number of phthisical subjects,1 found alterations in the pneu- 
mogastric and phrenic nerves. During life, he states, these subjects 
suffered from facial, sciatic, and intercostal neuralgias, pains in the 
region of the sternum and at points along the spine, arthralgia, mus- 
cular pains, hyperesthesia, analgesia, contractions, paresis, and dila- 
tation of the pupil on the affected side. As to how far the peripheral 
nerves are involved in the phthisical process we have the work of Dr. 
Jappa2 (Zur Frage uber die veranderungen der peripherischen 
Nerven bie Scliwindsucht} to show that the degeneration in these 
structures is quite remarkable. He examined the sciatic, post-tibial, 
internal plantar, crural, internal saphenous, superficial peroneus, 
median, ulnar, and radial nerves of the bodies of fifteen persons whose 
death was caused by pulmonary consumption, and in every instance 
marked deterioration existed in most of these nerves. The changes 
were in the axis-cylinder and perineurium, as well as in the sheath of 
Schwann, and the author says they should be regarded as parenchy- 
matous in character. The intensity of the morbid changes was greater 
in the peripheral endings than in the trunks of the nerves. In all 
these cases there existed during life only the ordinary nervous symp- 
toms found in the phthisical, such as some undefined neuralgias and 
muscle-pains, general hypersesthesia, high fever, and emaciation. 
From these facts it is evident that nerve degeneration and pulmo- 
nary consumption are constant accompaniments, and the only reason 
why the nerve derangement is not more often found in this disease is 
because it is not sought after. What relation does the one bear to the 
other ? Is the nerve disorder a cause or a consequence of the pul- 
monary trouble ? From the very nature of the case this is difficult to 
establish on a positive basis; but when we view the subject in a broad 
light, and consider that haemoptysis, pulmonary infarcts, and oedema, 
as well as catarrhal pneumonia, are produced by division of the pneu- 
mogastric nerves; that continued pressure of aneurisms and tumors 
on these nerves leads to phthisis; that phthisis follows alcoholic and 
1 L'Union Medical, February 9, 1874. Chicago Journal of Nervous and Mental Dis- 
eases, vol. ii. p. 448,1875. 
2 Neurologisches Centralblatt, Bd. vii., 1888, p. 425. 4 
MAYS, 
syphilitic degeneration of the same nerves ; that phthisis is very prone 
to develop in the insane or in the neurotic, I think it becomes very 
palpable that the pulmonary is consequential to the pneumogastric 
disorder. We certainly do not manifest a more illiberal spirit when 
we come to reason on the relation which exists between disease of 
other organs than the lungs and their nerve-supply. Sir James Paget 
relates the case of a patient in which the median nerve was compressed 
by callus thrown out to repair a fractured radius. Inflammation and 
ulceration of the thumb and middle fingers took place, which resisted 
all treatment until the wrist was so bandaged that the parts on the 
palmar aspect were relaxed and the pressure on the nerve removed. 
So long as this was done the ulcers became and remained well; if 
not, the ulceration returned. The same pathological connection 
obtains in other parts of the body. Injury to the trigeminus, within 
the cranium, is followed by cloudiness of the cornea, inflammation and 
ulceration of the lips and gums; and sloughing of the heels and of 
the back is produced by a lesion of the spine. If we believe that 
sloughing in the heel or over the sacrum can exist on account of a 
spinal lesion, or that ulceration of the thumb and middle fingers may 
be produced by the median nerve being compressed by callus, then 
we can, with equally good logic, conclude that pulmonary phthisis is 
the result of a degeneration of the pneumogastric nerves caused by 
pressure of tumors or aneurisms on the same. If we admit this, and 
I can see no reason why we should not, it naturally follows that 
phthisis may arise in consequence of any cause which has the power 
of disintegrating these nerve structures. 
This view of the origin of phthisis is also confirmed by its clinical 
history. Diseases of the brain and of the nervous system and phthisis 
travel hand in hand. All of these affections are comparatively absent 
among savages and are universally present in civilized life. Look 
where we may, we find that the causes which produce the one are also 
operative in the case of the other. Wherever the struggle of life 
enforces a high state of nerve-tension, or where indulgences and ex- 
cesses entail an inordinate waste of nerve-force, there consumption 
and diseases of the nervous system exist, either separately or simul- 
taneously. But whatever view we take of the origin of phthisis, I 
trust that I have ma'de it sufficiently plain that the nervous lesions 
in this disease are constantly present, and he who desires to treat it 
successfully cannot afford to ignore them. 
When viewed from the neurotic standpoint, the treatment of pul- 
monary consumption divides itself into rest, dietetic, and medicinal. TREATMENT OF PHTHISIS PULMONALIS. 
5 
Of these, rest is the most important, although no good results can be 
expected from it alone, unless it is reinforced by the faithful adminis- 
tration of an abundance of nutritious food. The consumptive must 
be regarded as verging on a state of constitutional bankruptcy. All 
the strength that he can muster is appropriated to the performance of 
the essential functions of life, which are carried on imperfectly in this 
disease. Digestion is weak ; the bowels are either constipated or are 
threatened with relaxation; sleep is restless and disturbed ; his mus- 
cular energy is impaired to such a degree that a short walk or a small 
amount of physical exercise saps his strength and renders him almost 
wholly helpless. Yet, conscious as he is of his feebleness, he persists 
that the taking of exercise is essential to his getting well. Strange 
and paradoxical as it may appear, this feeling is not confined to con- 
sumptives, but exists in behest of a strong public sentiment. It is 
based on the knowledge that in health exercise gives strength. But 
what a difference between the body in health and when suffering from 
a chronic disease like consumption ! The two conditions may be 
illustrated by comparing a banker who is threatened with insolvency 
with one whose credit is good. If the former pays out as much as he 
takes in, his finances will always be in a crippled state, and he will be 
in constant danger of going into bankruptcy ; but if he halts-that is, 
if he diminishes his outflow and maintains or increases his income- 
his capital will accumulate, and in time he will be able to compete 
with other capitalists. But the banker whose credit is uninjured goes 
on and invests all his surplus capital-that is, he exercises his financial 
strength to the utmost limit of prudence-and thereby enhances and 
improves the integrity of the institution which he represents. So it 
is with the taking of exercise. If this is to be beneficial a certain 
amount of strength must preexist, and by putting this strength to 
proper use-or out at proper interest-it will grow and accumulate; 
but he who has no or very little strength at the outset must reduce 
his expenditures and enlarge his income or else go into physiological 
bankruptcy. The consumptive must be made to realize that, with 
him, it is wholly a question of constitutional resistance; that both 
health and disease are quantities which constantly vary; that when 
he is weak the disease is strong and advances, and when he is strong 
the disease is weak and recedes; and that the force which he expends 
in taking exercise abstracts so much from the total quantity of vitality 
and allows so much less for the body to cope against the disease and 
to perform the other necessary functions. 
In accordance with these principles, it has been my custom, during 6 
MAYS, 
the last few years, to give all my consumptive patients the full benefit 
of rest, so far as this could be carried out. Almost invariably, on 
beginning to treat such a patient, he is ordered to bed and kept there 
until I am satisfied that sitting up or walking around the room will 
not tire him. Those patients who are always tired, and many there 
are of this kind, I insist on remaining in the horizontal posture for a 
month, or six weeks, or longer. This does not mean confinement to 
the room; but they may be carried out in the open air and remain 
there during the greater part of the day-care being taken, of course, 
that they are warmly clothed and well protected from unfriendly 
currents of air. Those who are stronger are allowed to walk out and 
sit quietly in the open air. Patients will often demur against this 
protracted rest, chiefly because they do not realize the seriousness of 
their condition. But if they once comprehend this fully, there are 
very few who do not appreciate the practicability of the proposal and 
aid you in carrying it out. 
The results which are obtained by this plan of treatment are, I am 
sure, much superior to the one where the patients are allowed to walk 
about and generally do as they please. In former times, when, in 
conformity with the teaching which still prevails, I believed that 
plenty of exercise was the one thing needful to restore the consump- 
tive, I was often disappointed and mortified in seeing patients who 
had been considered well enough to leave bed and walk out almost 
invariably experience a relapse. Much of the successful treatment of 
consumption in mountain resorts is due to the measure of enforcing 
rest and quiet on the patients. Dr. Brehmer, of Gbrbersdorf, and 
Dr. Dettweiler, of Falkenstein, both consider an unlimited amount of 
exercise detrimental to the consumptive's well-being; and Dr. Vollaud, 
of Davos, states, in his work on the Treatment of Consumption in 
High Mountains, that rest in the open air is the first duty of the 
patient, and that, if he is able, he is allowed to sit out-of-doors, and 
if not, he is confined to bed in a well-ventilated chamber. 
All our efforts will prove entirely fruitless, however, if we do not 
succeed in making our patients eat. Nothing taxes the ingenuity of 
■ the practitioner more, and nothing demonstrates his ability better than 
his success in devising ways and means whereby his patient is led to 
partake of a sufficient amount of nourishment. The majority of such 
patients not only suffer from anorexia, but loathe food. I am con- 
vinced, however, that if they can be induced to swallow food, the 
stomach possesses in most instances the power to digest the same. 
Hence, the importance of promptness and perseverance in feeding. 7 
TREATMENT OF PHTHISIS PULMONALIS. 
A small quantity of food, like half a teaspoonful of beef-pulp, a table- 
spoonful of the juice of fresh beef, or a glass of milk with a little lime- 
water, every two or three hours, will furnish a large amount of nour- 
ishment in twelve or sixteen hours, and will convince the patient that 
he is able to digest a great deal more than he thought he could. 
When they refuse or are unable to eat sufficiently, I resort to washing 
out the stomach, and introduce the food with a tube specially adapted 
to this purpose. It is astonishing as to the quantity of food which 
can be given in this manner, and I have seen some very excellent 
results follow this practice. Feeding by the rectum is another method 
of great value in the treatment of this disease and should be employed 
whenever it is deemed necessary in stubborn cases. In feeding these 
patients one point should always be borne in mind,'and that is, that 
only those foods which contain the greatest amount of energy in the 
smallest bulk, and which at the same time confer the greatest amount 
of good on the body with the least expenditure of vital force in diges- 
tion, should be administered. 
Additionally, we must not lose sight of the inestimable value of 
well-directed medication. Among the most useful agents which ren- 
der support to the nervous system in this disease are antipyrin, 
phenacetin, strychnine, quinine, atropine, the hypophosphites, cod- 
liver oil, etc.; but this is a subject too voluminous to be entered into 
at the present time.