WF 1856 tzssz y/S^S'jwx fc—Wi't'Jli.. s£\ THE NATURE, CAUSES, AND SYMPTOMS "of DISEASES OF THE LUNGS AND THROAT; WITH THEIR TREATMENT BY THE USE OF COLD MEDICATED INHALATION. BY GUILFORD p. SANBORN, M.D., PHYSICIAN TO THE NEW YORK LUNG INSTITUTE, So. 6 BOND, STREET NEW YORK.; '■:nWX- "When will people learn to avoid the causes, and thus escape the consequences, of that • _ dreadful disease, Consumption ? When will they understand the absolute necessity of pure air, free exercise, and a healthful diet, to ward off and prevent a malady which desolates ;V-■, every hearth with its ravages 1 When will they discover the worse than utter folly of de-;.'i •»'. pending upon drugs for its prevention and cure ?"—Authob. '':';.-/ NEW YORK: PUBLISHED FOR THE AUTHOR, AND FOR SALE BY ALL BOOKSELLERS. ,'- ' ' 1856. Hexet PalmeS; Sterrotypkr, 19£ William Siexxft W F SlJ9n I? 5 (=> CONTENTS. PAGE PREFACE..........................,............................ 5 ON THE ANATOMY AND PHYSIOLOGY OF THE LUNGS........ 9 The Lungs............................................... 9 Uses of the Lungs......................................... 15 Effects of Want of Air.................................... 19 OF THE DISEASES OF THE LUNGS-CONSUMPTION............ 21 What is Consumption ?..................................... 22 THE CAUSES OF CONSUMPTION................................ 26 Hereditary Consumption................................... 27 The Predisposition may be Overcome........................ 29 The Right of Consumptives to have Offspring................. 31 Acquired Consumption...................................... 32 Impure and Insufficient Air................................ 32 "Self-Abuse"............................................ 33 Other Depressing Causes................................... 35 Climate.................................................. 35 Poverty.................................................. 36 Drug-Taking............................................. 36 Tobacco.................................................. 36 Mechanical Causes........................................ 37 Inhalation of Irritating Particles........................... 39 OF THE DISEASES WHICH PREDISPOSE TO PULMONARY CON- SUMPTION .............................................. 39 MORTALITY FROM CONSUMPTION.............................. 44 Is Consumption Contagious ?................................ 47 SYMPTOMS OF CONSUMPTION.................................. 48 Cough................................................... 53 Shortness of Breath....................................... 53 Chilliness and Heat....................................... 53 The Pulse................................................ 54 iv Contents. FAGB Pain..................................................... 54 Debility................................................. 64 Hemorrhage, or Bleeding frcm the Lungs.................... 55 Symptoms of the Fourth or Last Stage...................... 59 Duration of Consumption.................................. 61 On the Diagnosis of Consumption.......................... 62 Is Consumption Curable ?.......;.......................... 66 THE TREATMENT OF CONSUMPTION........................... 71 The Inhaler: Method of Inhalation......................... 74 General Indications of Treatment........................... 75 The Remedies Employed................................... 76 OF BRONCHITIS................................................ 80 OF CATARRH, OR COLD IN THE HEAD...........'........= ..-- 84 OF LARYNGITIS, OR SORE THROAT............................ 86 OF TONSILLITIS, OR QUINSY................,.................. 91 Elongated Uvula, or Palate................................ 93 OF ASTHMA.................................................... 94 THE HYGIENIC MANAGEMENT OF CONSUMPTION.............. 97 Air...................................................... 99 Food.................................................... 99 Exercise................................................. 99 ON THE EVILS OF THE USE OF PATENT NOSTRUMS.......... 100 CASES REPORTED.............................................. 103 OPINIONS OF PHYSICIANS RESPECTING INHALATION BY THE USE OF COLD, MEDICATED VAPORS................... 108 Conclusion................................................. 119 Cat*. View of the Lungs and Heart...................................... 10 Section of Lung, showing Tubercles................................. 22 Section of Lung, showing Cavities.................................. 24 Cammann's and Common Flexible Stethoscope........................ 58 Form of Inhaler.................................................. 74 Ulcerations of the Larynx......................................... gg Form of Nasal and Tracheal Showering Syringes..................... 90 PREFACE. The purpose of this brief work is to lay before the public a concise and clear description of the Diseases of the Lungs and Throat, together with the causes that lead to them, the symptoms by which they are known to exist, and their true and rational mode of treatment. In carrying out this object, the reader will observe that all technicalities have been avoided, as far as was consistent with a correct statement of the facts relating to the anatomy and diseases of those organs. It is believed that the subjects treated of are made plain and intelligible to all; and that much important information, which is now too generally locked up in medical treatises, is thus placed within the reach of the unprofessional reader. The book is designed to be the Invalid's Guide. It will be seen that, with a view to this end, particular attention has been given to the causes of pulmonary dis- eases, some of which are not yet generally known, or at least not appreciated as their importance deserves. It is the writer's firm conviction that these diseases, now so fre- quent in their attacks in every community, and numbering vi Pee face. their victims in almost every family, will never be less general or less fatal until the causes producing them are better understood, and more systematically and carefully guarded against. Had mankind always lived in accord- ance with natural laws, disease could never have existed. Medical science and the medical profession are but the necessary results of disease. It has come to be considered the business of the physician to dispense the balm of heal- ing to the sick. How much more important, because so much more valuable to the community, that he should in- struct in regard to the causes of disease, and the means of avoiding it, and thus aid in lessening the sacrifice of health, time, and life, now so painfully apparent! Until disease shall be more generally prevented, how- ever, efforts must be made for its cure. It becomes a great duty on the part of the physician to seek for remedies for those diseases which are most prevalent and fatal; and more especially it is his duty to diffuse information regard- ing any new and unusually successful mode of medical treatment which he may have discovered. This he should do, although the profession in one phalanx should oppose him, and although prejudices among the people meet him at every step. The tendency to adhere to established doc- trines, however worthless, is felt as it ever has been; and yet, in this age of manifold new and beautiful discoveries it must sooner or later give way. The profession and the Preface. vii people will, it is believed, be willing to inquire into the truth or falsehood of a new principle, and to investigate the virtues and success of a new mode of medical treat- ment. If we look around us at the terrible ravages of consump- tion, or consult the "bills of mortality," we see on every hand the victory of Death, and the hopelessness of the old methods of treatment. No check has hitherto been given to the progress of the destroyer. Lingering day by day, the unhappy patient has only looked forward to the grave as the end of his sufferings. There has been for him no " balm in Gilead," and no " physician there." In the application of remedies for the cure of this dread- ed disease, it will be seen that I differ entirely from the members of the profession at large. By the treatment I have been led to adopt, remedial agents are applied directly to the diseased parts. To control existing disease, to pre- vent its extension, and to eradicate the seeds of it already sown in the system—these are the objects which my treat- ment aims to accomplish, and which, from the success that ! has attended it under my observation, I do not hesitate to affirm it does accomplish. In presenting this book to the world, I do not claim that it is entirely free from errors. It has been written in the hurry of professional labor, and at such intervals as press- ing duties would allow. Yet its pages have been closely \ viii Preface. scanned, ana its teachings are believed to be correct on all fundamental points. It has been my great aim to awaken the public to a sense of their danger from a class of insid- ious diseases, and to point out the means of escape from their terrible consequences. I ask a careful perusal of this volume, and await without fear the verdict that will be passed on its merits. If it shall be the means of relieving the sorrows of a single suf- ferer, or of sparing one life to the family circle, the high- est wish of its author will have been gratified. No. 6 Bond Street, New York. ON THE ANATOMY AND •pjji|siali)gif nf tjje lungs. Every living thing requires a constant renewal of air to prolong life. In the creation, man remained an inanimate mass of matter until the Almighty "breathed into his nostrils the breath of life;" and it was only then that "he became a living soul!" This " breath of life," science declares to be the vivifying air by which we are surrounded—the great aerial ocean in the bottom of which we exist, as do fishes in the smaller oceans of water on the earth— and out of which we should be out of our medium, and perish even sooner than do the fish when removed from their native ele- ment. By inhaling the invisible fluid of this vast ocean the first man received the boon of life; and only on the same conditions can life be retained by his progeny, so long as the system of nature remains what it is. Vital air, introduced almost unconsciously to ourselves within the mysterious mechanism of our physical being, acts there as the bent spring which keeps the wheel of life in mo- tion, and perpetuates the wonderful capabilities of thinking and doing, of emotion and desire ! The Lungs.—In man, the organs which introduce air into the system are the lungs. These are two large, spongy bodies, which, with the heart and the commencement of the larger blood-vessels, fill up the cavity of the thorax, or chest. These organs are pro- tected against external violence by a framework of bones, consist- ing of the ribs, with the back-bone and the sternum, or breast-bone, to which they are united, the shoulder-blades and collar-bones. All 10 Sanborn on Diseases these bony structures are connected with each other by cartilages, so as to allow of the expansion and contraction of the chest, by which it accommodates itself to the action of the lungs in breath- ing. The cavity of the chest is separated from that of the abdo- men, containing the stomach, liver, and intestines, by a strong mus- cular division called the diaphragm, or, in common parlance, the midriff. The inside of the chest is lined by a membrane called the pleura, another layer of which envelops the lungs, and gives to them that glistening surface which they present in all animals, when removed from the body. The right lung has three large divisions called lobes ; the left, two. The size of the lungs varies with the age, capacity of the chest, and often with the health of the person. Their natural color is a pinkish gray, mottled with darker spots. They are not fixed in the cavity of the chest, but are suspended, each by a large and strong branch of the trachea, or windpipe, which divides into two behind the breast-bone, and through which the air from the mouth or nostrils is conveyed in the act of breathing into the lungs. Fig. l. Explanation of the Cut.—The above figure gives a front view of the lungs and heart, with the trachea and the large blood-vessels about the heart the whole being represented as the parts exist in their natural position, except 0 F T II K L V NGS .\ N I> T II R O A T. 11 that the anterior edges of the lungs are slightly turned back, in order to afford a better view of the blood-vessels, which lie beneath them. 1 repre- sents the right ventricle of the heart, the left ventricle being behind this ; 4, a portion of the left auricle, the right auricle being the loose-appearing struc- ture below the vena cava, which is marked 10 ; 5, the commencement of the pulmonary or lung artery, which conveys the venous blood from the right ventricle to both lungs; C, the point at which the branch passes off to the right lung; 7, the branch to the left lung; 8, behind this figure the left branch of the trachea (left bronchus) passes in a downward direction to the left lung; 9, the aorta, or great artery, conveying the arterial blood from the left ventricle to all parts of the system; 10, the vena cava descendens, conveying venous blood from the head and upper portion of the body, meet- ing the vena cava ascendens, with the venous blood from the lower part, and emptying into the right auricle; 11, the arteria innominata, or nameless artery, a branch of the aorta; 13, the external vessel is the right jugular vein, leading into 12, the right subclavian vein—the internal, the right carotid artery, going to the head, and a branch of the arteria innominata; 14. 16, the left subclavian vein; 15, the external vessel is the left jugular vein—the internal, the left carotid artery; 17, the trachea, or windpipe, di- viding into two large branches just behind 14, one of which passes into each lung; 18, the right branch of the trachea passing horizontally to the right lung ; 19, small branches of the left pulmonary artery and veins; 20, 20, the pulmonary veins, two from each lung, conveying the arterial blood from the lungs into the left auricle of the heart; 21, superior lobe of the right lung; 22, middle lobe; 23, inferior lobe; 24, superior lobe of the left lung; 25, f inferior lobe. In breathing, the muscles outside the chest contract, raising the ribs and greatly enlarging the cavity of the thorax. The pressure upon the outer surface of the lungs being thus removed, air rushes into them and expands or swells them so as to fill the enlarged cavity. Immediately afterward the chest-muscles relax, the ribs are allowed to fall again, the cavity is diminished; and the air being thus forced out of the lungs, these organs collapse or shrink to a much smaller compass. This process may be compared with the alternate swelling and shrinking of two large sponges, into which water is alternately soaked, and the next moment squeezed out again. If we examine the structure of the lungs, we shall understand how it is that these changes in their size take place. We discover that these organs are entirely passive in the work of respiration, 12 Sanborn on Diseases having in themselves little, if any, muscular substance. But upon cutting into them we meet with a perfect honey-comb structure, which is formed by the trachea branching out into innumerable tubes called the bronchial tubes, that grow smaller and smaller, like the branches of a tree; and by the numberless clusters of air- cells which exist about the sides and extremities of these little tubes, like the clusters of grapes on the twigs of a grape-vine. The same mucous membrane which we see lining the mouth and nostrils, extends downward in a continuous sheet, lining also the windpipe and the smallest bronchial tubes, until the tube itself ceases, and this membrane, which has now become extremely thin and transparent, like the substance of a soap-bubble, takes the form of minute bags or bladders, each with at least one opening into a bronchial tube to admit the air: these little bladders are the air- cells. Hence, when the lungs expand, it is because the air finds its way into millions of these air-cells; and when the lungs contract, it is because the falling of the ribs presses a portion of this air out again. Between and around the air-cells are numerous capillary blood- vessels (called capillary, i. e., hair-like, from their size) which bring almost the entire blood of the body in every round of the circulation into the lungs, and, it may be said, in direct contact with the air ; since the two thin and moist membranes present no obstacle to the free passage of the oxygen of the air into the blood. The number of air-cells in the lungs has been computed to be not less than 600,000,000! Under the microscope the diameter of these cells is seen to be from the one-twentieth to the one-hun- dredth of an inch. In the lung removed from the body and inflat- ed, some of these cells may be seen lying just under its exterior covering, and in appearance resembling millet seeds or small white beads. Could the separate portions of membrane composing the air-cells of a well-developed pair of lungs be connected in one sheet, like a sheet of tissue-paper, the whole surface which they expose to the action of the air would be found to be 20,000 square inches, or thirty times the entire outer surface of the body ! Thus we have seen that the trachea, starting like an inverted tree from the throat, sends its trunk downward, and dividing, throws its 0* thk Lungs and Throat. 13 countless branches to every part of the lungs, studded with mil- lions of bulbs, each of which plays a needful part in maintaining the mysterious processes of life ! If one single cell is destroyed, or so filled up with foreign matters as to be rendered useless, just so much of the life-force is lost; and it can only be restored by re- moving the cause of obstruction, or by healthily enlarging other cells, so that they may perform an additional labor, and compen- sate for the loss incurred. How complex and beautiful is the mechanism of these wonder- ful organs ! And how admirably do they exhibit the wisdom and skill of the Divine Architect, who has so ingeniously contrived every part of the human body for the offices it is required to per- form! Even the bony structure of the chest is exactly adapted to its double office of yielding to the movements of respiration, and yet protecting powerfully the contained organs. In a well-devel- oped body, the cavity within this bony casement is large enough, and only large enough, to accommodate a pair of sound and effi- cient lungs. How unfortunate, then, the meddlesome spirit of " fashion" and false taste, that by the force of ligatures, and even of pulleys, cramps and compresses the chest, confines and dwarfs the vital organs within it, and thus undermines the very stronghold of life! Such an infringement on the functions of the lungs and heart can never be practiced without producing feebleness, misery and disease, and premature death. The ordinary capacity of the lungs for air varies much in differ- ent individuals. Mr. Hutchinson has shown that there is a con- nection between the height of a person and the capacity of his lungs. Thus, in 172 males under the height of five feet, the aver- age capacity was 220 cubic inches; while of 82 males whose height ranged from five feet eleven inches to six feet, the average capacity was 255 cubic inches. The apparent size of the chest, therefore, is not in all cases a correct criterion of the capacity of the lungs. In common measure, a well-developed pair of lungs in the adult will contain from twelve to sixteen pints of air in ordinary breathing, the quantity in the case of the female being slightly less than in that of the male, but in either being greatly increased by a forcible inspiration. 14 Sanborn on Diseases Each act of respiration consists of two parts, the first the draw- ing-in of the air, termed inspiration; the second, the expelling of the air, termed expiration. Both these actions must be properly performed, to accomplish the healthy change and purification of the blood. That portion of air which enters or escapes from the lungs is called breathing air; the deeper, sighing breath which is sometimes necessary to carry on more completely the change in the blood is called complementary air. That which can be forced from the lungs by an unusual effort, is termed reserve air; and that which remains in the lungs, and which we can not expel by any effort we may make, is called residual air. It will at once appear from the largeness of the cavity of the chest, and from the cellular structure of the lungs, that the latter organs can never be wholly emptied in breathing. And the fact is, that while from twelve to sixteen pints of air ordinarily occupy the lungs, not much more than one pint enters and leaves them at each inspiration. It is the residual air that buoys up the lungs in water, and causes them to float; and that also contributes materially to the lightness of the human body, enabling a person with a little skill in retaining a due share of air in the lungs, jto float upon water. The residual air seldom amounts in healthy lungs to less than 200 cubic inches. Owing to the constant presence of this residue, which is slowly changed during repeated acts of breathing, the purification of the blood in the lungs does not take place by » fits," but is constantly and regularly going on. The full development and vigorous action of the muscles of the chest, by which respiration is performed, must necessarily be in the highest degree important to the health. If the whole person be sickly and weak, or if artificial methods have been resorted to for the purpose of diminishing the size of the chest (the waist being but the lower portion of the chest), the respiratory muscles will of necessity be feeble and perform their office imperfectly. On the other hand, exercise in speaking, singing, or any active employ- ment, especially in the open air, will give strength to these mus- cles, and, if no mechanical hindrances be interposed, will insure a deep, full, and vigorous respiration. Those who have observed the great size obtained by the arm of the blacksmith and the leg of of the Lungs and Throat. 15 the danseuse, will understand the power of healthy exercise to in- crease the development and strength of the muscles. No one can doubt the importance of the action of the lungs to life and health, when it is recollected that through them, as I shall now proceed to show, must be received the supply of oxygen, or vital air, which is to purify and vitalize the blood ; and that through them the noxious gases constantly collecting from the breaking. down of worn-out parts of the system must chiefly escape. How carefully, then, ought all to guard against interfering with their action, and against exposures or any agencies whatever that are liable to disease and disorganize these delicate but important structures ! Uses of the Lungs.—In the previous section it was stated that there are two movements of the lungs—expansion and con- traction—by which air is received and expelled by those organs. I shall now proceed to state the object of these movements, and the peculiar offices performed by the lungs, the heart, and the air. The blood which passes from the right side of the heart to the lungs is of a dark color, and is termed venous, as it is collected by the veins, and from all parts of the body. The darkness of its color indicates the impurities which it has taken up in its course, and it is for the purpose of being freed from these impurities, and of being again vitalized by the action of the air, that the blood must be sent to the lungs, and that these organs exist. When the blood has left the lungs it has again acquired the bright scarlet, arterial color; and passing to the left side of the heart it is dis- tributed thence to the system at large. It will be interesting to study for a moment the chemical changes which take place in the blood during its passage through the lungs. The chief constituents of.the air we breathe are two gases—oxygen and nitrogen—the latter forming nearly four fifths, the former one fifth, of the atmosphere. Both these gases are without smell, taste, or color. Nitrogen will not burn, and thoufh destitute of any noxious properties, it has at the same time no power to support life; so that a person compelled to breathe it in a pure state, would be negatively poisoned, i. e., 16 Sanborn on Diseases would die for want of vital air. This vital air is oxygen; which is at once the most powerful supporter of combustion, and the only mechanical element among the fifty or sixty in and about our planet that will support animal life. Indeed, combustion is in all cases a chemical process, and generally consists in the union of oxygen with the substance burned, and animal life is but one of the results of this combustion which is constantly going on at a slow rate in all living animal bodies. Oxygen, entering the blood through the breathing organs, burns up the old and worn-out substance of the body, producing heat and vital force; and the products of this burning are then removed by the proper organs from the system, their place to be supplied by the fresh materials taken daily in the form of food. A red-hot rod of steel plunged in a vessel of oxygen imme- diately blazes intensely, throwing off a multitude of brilliant sparks ; and in a person who breathes this gas pure, the circulation and' breathing are excited, heat and activity are increased, and death, if the experiment be persisted in, soon results. Hence the use of the nitrogen of the atmosphere is simply to dilute oxygen, and render it capable of being breathed with safety and with benefit. Hence, our reason would teach us that the atmosphere has its ingredients mixed in just such proportions as to make it compatible with the highest degree of activity and health in the systems of all animals; and that any deviation from the natural proportions of its elements, as is produced by breathing repeatedly the same portion of air, must be directly injurious to the health; and these conclusions are corroborated by the testimony of science. Without oxygen, all animals would immediately cease to exist. Compelled to breathe it pure, they would meet the same fate. But diluted oxygen, in just the proportion we find it to form in the free expanse of the air, and just as it came from the hand of the All- wise Author of nature, sustains life in the highest perfection ; and that is health. . Carbon, that is, coal, forms a large part of human flesh and blood, and especially of the fatty substances of the body, and a large part also of the different varieties of food which we consume. This is proved by the fact that human bodies are charred in the fire of the Lungs and Throat. 17 as perfectly as wood is ; and that charcoal may in the same man- ner be obtained from every species of food. Oxygen, which unites with the carbon in wood or coal to produce fire, unites slowly also with the carbon of the human body and of some parts of our food for a similar purpose, while other portions of the food go to re- place the waste in the bodily substance that thus occurs. Oxygen and carbon, uniting in the process of combustion, form carbonic acid. This composes a large part of the heated air or smoke ris- ing from every fire ; and this forms the smoke of that living fur- nace—an animal body. It follows, therefore, that in every inspira- tion oxygen in considerable quantity enters the lungs ; and that with each expiration, carbonic acid gas—the result of the burning- up of worn-out material in the body—escapes. This carbonic acid is not chiefly formed in the lungs. The oxygen passing from the air-cells into the blood is conveyed in that fluid to all parts of the system ; and wherever it meets with carbon in a state of readi- ness, chemical union takes place ; the carbonic acid formed in all parts is gathered into the blood, and conveyed to the lungs as the natural vent—the chimney—by which it escapes. The result is, a change in the condition of the blood in the lungs, as already mentioned, from a purple to a bright scarlet color, and from being loaded with impurities, to becoming pure, capable of ministering to the nutrition of all the organs of the body, and of imparting a pi»oper stimulus to the nervous and muscular appa- ratus. When thus purified it is immediately propelled to all parts of the body through the arteries, which divide and subdivide until they become so minute and so numerous that, as is well known, in the skin even a cambric needle can not be thrust in without wound- ing one or more of them, and drawing blood. From these small vessels the blood deposits the nutriment that may be needed, and again becoming loaded with impurities and robbed of its vitality, it is hurried off to the lungs for re-purification. No one will fail to perceive that whenever the supply of oxygen is from any cause de- ficient, or whenever from defective action of the lungs or from other causes the impurities of the blood can not properly be thrown off disease in some form must be the result. Thus there are two things indispensably requisite to healthy blood, and of course to 18 Sanijorn on Diseases health of the body, a sufficient supply of nutritive food, and a free supply of ptire air. We thus see how beautifully the complicated machinery of the human body is adapted to the accomplishment of the object for which it was designed. And yet how often, by erroneous habits of living, we throw this delicate machinery out of balance, produc- ing innumerable diseases to embitter existence, and hurry us " before the time" to that bourne from which there is no return! The follies of youth impair the natural energies, waste the strength, and leave the system an easy prey to whatever causes of disease it may have to encounter. But, more than this, the very air that "should minister life and health is sometimes heavy with the seeds of disease ; and the food we eat too often conveys into the blood impurities, and even poisons, that undermine the life it was intend- ed to sustain ! For the long catalogue of diseases we have an equally long and startling catalogue of causes of disease; and when we look mi- nutely at the delicacy of the structure of our bodily organs, and at the multiplied forms and immense amount of the labor they have to perform, we are led to wonder that their derangements are not more frequent and more fatal in their consequences. At least, we can not fail to learn from the consideration of this subject a lesson of vigilance in regard to our health, and to the action of those influences that tend, during every hour, either to build up or to pull down this tenement in which we hold our ': lease of life." The act of existence is one of continual destruction; for the death of one becomes the life of another, and the removal of one atom is necessary to the incorporation of another. In the world around us, a re-arrangement of atoms is constantly going on ; and the same is true of the world within us. Every word we utter every action of a muscle, results in the decomposition of some part of the structure that is called into use. The very act of thinking requires the expenditure of nervous power, and to pro- duce this power requires decay of nervous substance. Thus the body literally "wears out" in action ; or, since all this decay is produced by oxygen, without the corroding action of which vitality with al] its powers would be impossible, we may say with just as much propriety of the Lungs and Throat. 19 that, in the fire of its own action, the body is continually burning away; while, by virtue of nutrition, it is, during life, continually renewed ! In regard to the effects of respiration on the living economy much has already been stated ; but a few additional facts should be mentioned before we proceed. All food is divided into two classes—that which is nutritious, or capable of forming flesh, and the non-nutritious,or respiratory food, which supplies the body with heat. The nutritious elements provide the blood, bone, and muscle with new particles, to take the place of those lost in the action of the or- gans. In another part of this volume will be found a table of the rela- tive value of different kinds of food, in respect to its nutritive power. In respect to the respiratory food, it is evident that fire can not be produced without fuel, nor will the fuel burn without a supply of air; and we have already seen that the same is true in the human body. The conditions of perfect health require, therefore, that the supply of oxygen should be just equal to the amount of waste or combustion made necessary by the activity and exposures of the body. But it is impossible, in a work so condensed as this must be, to enter as fully as I would desire into the beautiful workings of every organ; and I shall proceed at once to speak of the effects of a deficient supply of pure air. Effects of Want of Air.—The elements of the blood, both in health and disease, are well known, and most alterations in its substance or action are easily detected. It may justly be said that the arterial blood is neither more nor less than the body in a liquid state, containing, as it does, the elements of every tissue. It is, as is often declared, " liquid flesh." Blood is principally composed of water, a substance called Albumen, which resembles the white of an egg, and Fibrin, which is the principle that "clots" in blood drawn from the vessels. Besides these, a multitude of minute, organized, roundish bodies are found in the blood, called "globules," which are of two kinds, red and white, the former always being abundant in states of vigorous health, and deficient in conditions of feebleness and chronic disease. The blood also contains a small amount of fatty material; a quantity of iron, mostly found in the red globules ; besides lime, common salt,potash, soda, minute quanti- ties of phosphoric and sulphuric aoids, and other chemical substances. 20 Sanborn on Diseases In regard to the two principal nutritive elements of the blood, Albumen and Fibrin, no great alteration in their relative propor- tions can take place without necessarily impairing the health. The first change observed in the blood when not sufficiently purified by the action of the air, is an increase in the amount of water and fibrin, and sometimes also of albumen, with an evident decrease of the red globules—the element most closely connected with vital activity and vigor of constitution. The effects of this change are obvious. They are seen in the bloodless countenance, the shrunken form, flabby muscles, debility, tendency to lingering dis- eases, often of a scrofulous character, and not unfrequently termi- nating in pulmonary consumption. Many of the unpleasant sensations produced by breathing im- pure air are well known to most persons. Frequenting crowded assemblies, or sleeping in ill-ventilated rooms, produces a feeling of dullness, languor, and nervousness, with headache. It is a com- mon occurrence to hear of death produced by the foul air of wells and vaults, into which workmen too often descend without due pre- cautions; as well as by the confined air of a close room, in which a fire, especially if it be a coal fire, has been burning. But in these cases the same thing occurs, only in greater degree, which takes place in any ill-ventilated room, public or private, in which there is not a sufficiency of fresh air supplied to perfectly meet the wants of those who must breathe it. In these cases an excess of carbonic acid accumulates—a poison so deadly that to inhale it pure causes convulsions and immediate death; and to produce this gas, an exhaustion of oxygen takes place, and the result of both these influences is seen in lassitude, and prostration of the bodily ener- gies. If these causes are not present in such a degree as to occa- sion fatal effects, they still must produce results tending to the same end, and always in the same proportion as they are°present. The deadly carbonic acid gas, it must be remembered, is thrown off with every act of expiration from each pair of lungs, and from every fire, as a product of combustion. On the contrary, fresh air, an animal diet, and alcoholic bevera ges increase the amount of the red globules, and (in case the last two are not indulged in to excess) improve the vigor of the con of the Lungs and Throat. 21 stitution. The jolly red face of the beef-eating Englishman is well known; and his blood is rich in red globules. Out-door exercise, by increasing the amount of respiration, produces—when not carried so far as to exhaust—the same good results. But the moment the entrance of a due quantity of pure air into the lungs is prevented, or that carbonic acid is retained within the system in undue amount, that moment an unfavorable change in the blood begins to take place. Statistics and observation alike show that persons whose lives are chiefly passed within door, are far more liable to scrofulous diseases and consumption, and much less robust and healthy, "han those who pass a large share of their waking hours in active out-door employments. And yet, among the many who are perfectly aware of these facts, how few there are who draw any practical deduction from them, or who make any prac- tical application of their knowledge in the way of learning *he causes of their own diseases, or of securing Nature's aid in their efforts to obtain a cure ! (Df \\)t Diseases nf tlje t\wp. CONSUMPTION: (phthisis pulmonalis.) The reasons which induce me to commence this treatise with the subject of Consumption may be stated in few words. This disease is the most frequently met with of all that afflict the res- piratory organs ; and it is at the same time the most fearful in its symptoms, and by far the most fatal in its tendencies. To the patient, and not less to the physician, then, the study of the causes, course, and treatment of this disease is a matter of the highest moment; and thus its right.to the first place in a work upon pul- monary diseases is sufficiently vindicated by its importance. The history of this baneful disease is the history of a false civil- ization, and of erroneous habits of living. We have no evidence of its existence in the primitive ages, and our knowledge of the 22 Sanborn on Diseases freedom of the most savage tribes of the present day from this disease, confirms the opinion that it did not then exist to be the terror and the scourge of the family of man. Even the medical records of a few hundred years past show that its frequency was very slight compared with the alarming extent to which its rava- ges now prevail. When we come to consider the causes that pro- duce this disease, the reasons for its great increase at the present time will readily appear. What is Consumption ?—There are but few who do not un- derstand something of this disease; yet how it is produced, andtvhy it destroys the " house we live in," is not generally known. This knowledge is important to the patient, that he may learn to avoid the disease ; and to the physician, that he may properly apply his remedies to cure it. Fig. 2. oiZ\ T;7, gUr6 repreSeDtS th° external surfac* and a section L a r c2' "t"dded,wlth tuWes- Th- »PPeai- to have been deposited in the a.r-cells, and so far as visible here, they lie chiefly just beneath the pleura giving to the surface the feelinn- 0f bein„,„,„,. of t^L^Z^ Zltt, J'^ "* these being interspersed thronrf, Ti ♦• ™Dercles in the same manner; organs in which they are found" "* "*"""" °f ** ^™ of ** Consumption is known to be caused by a deposit from the blood, of the Lungs and Throat. 23 into and around the air-cells of the lungs, of a soft, cheesy matter, which is mostly found in the form of small, roundish bodies, in size varying from that of a millet-seed to that of a pea, or larger, and called tubercles. But how came this foreign matter in the blood ? According to the prevailing belief of physicians, this diseased condition of the blood is the first step in the production of Consumption, or Phthisis, and it is this that, in their opinion, oiiginates the disease in the lungs. They consider the difficulty as general, before it is a local one. Based upon this theory is the long-established practice of administering medicines by the stom- ach, in the expectation of cleansing from the blood certain impurities, and in this manner curing a disease that has its seat in the lungs. It is true that the blood of a consumptive invalid is changed, containing too much water and too few red globules—that it lacks vitality. Yet to those who have read the chapter upon the " Uses of the Lungs," it will hardly be necessary for me to demonstrate, what I claim to be true, that the changes observed in the blood are really the result of a previous change in the air-cells of the lungs, which do not admit enough of oxygen, nor properly allow of the escape of carbon. The stream, it is true, is impure; but only be- cause the fountain has been troubled. To use a homelier simile, the house is full of smoke, and soot is collecting on the costly fabrics within, only because the draft of the chimney is insufficient. I consider this a very important point to establish, whether con- sumption be first a general or a local disease, and to ascertain where the causes first act which develop it; for upon the different views held in regard to this point are founded the two opposite methods of medical treatment—remedies for the blood, through the stomach, or remedies directly to the lungs. I have said that tubercles deposited in the lungs are the imme- diate cause of consumption. The deposit takes place into the sub- stance of the lungs or into the air-cells, in either case crowding upon or filling up these cavities and preventing the admission of air. It generally commences at the upper part of the lungs, and more frequently in the left, and from this point, in some instances slowly, in others with great rapidity, extends throughout the whole of one, and more commonly of both the organs. The number of 24 S A N IJ O it N ON D I S 10 A S K S these foreign bodies is sometimes greater, sometimes less, and their appearance and feel is that of hard, unyielding kernels, of a whitish or yellowish color, scattered through the soft and pliable substance of the lungs. These tubercles, when once deposited, undergo certain changes, in some cases occupying but a few weeks or months, in others re- quiring a period of several years. A few of them soften at first at the center, and inflame the lung around them, forming a small abscess, the matter of which sooner or later makes its way into a bronchial tube of some size, and is then coughed up. If the dis- ease is not now checked, these abscesses enlarge, and new ones are formed by the softening of other tubercular masses. Thus tuber- cles act to destroy the lungs in the same manner as splinters de- stroy the flesh—producing at first a slight irritation, then inflamma- tion, and finally ulceration and breaking-down of the parts sur- rounding them. Fig. 3. ExPi.ANATiox.-The figure shows cavities of different sizes in the substance of a portion of lung, or, in other words, abscesses, formed by the softening of tubercles The bristles introduced into the cavities, pass into bronchial tubes, Bhowmg how the former open into the latter, and so discharge the matter, blood, etc., formed in these abscesses, through the windpipe and the mouth in expectoration. It will be seen that the abscesses eat away the substance'of the lungs, in the same manner as an external ulcer destroys the flesh around of th k Lungs and Throat. 25 it, and thus grow larger until they meet, destroying finally, unless checked, the whole, or a large part, of the lung. Let us inquire for a moment what must occur after tubercles have become largely deposited, or ulceration has commenced. It is well understood that vital power acts to preserve the living solids of the body against the excessive action of oxygen, and so pre- vents a too rapid destruction of the tissues by that agent. But an extensive deposit of tubercles, or ulceration of the lung, reduces the vital power, and oxygen being no longer duly resisted, seizes upon the blood and the solids. Rapid decay takes place, the breathing is quick, the blood poor and of a florid color, and the patient wastes away. The sedentary workman will acquire con- sumption by breathing too little pure air ; but when the disease is progressing he breathes too much for the vital resistance of his sys- tem, and a real consumption of his flesh and strength occurs. This is an important point, as bearing on the value of alcholic inhala- tions and beverages to check the progress of the disease. Well-authenticated facts are abundant, going to sustain the view here taken of the nature and origin of consumption. An animal kept in confined air exhibits, after a few days, tuberculous or scrofu- lous deposits, always in the lungs, and often in the liver, kidneys, and spleen. Although the most nutritious food be given to animals while undergoing this experiment, the result is the same. The blood becomes filled with impure carbonaceous matters—the un- burnt carbon of the food. The lean flesh or muscle wastes, at the same time that the animal becomes fat or bloated. Swine fattened in tight pens, without a due supply of air, invariably exhibit signs of scrofula or tubercles in the lungs or liver. What we here observe in the lower animals, we see daily ex- emplified in our own species. In prisons, hospitals, churches, places of amusement, in close or ill-ventilated sleeping apartments, in damp cellars, in merchants' offices—in short, wherever an unin- terrupted supply of pure air is impossible or neglected, the con- sumptive process is continually going on. Tuberculous deposit may not take place ; it may never take place; but the predisposition is certainly being established, and in a large share of the cases thus exposed to its influence, the actual disease sooner or later develops ______2____ 26 Sanborn on Diseases itself. The first great source of scrofulous or tuberculous disease is still to be found in insufficient or impure air. A majority of those that are consigned to our prisons, are at the time healthy and robust, exhibiting in most instances no signs of scrofula or of tendency to tubercular consumption. Generally leading an active life in the open air, they have laid the foundation for at least a good constitution and long life. Now we have tables showing that by far the greater number of those who die in our prisons, die of consumption ; and in nearly every instance of death from other diseases, tubercles are found to exist in the lungs and liver ! Here we have an effective lesson of the influence of con- fined and impure air. In speaking, under the succeeding head, of the causes which pro- duce this disease, we shall show that all the causes yet ascertained, of whatever nature, and acting in whatever way, do affect directly or indirectly the breathing capacity of the lungs, by compressing those Organs or diminishing the number of active air-cells, or else that they are such as exclude to a greater or less extent a due sup- ply of fresh air from the pulmonary apparatus. €jr* €ni%t% nf CnttHumpfiatt, The causes of consumption are upon the right hand and upon the left; its seeds meet us everywhere, and in almost numberless forms. We are in danger from its poison at every breath—in the ill-ventilated sanctuary, and in the prisoned air of our dwellings. It is painful to reflect that a disease so deadly in its progress as consumption, should be so stealthy and insidious in its approach. Who knows that he, or she (as it may be), has consumption, until : the dry cough, shortness of breath, pains in the chest, or spitting | blood reveals the wily foe that has fastened on the vitals ? But 1 when these appear, the work is already half done ; and nothing but the highest skill and the wisest course of treatment, or an effort of the powers of nature, can avert the shaft that, like the sword of Damocles, hangs suspended by a hair over the victim's head ! of the Lungs and Throat. 27 How little we think of the unseen dangers to which, in our vari- ) able climate, and with our perverted habits, we are daily liable! • Day after day, hour after hour—while we work and while we sleep ! —while we rejoice and while we grieve—if we breathe an atmos- phere robbed of the life-giving element, or are under the influence of any of the causes of consumption, the blood goes on dropping I —silently, yet surely—its load of morbid materials into the deli- cate structure of the lungs. However terrible the "harvest of death" when it comes, the seed is sown in silence and unsuspected; and before the victim knows that he is even marked for sacrifice, j he is already garlanded for consumption's altar. I So delusive is this disease, that even when all its symptoms are | upon the patient, he still calls his difficulty a " severe cold," " bron- chitis"—any thing but its true name; and in this way thousands f cajole themselves into a false security, until all hope is past; when, if they would but confess the truth to themselves in time, their ;. lives might be the reward of their courage and prudence. ;| Tubercular consumption is either hereditary or acquired, accord- l| ing as its causes are to be found in transmission from the parents, •' or in the influence of external or artificial conditions of life. HEREDITARY CONSUMPTION. jf Hereditary transmission of qualities is a fixed law of both the ;] vegetable and animal kingdoms. In the human species we see If this law exemplified in physical as well as mental qualities, in the |J reproduction of health as well as of disease. " Like begets like." \ No sane man sows barley expecting to reap wheat, or cultivates ] thistles in the hope of gathering figs. We do not even hope to 1 raise white violets by setting out blue ones; nor perfect speci- lii' mens of any vegetable by planting seed that is blighted and sickly, i,, And it is just as contrary to all experience and reason to look for health and longevity in children sprung from parents who are i wasted with an exhausting disease. 1 If the morbid tendency of the parent system be to consumption, I the predisposition of the child will be to the same disease ; if the | former be afflicted with epilepsy, epilepsy will be the inheritance i 1 of the latter; and so on through the whole catalogue. It is, I 28 Sanborn on Diseases however, an acknowledged fact that consumption is more fre- quently transmitted than any other malady. And this can not ap- pear strange when we remember the direct influence the lungs must have upoivthe formation and preservation of a sound constitution. The fact that consumption is so frequently hereditary has been employed by those who hold that the disease is a general one, and ;. / dependent on a deranged state of the blood, as the strongest argu- ment in favor of their doctrine. If, therefore, we show that this fact is no argument in favor of the constitutional origin of con- sumption, but rather the contrary, it will not be worth the while to spend time upon the minor proofs brought forward to sustain the same view. Let us see, then, how the case stands. We have already shown that the lungs are the great fountain of vital power, to sustain which requires that, in a healthy adult, the enormous amount of 60 hogsheads of air, and 30 hogsheads of blood should, in every 24 hours, pass through those organs, whose millions of air-cells go on expanding and contracting with the reg- ularity of clock-work. Now if it be true that parents transmit their own physical qualities to their children (and no reflecting *^iind can or does dispute this.truth), then it must follow that if the lungs are the weak or imperfect organs in the parent, they must be weak or imperfect in the offspring. A well-developed, full £■ chest, and a large, sound pair of lungs never were and never will be ! found in the son or daughter of parents whose chests tvere cramped and narrow, and their lungs small, contracted, and deficient in capacity and energy, unless the former have developed their previously ■ ; imperfect lungs into a comparatively perfect state, by a course of long-continued and judicious exercise. At all events they will never be born with such lungs. But the small and imperfect ['•-. lungs in the child, by failing to properly purify and vitalize its :;,;' /blood, and by constantly failing to do so, must, if their capacity be not improved by suitable methods, develop in him the same scrof- .; j' ulous or tuberculous tendency which existed in the parent, and, in ;\{ a majority of cases, eventually the same disease. Strictly speaking, then, it is not the attack of consumptive dis- ■: ease that the child inherits, but the feeble and imperfect lungs that are |j almost certain to lay in them thcfoundations of tubercular consumption. i of the Lungs and Throat. 29 By a careful reference to statistical tables, and by observation, I find that a consumptive tendency is more frequently traced to the mother than to the father. This is no doubt partly due to the j fact that more women than men have the disease, but still more to i the direct and powerful influence of the maternal constitution in j molding that of the child; the physical condition of the former, from the time of conception until the end of gestation, being faith- j fully daguerreotyped upon the plastic body of her offspring. If the lungs of the mother be loaded, during that period, with tuber- cles, there is not one chance in ten for the child's escape from the disease ; and if the father at the same time has tubercles, it will be .1 as impossible to develop the child into a healthy man or woman, J as to raise a healthy plant or a beautiful flowei from an imperfect ! germ. If one parent, only, shows the consumptive tendency, the pre- disposition in the child is generally less strongly marked than j where both parents are so afflicted. Where tubercles have but just j begun to be deposited in the mother's lungs, at the time of gesta- j tion, I believe the child's chance of escape is better, especially if a judicious and systematic course be taken to enlarge and strengthen the lungs of the latter, so as to secure purity and vitality to its blood. There are cases where, while certain members of a family die of the disease, others escape entirely. And even in some instances, although both the parents may have died of the ' disease, the children may escape. The consumptive habit seldom skips, in this way, more than one generation, and where patients j tell us that their parents were free from the disease, we shall some- . times discover that its germ, nevertheless, existed in the family, i in the testimony that one or more grandparents, uncles, or aunts j have died of tubercular consumption. The Predisposition may be Overcome.—All these facts go to prove that the hereditary tendency to consumption, where it ex- ists, can in some way, be corrected. What the exact influences are that overcome this tendency, can not, in all cases, be known ; but certainly it is reasonable to believe that by an early commence- ment, and a thorough and judicious following up of a system of physical training, this happy result may the most certainly be se- 30 Sanborn on Diseases cured. Give the child nourishing food, cause him to lead a life of active pursuits of some kind in the open air, insist on cleanliness and regular habits, and especially see to it that the chest is largelv developed and the respiration full, and beyond a doubt the con- sumptive tendency will, by these means, often be broken up, and an early decline exchanged for a long life of health and usefulness. Farmers know well how to increase the vigor and hardihood of a weak and puny race of domestic animals. Now let them apply exactly the same kind of knowledge, and the same amount of thought, to the physical training of their sons and daughters, and they will certainly improve a "stock" in which they ought to take more interest than in " Devonshires" and " Durhams." Carry out such a course universally, and in a few generations the ravages of consumption would be reduced to less than a tithe of what they are now. It does not necessarily follow that because the parents have died of consumption, the children must forever carry the scrofulous taint in their blood. I firmly believe that, although the child may have transmitted to him a consumptive tendency, and-even be born with tuberculous matter in his blood, the predisposition can be so eradicated that not a trace or symptom shall ever manifest itself. There is a mistake often made respecting hereditary transmis- sion of this disease, which has a particularly unfavorable influence upon the mind of the patient. A person who has acquired con- sumption is apt to have more faith in the possibility of a cure, than one who believes the disease to have been entailed upon him from his parents. Hope is more strong in the former, and may greatly aid in bringing relief. Now I have often asked patients if one or both their parents had died of this disease, and have been answered in the ;iffirmative ; but upon further inquiry I have learned that it was thirty or forty years after their birth that the disease in the parents manifested itself. Under such circumstances we have no certain evidence of a hereditary tendency; and if the disease shows itself in the offspring, it is more reasonable to consider it acquired than inherited. Hence, in these cases, the fears of the patient in regard to the greater incurableness of his disease are groundless. of the Lungs and Throat. 31 In conclusion, we have seen that the fact of the hereditary trans- j mission of consumption is no disproof of its being, in all cases, I essentially a local disease; since the parent transmits to the child j the small or imperfect lungs that in all cases lead to the develop- ment of the disease. A rational practice can never be founded on j the antiquated theory, that the blood is the cause of consumption ; for the remedy, according to that theory, is directed only to the effect, and ; not to the cause. And again ; however frequently the disease is transmitted, it is always acquired in the first instance. Let those in whose families the scourge has appeared, then, be ever watchful against its appearance in their own systems; and let even those j who come of a stock that has been exempt from the spoiler, be no I less watchful, lest they become the first of a long "line" of con- | sumptive victims ! ji The Right of Consumptives to have Offspring.—The query here arises, Have parents the moral right to entail upon their j offspring consumption and an early death ? j I do not ask whether the person who inherits a consumptive ten- ] dency, but as yet shows no symptom of the disease, should marry; \ for I claim that the sentiments of home and affection are too deeply | implanted in our nature, and too sacred in themselves, to be made i to yield to uncertain questions of prudence. They can not be ' sacrificed without moral, and too often physical injury. It is a fact ■ noticed by all observant physicians, that a fondness for the society of the opposite sex is even stronger in the consumptive than in per- sons in health—too strong, unless carefully regulated, for the invalid's \ own benefit—yet the cravings of an unsatisfied mind are doubtless the most fatal of influences to the constitution of the susceptible subject of this disease ; and these unfavorable influences should, if possible, be avoided. I have no sympathy with the popular cant that would forbid a person predisposed to consumption from mar- ! rying. But I would urge on all such the necessity of great pru- dence in the marriage relation. But the question whether the known inheritor of consumptive tendencies should allow himself or herself the pleasure of offspring, is altogether a different one, and requires a different answer. Who that has the noble generosity of manhood, or the tender instincts 32 Sanborn on Diseases of a true womanly nature, could knowingly consent to be instru- mental in bringing into the world children so delicately organized as the consumptive child is apt to be, only to form the keenest attachments for the objects of life, and then be cut down in the prime of manly power and felicity by a lingering and painful dis- ease? Reason and conscience revolt at the consequences of such a step, and the decision of our best judgment, while it allows the consumptive to marry, forbids his propagating a race doomed to early disease and death. If there is any exception to this rule, it is where the tendency to this disease is supposed to be not very strong in the parents, and where they are possessed of the means and intelligence requisite to undertake, systematically, the work of securing a full physical de- velopment in their offspring, and so eradicating the seeds of the disease, as I have already shown to be possible. But as it is now, the children of consumptive parents generally die early, often soon after birth. And it is well that they should., "A (healthy) child in a house is a well-spring of pleasure;" but it is a most pitiful spectacle to behold a child with that rich legacy, consumption, entailed upon it, and to reflect upon its probable brief career of suffering and death. When such are called away, we should rejoice that they have been allowed to quit the scene before they could learn what a supreme mockery life must have been to them ! ACQUIRED CONSUMPTION. The cause of hereditary consumption is beyond the control of the person who may be its subject; the causes of the acquired dis- ease may, to a certain extent, be avoided. This class includes all causes which tend, directly or indirectly, to exclude from the lungs their needful supply of air. Impure and Insufficient Air.—This is, as already stated, the great and prolific cause of the disease under consideration. The Almighty, in His wisdom, made the air just as He intended His creatures should breathe it. Our \ery existence depends every moment on its use. We may live many days without food, many hours without water, but not three minutes without air. Now the of the Lungs and Throat. 33 supply of air necessary to health may be cut short in many ways, most of which will readily occur to the reader's mind. Confinement in ill-ventilated rooms, or in rooms where the air is over-heated and greatly rarefied, is a frightful means of obliterating the air-cells, and thus establishing a weakened condition of the lungs. Every person has felt at some time the difficult and labo- rious respiration that is caused by warm and crowded rooms. In the natural state every air-cell is of full size, rounded and plump, like a bladder distended with- air. The cells should never be empty, or collapse. It is well known that if the arm be suspend- ed in a sling, the muscles, remaining in a state of rest, become shrunken, and flabby, and weak. Just so, if the air-cells are not continually and vigorously distended with fresh and natural air, they become inactive, relaxed, and as some of the fibers of the unused muscle shrivel and disappear, so a greater or less number of the air-cells will collapse; and if not soon restored by breath- ing a sufficiency of pure air, they become permanently closed, and the capacity of the lungs will be so far destroyed. But as confined air is always more or less robbed of its oxygen, and impure, there is a double reason why confinement in such an atmosphere should prove a cause of producing tuberculous matter in the blood. The person subjected to such influences suffers a slow and partial suffo- cation, or hanging ; and the manner in which this leads to the de- posit of tubercles in the lungs, and finally to consumption, has been already explained. Hence we may readily understand why it is that persons whose occupation is within doors, and whose habits are sedentary, are so much more liable to this disease than those whose feet daily press the green earth, and whose brows are fanned by the breezes of heaven. '■ Self-Abuse."—Excepting confinement in impure air, no cause is more productive of consumption than this. Its victims are found alike among the young and those of middle age, in both sexes, and in all classes and avocations in life, not excepting (strange to say !) even the ministers of the pure Gospel of Christ! Few persons are aware how many of the "loved and lost" have been dragged prematurely down to the grave by this deadly vice of unnatural indulgence. A sentiment so proper in itself, so necessary to our m 2*____ 34 Sanborn on Diseases present state, that without it the race would be annihilated, is thus perverted, in the face of reason, chastity, and conscience, to the basest purposes; and in place of conferring unmingled enjoyment, is made the source of misery, disease, and death. Nature is per- fect in her adaptations, as her Author is perfect in wisdom and beneficence; and we should never have been called to behold on every side so many dwarfed and diseased human frames, so many shattered and puerile human beings, but for the astonishing preva- lence of this " solitary vice," which saps the foundations of the con- stitution in its very growth, and consigns the powers of soul and body to ruin ! Every year this vice carries its thousands of wretched victims to the consumptive's grave. To the catalogue of the causes of consumption must be added licentiousness, and excessive sexual indulgence in cases where legal ties seem to give free rein to appetite. Yet it is probably true that where these slay their hundreds, "self-abuse" slays its tens of thousands. Excess culls a sacrifice here and there—and, alas! but too many are offered on its altar; yet where one falls under its baneful influence, a hecatomb is cut down by the allurements of "solitary vice." Insanity, as well as consumption, is produced by the practice of " self-abuse." From the reports of the Massachusetts and Ohio Lunatic asylums, it is found that the ratio of cases arising from this cause to the whole number of cases admitted, is fully as great as 10 per cent. It is not too much to say that in one third of all the cases of death by consumption between the ages of 18 and 30, sexual excess in some form is the chief cause, or at least one of the active causes, of the disease. How many cases of decay of the bodily powers, and of early dissolution, for which other causes are usually assigned, and even in the instance of young married per- sons, are really due to the prostration of the vital energies induced by this fatal form of excess ! Let the young of both sexes, mar- ried and single, as they regard their present and future happiness, and as they would escape the slow but sure coils of consumption, religiously restrain this passion, and keep it under the control of judgment and reason ! m The way in which consumption is induced by these causes will of the Lungs and Throat. 35 readily appear to the thoughtful reader. Than " self-abuse" or ex- cessive indulgence, no other cause produces more certain and more lasting debility. They depress and enfeeble all the vital operations. The respiration especially becomes lowered and feeble, and the cir- culation languid. Hence the blood is made to retain its impurities, while it loses its vitality ; and in this way the conditions that gene- rate consumption are established, and unless these tendencies be counteracted, the disease in due time must appear. Other Depressing Causes.—Whatever greatly reduces the strength or depresses the feelings is liable, in the way just explained, to produce tubercular consumption. Among such causes are excessive toil, with the hands or brain, fear, despondency, grief, care, and anx iety. These allow the vital powers to ebb low, and lay the founda- tion for that disease which " cometh like a thief at night." How many thousands, by living too fast, or by nursing some secret care, are even now sowing within their own organs the seeds of a linger- ing death; seeds of whose taking root a " troublesome cough" is soon to give the first warning indication! How many a wife or mother has gone down from her watch of weeks or months at the bedside of a sick and dying husband or child, to a consumptive's grave! Attendance on places of evening amusement, with the loss of rest, fatigue, and influence of impure air that must be experi- enced, is a fruitful source of consumption. Several instances" of consumption have come under my notice which were directly produced by mental anxiety concerning the loss of friends or property. The patients had previously shown no signs of tubercles, and were of a sound and healthy constitu- tion. But now the respiration was feeble, the countenance anxious, the digestion and appetite gone. The demon of care seemed to sit like a brooding angel in the chamber of the soul. Hope, on the contrary, is known to be a powerful tonic to the system. And yet, although Hope, like a guardian angel, attends the consump- tive through all his lingering journey to the grave, it fails in this inexorable malady, if in no other, to restore health, unless aided by some mysterious interference of nature, or by the most judi cious medical treatment. Climate.—Very little is yet known in regard to the influence of 36 Sanborn on Diseases climate in producing this disease, although very much has been said and written on the subject. It is certain that a cold and damp climate, or one liable to frequent and sudden changes, is the source of a strong predisposition to consumption. On the other hand, sections in which bilious diseases prevail, are quite free from this scourge. Long exposure to cold and dampness, as in the case of workmen engaged about marshes or streams, or persons insuf- ficiently protected from the cold of winter by shelter or clothing, is a fruitful source of the disease. Poverty—This is not itself a cause of disease, but it becomes such through the unfavorable conditions that attend it. These are: insufficient and unwholesome food, exposure, anxiety, and want of cleanliness. Lombard estimates the number of deaths from con- sumption among the wealthy classes in Geneva (Switzerland) to be not more than one half of that occurring among the laboring population. Drug-taking.—The body can not maintain its vigorous life, and resist the encroachments of disease, while we constantly introduce into it the most foreign, nauseous, debilitating, and often actually poisonous materials. The ignorance of physicians who prescribe these noxious drugs, and the timid fears of the people that lead them constantly to swallow such preparations, are accountable for too large a share of the consumptive mortality we witness on every side. I boldly affirm that, after a deposit of tubercles has taken place in the lungs, no medicines given into the stomach can pre- vent their further formation in the blood, or remove those already deposited. Instead of preventing the further progress of the dis- ease, the direct effect of drugs is to derange the system and reduce the strength, and thus to hurry on a fatal termination. No case of tubercular consumption was ever cured by the administration of drugs into the stomach and none ever will be, so long as the disease and its causes remain what they are. I shall speak more fully of the effects of drugs when i come to consider the preven- tion and treatment of this disease. Tobacco.—There can be no doubt that the free use of this poi- sonous herb, especially by the young, is a prolific cause of con- of the Lungs and Throat. 37 sumption. By its deadening effects upon the nervous system, it interferes with all the operations of life. The irritating air of the cigar or pipe, and the stupefying influence of the quid, alike sow the lungs with the germs of disease and dissolution. Tobacco, being a stimulant to the nervous system, produces a forced life—an unnatural activity, yet being at the same time a deadly narcotic poison, so much so that a few drops of its oil placed on the tongue instantly destroys life, it exerts a paralyzing and weakening effect upon the heart and the entire muscular system. Many have experienced the death-like feeling of prostration pro- duced by swallowing the juice of tobacco. In either smoking or chewing, this property of the herb has its effect on the air-cells, weakening their action, while in the former case, the irritation oc- casioned by the entrance of a hot, acrid smoke which seldom fails to draw tears from the eyes, into the equally delicate structure of the lungs, can easily be conceived. A person with consumptive predisposition should religiously avoid the use, in any form, of this debilitating and poisonous weed. Mechanical Causes.—These constitute a fruitful source of con- sumption. I include, under this head, whatever acts to produce pressure upon the lungs, so as to hinder their free and natural ex- pansion. Lawyers, clergymen, clerks, shoemakers, tailors, seam- stresses—all who follow sedentary pursuits, especially those sitting at writing-desks—are apt to adopt a posture which cramps the lungs, and thus induces the disease. Physicians, whose duties re- quire them to be much in the open air, seldom die of consump- tion. Some writers attribute the disease to public speaking ; yet I know of no better preventive, in fact, than a thorough and fre- quent exercise of the lungs in speaking, provided it be in & pure atmosphere. How many in this great city date the origin of con- sumption from the counting-room. Confined steadily for hours, in an unnatural posture, and in over-heated rooms, they seem to be self-devoted to the influence of the deadly scourge. In many in- stances, several clerks thus sit together in a very small room, the air of which is still further poisoned with tobacco-smoke! To ex- pect that health can exist under such circumstances is to expect impossibilities; and it is no "dispensation of Providence" that the 38 Sanborn on Diseases penalty of death is visited upon him who thus, knowingly or igno- rantly, violates the laws of his existence. Females suffer the same effects, only in a still higher degree, from the destructive habit of " tight lacing." To think that intel- ligent beings should sacrifice health and life to a misconceived idea of beauty, is unpardonable. In the statue of the Venus de Medici, or in any of those fine statues of antiquity which are justly con- sidered as models of the perfect female form, it will be found that the waist is large and the chest full. By "tight lacing," the stomach is compressed and digestion interfered with. But the greatest evil is the dead grip of the unyielding band that encircles the lungs, and stifles their natural expansion. Who has not wit- nessed in these instances the rapid and labored breathing, showing itself, where only it can, in the upper part of the chest, as if the lungs were ready to burst the bonds so unnaturally imposed upon them ? Strangulation is taking place as effectually as if a rope were around the neck. Suicide is being committed; consumption is being invited. And yet every year new implements of torture are imported, thus to sap the foundations of the life and health of thousands! Besides the effects already alluded to, " tight lacing" paralyzes the nerves on which pressure is exerted, compresses the blood-ves- sels, and produces injury in many other ways. Its subjects take the power of the Almighty into their hands, and hurry themselves into eternity before the allotted time. The "shortness of breath," and the impossibility of drawing a deep and full inspiration, that follow this process, are easily explained. Under the continued pressure many of the air-cells become closed, and, without doubt, permanently, so that by artificial means a pair of lungs naturally of good size are thus made small for life. Vigorous health will support the graceful curves of the osseous framework of the body without the necessity of artificial props. Let the chest have free expansion; let the blood-vessels perform their office untrammeled by fashionable fetters; leave to the nerves the power of sensation, and to the blood its purity and vigor, and the grand temple made for God's spirit to dwell in will appear be- fore us in all its perfection and beauty ! of the Lungs and Throat. ' 39 There are other causes, however, why the mortality among females from consumption is greater than among males. The occupation of most females precludes out-door exercise. If the ad- vocates of " Woman's Rights" would first of all inculcate the right of every woman in the land to out-door exercise, pure air, and, in fact, complete physical development, and the duty of every one to secure these, they would be conferring on their fair countrywomen a real and lasting benefit. Inhalation of Irritating Particles.—The continued inhalation of certain mineral and other vapors, as the vapor of mercury, of var- nish, and of the "drying oils," is a frequent cause of consumption. The same is true of the inhalation of the fine dust from their work, by stone-cutters, needle.pointers, knife-grinders, and those who work in feathers, hair, wool, and cotton. With this subject I close the consideration of the causes of con- sumption (excepting the case of those maladies which act to gen erate the disease) ; yet I do not claim that outside of that excep- tion even, the list now given is complete. So long as the laws of life and health are daily and hourly violated, consumption will ever remain the great " destroyer" of the human race. When will people learn to avoid the causes, and so escape the consequences, of this dreadful disease! When will they under- stand the absolute necessity of pure air, free exercise, and a healthful diet, to ward off and prevent a malady that desolates every hearth with its ravages 1 When will they discover the worse than utter folly of depending upon drugs for its prevention and cure 1 OF THE DISEASES WHICH ^rtfepM to ^tjlmnmtnj Catrattijittatt The first of these which I shall name is bronchitis, or an inflam- mation of the mucous membrane of the throat, trachea, and bron- chial tubes. It must be remembered that it is through this mem- brane where it has become exceedingly thin, as in the air-cells, that the important change takes place, consisting in the entrance of 40 Sanborn on Diseases oxygen into, and the escape of carbonic acid gas from, the blood. In a healthy condition this membrane secretes a small amount of a glairy fluid called mucus, the office of which is to shield the mem- brane itself from the direct contact of the air contained in the lungs. This membrane also lines the cavities of the nostrils; and it is well-known that in winter an increased amount of its secre- tion is often discharged both from the nostrils and from the throat and lungs. In the former instance we speak of the difficulty as a "common cold," "cold in the head," or "catarrh;" and in the latter, as a "cold on the lungs," or " bronchitis;" or, if the inflam- mation is confined to the throat, a "sore throat," which is also technically termed "laryngitis." Much practical information may be drawn from a clear under- standing of the way in which any of these forms of " common cold" lay the foundation for confirmed consumption. When in- flammation takes place upon the mucous membrane of the nose, throat, or lungs, the natural secretion is at first greatly increased, and is thin and watery. After a time the secretion becomes thick and tenacious, so as to require a violent effort to dislodge it; and finally it is still more changed in character, becoming whitish, yel- lowish, or greenish, heavy, and more easy of expulsion, when the cold is said-to have become "loose." In all stages of the cold,. this secretion occasions sneezing, or cough ; and this continues as long as its quantity is much increased. The cough is an effort of the system to remove the existing difficulty ; as in no instance can the diseased mucus be absorbed into the blood, and the only outlet for it is by cough and expectoration. When these difficulties affect the mucous membrane of the lungs they interfere in two ways with the necessary change of the blood in the lungs. First, the effect of inflammation is always to thicken the membrane, and in cases where colds on the lungs have been frequent, the membrane becomes permanently thickened, the effect extending to the air-cells. Secondly, the secretion fills up a por- tion of the air-cells and of the bronchial tubes; and in both these ways the quantity of air coming in contact with the blood is di- minished. Thus the condition of the blood which tends to the formation of tubercle is produced. of the Lungs and Throat. 41 Now, the secretion expectorated in a common cold is far from being tuberculous; it has no resemblance to it. It may be the cause of tubercles, however, by filling and closing the air-cells, or the passages to them. The discharge of a common cold is formed by the lining membrane, but changed in quality from that of health ; while the matter of tubercle is poured through from the blood into the air-cells, or into the substance of the lung, as gum is poured out upon the bark of a tree. Either of these secretions in the lungs may produce death, but in very different ways. It must be remembered, in this connection, that the constant tendency of attacks that are at first confined to the head or throat, is to " to travel down" into the lungs, and thus, after a number of repetitions, the " cold in the head," or " sore throat," affects the membrane of the bronchial tubes, and produces the same consump- tive tendency as in the cases already alluded to. But again ; the trouble in the throat or bronchial tubes is often but an indication of tubercles in the lungs, which has not yet manifested itself in any other way. Thus very often an obstinate " throat disease" absorbs all the attention of the patient and physician, while, in reality, it is but a concomitant of the more terrible disease, consumption, which in disguise is steadily working its ravages in the lungs. And we must bear in mind, also, that a susceptibility to colds is itself one of the symptoms of consumption ; so that in many instances the common cold, instead of being the trifling matter it is often supposed to be, is really but one indication" that the vigor and warmth of the body are already beginning to fail before the invasions of tuberculous disease. Cough is always a prominent symptom of inflammation of the throat or bronchial tubes. It is particularly' a symptom of con- sumption. How are we to distinguish the two cases, which require a widely different treatment] Much has been said and written upon the value of auscultation and percussion, as tests of the nature of the disease present in a given case. By auscultation we are to understand the act of listening to the sounds made in the chest during breathing; and by percussion, the act of tapping on the chest with the fingers, to ascertain whether the sound of the cavity within is hollow or dull. Now these methods are valuable when 42 Sanborn on Diseases understanding^ practiced, and taken in connection with the ordi- nary symptoms of the several diseases ; but taken alone, or as practiced by an inexpert person, no value should be placed upon them. There are many physicians who carry about with them a hollow stick, tipped with ivory, which they call a stethoscope, and . of which and their ability to use it they make a great parade, who • might as well apply their instrument and do their drumming on the patient's head, as upon his chest! There are many of these who know about as much of tubercular consumption as an Arab... may be supposed to know of a steam-engine, and yet who are for- ever flourishing their stethoscopes, especially when the patient in the case is a lady ! To employ auscultation and percussion to any purpose requires a quick and practiced ear, and a nice and delicate touch. But the only sure and positive means of distinguishing between long-stand- ing bronchitis and tubercular consumption, is that afforded by chemical and microscopical examination of the expectorated mat- ters ; and by these means the distinction is as easy to the prac- ticed eye, as that between arterial and venous blood is to the ordi- nary observer. Under the microscope the difference in the forma- tion of the two kinds of expectoration is clearly seen; and in the same way we may also detect the different stages of either of the diseases named. What has been said of bronchitis as a cause of consumptive dis- ease, may also**be said of pneumonia, or " lung fever." In this disease, which is an inflammation of the substance of the lungs, the air-cells become closed by the swelling of the surrounding tissues • i as well as by the collection of bronchial mucus. How often is consumption truly dated from an attack of lung fever ! Every one knows the importance of keeping the cough loose in this complaint and of promoting expectoration. Indeed, any disease which greatly reduces the vitality of the system may, in the manner which has been already explained, result in producing tubercular consumption. Thus we see this disease frequently following fistula in old persons, and diabetes and certain fevers in persons of all ages. It is particularly liable as is but too well known, to follow almost immediately upon i of the Lungs and Throat. 43 attacks of measles. If, in this disease, the eruption is not well brought out, and more especially if from a cold it is caused to recede, or " strike in," the morbid matter which should escape by the outer surface is almost certain to be thrown upon the mucous membrane of the bronchial tubes; an obstinate inflammation, ac- companied with cough, is the result, and the difficulty, in three cases out of four, terminates in consumption. Thus I have endeavored to give, as briefly as their importance would allow, an account of the principal causes of the most dreaded malady, in all considered, that now afflicts the human family. These causes merit the study of all, but especially of those who have families to rear, and of those who know themselves to have sprung from a lineage on which, in greater or less force, consumption has been entailed. It is not always, nor often, a single cause that originates consumption; and hence those who know they are under the influence of one of its causes, should be more prudent in avoiding all others. In pointing out the causes which directly or indirectly lead to pulmonary consumption, or which hasten its progress when once its seeds are sown, I have presented a chart only of the principal streams leading to the great terminus. Upon this subject I claim to have thrown no new light, but I believe the reader will confess that I have taken unusual pains to present a clear view of the prin- cipal causes of the disease which I have been considering; and in showing how it is that all these causes act to indue© the disease, I claim to have taken one step in advance in the elucidation of the mystery that has long overshadowed this subject. I have endeav- ored to raise the curtain, that the spectator might witness the secret operations of nature going on behind it. And I believe I have shown that the long-cherished doctrine, that tubercular con- sumption is a general disease, is erroneous in theory, and the foun- dation of a false and unsatisfactory practice. 44 Sanborn on Diseases Jflnrtnlitq from Cnttsnmptinti. How few of those moving among the living, know of the buried dead that have fallen victims to this terrible disease! How few have ever calculated the numerical strength of the slain! Yet every year there is a mighty army of living beings hurried off by the dread "Destroyer;" and if I should say that his victims out- number those of war, I should but assert what the statistics are at hand to prove. It is time that the profession, that society should awake from its secure slumbers, and weigh well the dangers of a disease that sweeps its thousands from the earth, as a scythe sweeps down the standing grain. It is time that each should "mark, learn, and inwardly digest" the statistics that have been.collected relative to the mortality of this disease, a few of which are presented in this section. Year after year the number of its victims increases, and should the funeral trains that have escorted their remains to earth be placed in a line, they would border all lands with the shadow of mourning. But the dead can not be raised; and my appeal, therefore, is to the living—to those who, with sorrowful and anx- ious eyes, are watching the drooping of some household flower— to that father, whose failing daughter has been his pride and hope ■—to that wife, who clings for support to the sinking arm of proud manhood—to that husband, whose adored partner is now droopino under the first breaking forth of the seeds of a lingering death. See! Read the frightful statistics here presented, and jud^e if it is not time to arrest the progress of the arch-enemy of life. From the weekly bills of mortality in different cities, and the reports of hospitals, it is found that the average number of deaths from consumption, annually, in the whole population, is as follows: Boston,.........1 in 236. New York......1 in 2G7. Baltimore,......1 in 290. Charleston......1 in 426. The ratio of consumptive mortality to that of other diseases in the same cities is found to be, in— of the Lungs and Throat. 45 Boston (period of 5 years)...................... 1 in 6.6 New York ( " « 4 years)...................... 1 in 7.2 Baltimore ( " " 10 years)...................... 1 in 5.4 Charleston ( " " 5 years)...................... 1 in 6.9 In two years, in this city, the deaths from this disease were— Among males—in 1848................................... 946 in 1850..................................982 1,928 Among females—in 1848................................ 923 " in 1850................................ 949 1,872 1,928 Total of two years, 3,800 The proportion of deaths by consumption at different ages, was as follows: Under 1 year. 1 to 2 yrs. 2 to 5 yrs. 5 to 10 yrs. 10 to^20 yrs. 20 to 80 yrs. 1848....62,.......41....... 55....... 31......133.......516 1850.... 76........63.......55.......28...... 144 .......559 Total...138 104 110 59 277 1,075 30 to 40 yra. 40 to 50 yrs. 50 to 60 yrs. 60 to 70 yrs. 70 to 80 yrs 1848... 549.........282.........164..........69........... 31 1850... 435.........274.........143..........88........... 35 Total... 984 - 556 307 157 66 The Registrar-General of London, in his Report for 1842, states the ratio of deaths by consumption to the whole population to be 1 in 262; and the ratio to the deaths by other diseases to be 1 to 7.1. Throughout England, 4 in 1,000 die annually of this disease, being from one fifth to one sixth of'the whole number of deaths. In the Windward and Leeward Islands, West Indies, the aver- age is 2 in 1,000 ; in Jamaica, 1 in 1,000 ; in Bermuda, 1 in 2,000; in the Ionian Islands, 1 in 1,250; at Gibraltar, 1 in 2,500; at Malta, 1 in 909. The effect of difference of climate on the frequency of hepatic (liver) disease is readily seen by referring to the tropical regions of the Eastern Hemisphere, where the deaths from this cause are more frequent than in any other part of the globe. Thus, at Mau- ritius, 82 in 1,000 men are attacked annually, and 4 in 1,000 men 46 Sanborn on Diseases die; while at Ceylon, 55 in 1,000 men are attacked annually, and 5 in 1,000 die. Lombard, in his " Essay on Consumption," states the average of deaths from this disease to be 114 in every 1,000 of all that occur, and gives the following table of the influences which tend to its fatality : 1. Inhalation of mineral and vegetable emanations......176 in 1,000 deaths. 2. " " various kinds of dust.................145 " 3. A sedentary life.............................----140 " 4. A life passed in workshops.........................138 " 5. A warm and dry atmosphere (?)....................127 " 6. Stooping posture of body..........................122 " 7. Shocks to the chest from violent movements in the arms(?)116 " Influences unfavorable to the development of consumption : 1. An active life......................................89 in 1,000 deaths. 2. Exercise of the voice...............................75 « « 3. Life in the open air................................73 « <« 4. Animal emanations.................................60 " " 5. Inhalation of watery vapor..........................53 « a It will be seen that I have questioned two of the statements of this authority, the first in regard to the unfavorable influence of a warm and dry atmosphere, and the second respecting shocks by violent movements of the arms. The latter is a cause not mention- ed by other authors, and one, the correctness of which, from the known beneficial effect of exercise, especially of the muscles of the arms and chest, in developing the capacity of the lungs, we may be allowed seriously to question. With regard to the effects of a warm and dry atmosphere, I have in my possession the statement of Dr. Zeiler, for many years a surgeon in the French army in Algiers, and now practicing in th.s city, who declares that consumption is peculiarly rare in that country, and that he has never known a death by the disease to occur among the native population there. Very hot and very cold countries are almost wholly exempt from this disease. On the latilud ' " *'W!I1-known that a «<** atmosphere and a middle at tude is peculiarly favorable to the production of consumption; and ,n ou, own country, lt is in those localities that are damp and m the Northern, Middle, and Eastern States, that the disZ'pt of the Lungs and Throat. 47 ticularly prevails. It is also a well-authenticated fact, that the mor- tality from consumption is greater in the vicinity of large bodies of fresh water, as along the shores of our inland lakes, than in the neighborhood of salt water, as for example along the Atlantic coast. In regard to the frequency of deaths from consumption in foreign countries, at peculiar ages, I extract the following from Swett's ad- mirable work on " Diseases of the Chest," one to which I am in- debted for other valuable tables in this volume. In London, the period of greatest frequency is from 25 to 35 years ; the second period, from 15 to 25 years; third, from 35 to 45 years ; fourth, from 45 to 55 years ; fifth, from 5 to 15 years ; sixth, from 55 to 65 years ; seventh, under 5 years. In Paris, the period of greatest frequency is from 20 to 30 years; second, from 30 to 40 years; third, from 10 to 20 years; fourth, from 40 to 50 years ; fifth, from 50 to 60 years; sixth, under 10 years ; seventh, from 60 to 70 years. I have presented these tables in order to show clearly to the non- professional reader the extent of the fearful mortality arising from the disease under consideration, and also the difference in its mor- tality in different climates, at different ages, and under diverse occu- pations. The reader who will carefully study these figures, will be astonished at the prevalence and destructiveness of this disease, and he will, I am sure, acknowledge the eloquent warning often conveyed in a page of statistics ! But there is a fact that must not be overlooked in this connec- tion, because it shows the true importance of the results stated in these tables. It is this: that all this startling amount of mortality \s premature mortality ! Death by consumption never could have been intended to be the natural mode of exit of any human being from the shores of time. Consequently these tables do not merely show so many deaths by consumption, but so many premature deaths—so many lives brought to an early and violent termina- tion, that should have been prolonged to a "good old age" of use- fulness, honor, and enjoyment. Is Consumption Contagious ?—An idea is entertained by many persons that consumption is contagious. But I do not hesi- 48 Sanborn on Diseases tate in affirming that this disease is in no case capable of com munication by one person to another. As cases of consumptive contagion, there have been mentioned many in which wives have seemed to contract the disease from their husbands, husbands from wives, children from parents, and parents from children. It is evident that those who maintain this view are very ignorant of the facts respecting this disease, or very short-sighted in their estimate of them. The wise doctors who countenance this belief have not duly considered, I fear, the long-protracted watchings of the wife and mother over the husband or child, her sleepless nights, spent in a close and confined air, or the grief and anxiety that weigh down her spirits. These will be found to be the causes that have produced the disease, instead of its having been "caught," as is an attack of measles; or that at the most have hastened its de- velopment, when the seeds were latent in the system. I do not believe that the air exhaled from tuberculous lungs is more healthy than pure air; but I confidently declare that no matter of conta- gion has ever been discovered in it. With as much reason might we suppose a common cold or a headache to be communicable by the sufferer to those around. Those who have friends sick with consumption, therefore, need have no fears of contracting the disease. Let them observe strictly the general rules of health, take exercise daily in the open air, ex- pand the chest by full inspirations, and attend to cleanliness and diet, and they will have in such a course a sure guaranty, not only against this disease, but against all the " ills that flesh is heir to." inmptnmir nf Cnttattmptintt. There are two stages in which the symptoms of tubercular con- sumption strike the physician with unusual force; and these are the only stages in which the work of the dreaded disease is appar- ent to the patient or to his friends. These are, first, the period of the Lungs and Throat. 49 from the first slight cough and feeling of uneasiness in the chest, to the softening of tubercles; secondly, from the commencement of softening and ulceration, to the termination of life. Medical writers, however, recognize three stages of the disease; the first being that in which the deposit of tubercles is going on in the lungs. To these I would add, or rather prefix, still another stage, the first in point of time, thus making four stages in all. This is the period during which the system is undergoing the changes that prepare it, by the formation of tuberculous matter in the blood, for the stage of deposit, since it is evident that this deposit can not take place until the very peculiar material of which it is composed has been allowed to form and accumulate in the circulation. Hence the four stages are, first, the preparatory ; secondly, that of deposit; thirdly, that of softening, etc.; fourthly, that of breaking down of the lungs, ending in dissolution. Having indicated these stages so that they may form in the read- er's mind a guide to the progress of the disease, I shall now proceed to the symptoms of the disease under consideration. In doing this, my attention will be directed chiefly to the earlier symptoms, since these may be more doubtful in the mind of the invalid; and it is proportionally of great importance that a correct judgment should be formed concerning the nature of the difficulty at this period. But when the disease has reached its last stage; when the hectic flush paints the cheek with unearthly beauty; when a constant cough racks the form, and when fever, night-sweats, and the panting breath fill up the sad picture of decay, then no one can fail to decide as to what is the disease present; and then, also, it is often too late to afford relief. It is my object to speak particularly of the early, and often un- noticed, symptoms of this disease; the first faint, but meaning, signs which declare tubercles to exist already in the lungs; pos- sibly that they are even now softening and destroying the sub- stance of those organs. Although obscure, and often little heeded by the patient, these symptoms, to the discriminating physician, are like mutterings of distant thunder, foretelling the coming storm. Some writers have enumerated many different forms of consump- 3 50 Sanborn on Diseases tion, as acute, chronic, latent, and so on. But I suspect the only value of this division is to show the learning of those who make it. The disease is always chronic and insidious ; never otherwise. If its course is more rapid in some cases than in others, and its char- acter different, it is wholly owing to difference of constitution and circumstances in different patients. A careful history of the symp- toms that have marked each case is the best guide to the treat- ment it will require. In previous chapters I have described the slow filling-up of cer- tain points in the lungs with tuberculous matter, which, being de- posited layer upon layer, forms small masses, at first resembling the white of eggs, but afterward becoming more hard and yellow, like cheese. It is this innocent-looking material that is as destruc- tive to lungs and life as so many sharp gravel stones would be, if such could be forced into the delicate structure of those organs. When the substance of the lung has been once totally destroyed by the ulceration that takes place in and around these tubercles, it can never, of course, be restored. It is useless to attempt the creation anew of any organ, or any part of it, that has been once obliterated; yet much may be done to delay, or even to prevent the injury with which the lungs are threatened, if the means are used in time. Hence the importance of understanding the pecu- liar symptoms that characterize the earlier stages of this disease. Keeping this point in view, I proceed in the first place to describe the history of a case of consumption as it usually occurs. Unfortunately, there are few symptoms by which we can detect consumption in its preparatory stage, or in the commencement of that of deposit; and even these are so slight and easily mistaken, that very little reliance can be placed upon them. There may or may not be slight emaciation, showing itself particularly about the hands, face, and chest. The fingers grow tapering, and seem long, and the skin becomes transparent, and sometimes has a pearly look, showing the blue veins distinctly through it. There is some- times an unusual liability to a feeling of chilliness, and the person easily takes cold. The strength may or may not be diminished. There is in many instances a delicacy about the expression of the countenance, a brightness in the eye, and a quick play of feeling of the Lungs and Throat. 51 that give to their subject a kind of unearthly beauty, especially, if the patient be a female, and in some way add, in the eye of the beholder, a peculiar interest to the whole character. But the reader will at once perceive that all these symptoms are too slight, and too often the result of other conditions, to be greatly relied on. During the stage of deposit, and of the changes that precede soft- ening, the symptoms begin to grow more distinct. It is often the case that a person commences to cough, as the effect of a cold, or he will fancy he has taken cold ; and this cough continues for some time; yet, being unattended with pain or uneasiness, little is thought of it, and the expectation is that it will soon subside. This it may do, and then after a time recommence, and go off again in the same way. Or it may come on with greater vigor and force, and the patient, becom- ing accustomed to it, pays no attention to the dread warning which is thus knocking for admission at the door of his judgment. He fol- lows his business as usual, while the disease is stealing quietly upon him, and fastening its hold with a grasp it will be hard to shake off. He reasons with himself about his difficulty and its cause, and probably ascribes it to some excess he has been guilty of, to a damp room, the weather, or that " scape-goat" for all anxieties about health—a " cold," and thus quiets his conscience while his disease goes on, undermining his constitution and strength. But the cough is next accompanied with expectoration. The patient finds himself hawking and spitting up " phlegm," which is colorless, or white and frothy. " Merely the result of a cold," he argues ; " wait a while, and it wrill pass off." Meanwhile the secretion increases in quantity, becomes thicker and yellower, or sometimes of a greenish hue. Pains now occur in the chest; and the patient is, perhaps, alarmed by the sudden appearance of blood which he can not doubt is raised from the lungs. The disease is now fairly at work; the whole system is suffer- ing. Tubercles are producing irritation and inflammation in some portion of the lungs; they are softening at the center, and laying the foundation for abscesses. The patient now feels tired and un- easy ; his appetite becomes irregular, sometimes loathing the most delicate food, at other times craving food of any kind in great quantity. The tone of the system is destroyed, digestion becomes 52 Sanborn on Diseases disordered, the bowels are irregular—at one time affected with constipation, at another with diarrhea. At this period respiration becomes difficult; the patient feels a sense of drowsiness and lameness. Walking hurries the breathing, and the patient sits down after any slight exercise, fainting and exhausted. Sometimes headache and anxiety accompany these symptoms. At night, the sleep is unrefreshing; dreams, often of a frightful character, disturb the mind, and the patient awakes to find himself in a profuse perspiration, and perhaps almost suffocating from the interruption of the breathing. Fever now sets in, appearing in the afternoon, and generally going off in a cold perspiration during the night, which constitutes the much-dreaded "night-sweats." At this point the patient may die, and thus the last stage may be ap- parently wanting. This probably occurs in cases whe*:e the deposit of tubercles is so general throughout the entire lungs, that the vi- tality of the system fails before the actual consumption of the lung is allowed to take place. But it must be borne in mind by the anxious invalid, that the strongly marked evidences of disease which I have now laid down, are not always present. In many cases the disease steals slowly and insidiously onward, so as to be almost unnoticed until the breaking forth of violent cough, with free expectoration, hectic fever, and night-sweats, and all the symptoms of the last stage of consumption. How important it is, then, that the patient should note the first warning of the advent of this disease—that the first symptoms should be taken as the enemy's " signal" for the contest, and that the constitution that has been marked for its prey should be intel- ligently aided to do battle against the destroyer with all the force and energy that are left at its command. For what can an ex- hausted system, broken down and almost ready for the grave, be expected to do toward staying the power of a giant, and the perse- verance of Death 1 Having thus given a general outline of the disease as it ordina- rily pursues its course, I shall in the next place speak at greater length of some symptoms which require to be particularly noticed especially that of hemorrhage, or bleeding from the lungs of the Lungs and Throat. 53 Cough.—This is generally the first, and always a most suspicious symptom of the presence of tubercles. It is usually slight at first, dry and hacking in its character, only noticed, perhaps, in the morning, or after exercise, and is apt to be attributed to a tickling in the throat. Or the cough may be severe from the first, and it always becomes more so as the disease advances. It may disap- pear in the summer, returning during the winter; and it may thus come and go for years. Like the other symptoms, this cough is not the disease, but an evidence of it. It is the unavailing effort of Nature to remove a disease that is too often seated beyond her power to reach. Shortness of Breath.—Another symptom accompanying the hacking cough, and sometimes even going before it, is a shortness of breath. This may not be experienced while sitting still, but only after hurried or violent exercise, as going quickly up a flight of stairs. The breathing is thus accelerated, and there is a sensa- tion as if the breath did not go low down in the chest. Now this shortness of breath is, to say the least, not a comfort- able symptom, particularly if it occurs in one who has reason to suspect that he inherits consumption. It indicates that some por- tions of the lungs are so clogged with tuberculous matter that they are prevented from performing their duty ; in other words, that they have sunk into a state of inaction. Chilliness and Heat.—A sense of chilliness, without any suffi- cient cause to account for it, and often amounting to distinct and frequent chills, is a symptom experienced in full one half the cases that have come under my observation, in the earliest period of the dis- ease, and often before any other symptom has appeared. This is a sign of the greatest possible importance. The person finds himself liable to feel a sensation of creeping chills over the back, at any hour of the day or night, but particularly in the forenoon. These may be followed by " flashes of heat," and burning in the palms of the hands and soles of the feet. There is also an unusual sen- sitiveness to cold, and to changes of the weather, so that the person easily takes cold from exposure. These symptoms should never be treated as things of slight account. They are ominous of grave changes going on in the lungs, and are the first intimations that 54 Sanborn on Diseases those organs are already beginning to fiil to perform their office in purifying the blood and supplying vital warmth. The Pulse.—In connection with the other symptoms named, the pulse is almost always somewhat quickened, especially toward eve- ning. This acceleration may be slight until some active exertion is made, when the pulsations suddenly become rapid, perhaps also irregular. Pain.—Shooting pains through the chest are very commonly observed, or a seated pain in the shoulder, or in the side; or this pain may come on after exercise. Sore spots are sometimes felt upon pressing over the lungs or along the spine. These indications - almost invariably point directly to inflammation about tubercles already deposited in the lungs. Debility.—Along with the hacking cough and other symptoms named, there is gradual loss of strength and slight wasting of the flesh, the muscles becoming soft and the skin more thin and clear. Even in an early stage of the disease, the hectic flush is often seen upon the cheek. With all the symptoms now named upon them, thousands have still fatally deceived themselves, and been deceived by their phy- sicians, with the flattering belief that their disease was only bron- chitis. It is not natural for a person with any or all of the symp- toms I have described to wish to believe that they indicate any serious trouble. Each seems disposed to attribute them to every cause except the right one. Now, in regard to bronchitis (which is a disease of the lining of the lungs, and not of the lungs them- selves), it may exist without tubercles; but tubercles can never exist long in the lungs without bronchitis being produced by them, as one of their natural effects. So a man may have bronchitis of a truth, and at the same time be dying of consumption ! When the symptoms above named occur in a person of sedentary habits, or naturally of a " consumptive build," or of consumptive parentage, lf they continue for any length of time, the chances are nine out of ten that tuberculous deposit has occurred or is taking place in the lungs; in other words, that the person is already in the second or third stage of consumption. The appetite may still re mam good, and the general health may seem but little impaired" of the Lungs and Throat. 55 But if it is proverbial that "appearances are deceitful," they are never more so than at the stages of this disease that have now been spoken of. To trust them, and overlook the growing indications of serious mischief that is being accomplished in the very strong. holds of life, is evidently to sign one's own death-warrant, and to bargain for months of pain and disease, and for a premature de- parture from the schemes and enjoyments of time. Hemorrhage, or Bleeding from the Lungs.—Bleeding from the lungs is a frequent and fearful symptom of consumption. It more certainly indicates the disease than all others put together. Whether occurring frequently, or at long intervals—whether so slight as to be scarcely perceptible, or poured forth in crimson tor- rents, it is ever ominous. In ninety-nine cases in a hundred, it tells that tubercles already exist in the lungs. Hemorrhage usually occurs unexpectedly, and without any marked symptoms of its approach. Most persons who have " raised blood," particularly if it be the first time, believe that it came from the stomach, throat, or nose, and are reluctant to admit that it was from the lungs. It is possible that a person may be laboring under all the other symptoms of which I have spoken, and still there may be a doubt whether the cause is tubercles; but if in connection with those symptoms bleeding should occur, every doubt may then be re- moved. Even if none of the other symptoms are present, " spit- ting of blood" is still an almost certain forerunner of the disease. For there are cases in which this is the first symptom observed ; and it may even occur many years before the other indications of the disease show themselves. Thus it may appear while the per- son is apparently in the enjoyment of good health; and it may be repeated at one or more long intervals, before the commencement of cough and wasting of the flesh. It then shows that tubercular deposit is going on slowly, for the bleeding is caused by tubercles, and, except in the rare cases which I shall hereafter mention, it is a certain proof of their presence. Bleeding is, however, very apt to come on for the first time during the early stages of the disease; and it may appear in any stage. From the tables which have been kept, it would appear that 56 Sanborn on Diseases nearly one fourth of those who die of consumption, have never bled from the lungs. I believe, however, that the number of those who have not bled at some period of the disease is much smaller than this. Of five hundred and thirty-four evidently consumptive per- sons, whose case has been particularly noticed in this respect, I have found that four hundred and forty-one had bled more or less. In itself, this hemorrhage from the lungs is not dangerous; it is only as an evidence of the steady march of consumptive disease that it is to be feared. Many who have bled live longer and suffer less than others who have not. It would seem to be one method which nature adopts to cure the disease, by removing the conges- tion of the lungs which tubercles ever produce. Now, it is true that a person may have consumption, and die with it, and yet never have had the least hemorrhage. Tubercles may be deposited, and soften, and yet cause no bleeding. How- ever, I believe that ninety in every hundred patients do bleed, sooner or later, much or little. " Can a person have bleeding from the lungs, and not at the same time have tubercles ?" is a question often asked of the phy- sician. There are hundreds who, to allay the fears of their patients, speak of this symptom as of but little importance, telling them that the blood raised came from the throat or nose; and that the hemorrhage is caused by some slight irritation. It is possible that some of these men are honest in their assertions ; but quite as likely that many of them are not so. I believe in telling patients the truth in regard to their diseases, and the whole truth. Where hemorrhage from the lungs is considerable, the blood coming rapidly into the throat produces gagging; and thus the patient may think it is from the stomach. Sometimes the blood appears to pass from the nose; but in both these cases we shall observe that the last of the blood is raised by coughing, thus show- ing that ,t is really from the lungs. Patients are apt to be in these cases the worst deceivers of themselves; and too often they seize on some flattering circumstance to preserve their quiet, or even conceal the fact of hemorrhage from their physicians But let it be remembered that bleeding/™™ the throat is a thing that almost never occurs, in any noticeable quantity ; takinff Plac ace of the Lungs and Throat. 57 from the nose, it can easily be determined with a little care ; and when it occurs from the stomach, it gives black, heavy clots of blood, very different from that which comes from the lungs. And let me say to those who have spit blood, I care not under what cir- cumstances, that there are not ten chances in a thousand that it came from any part except the lungs! I am not prepared to say that a person can have true hemorrhage from the lungs, and not have tubercles. I am aware that " bloody expectorations" are common in acute pulmonary inflammations, and in some forms of fever; yet patients may recover in these cases, and never exhibit any disease of the lungs afterward. Females whose " menses" are interrupted, or imperfectly established, fre- quently have a monthly bleeding from the lungs. Again, this may occur at the " turn of life." Now, persons thus afflicted may re- cover ; but in more than half the cases they do not. Most of the instances in which bleeding from the lungs does not positively denote the commencement of consumption or the exist- ence of tubercles have now been mentioned, and it will be seen at once that these instances are extremely rare—they are, emphati- cally, " few and far between." In this city alone, three thousand persons must have bled from the lungs within the last year, and the direct cause in more than twenty-nine hundred has been tubercles in the lungs. I say again. it is a fearful and almost certain indication of the presence of that disease which " cometh like a thief at night." It should ever be regarded with suspicion. And the man or woman who has had this symptom, if health has for such a one any charms, life any attractions, or the world any objects they would not willingly leave so soon, should lose not a day in deciding upon and taking such action as may be necessary to subdue this disease at a time when, if ever, it may be subdued, and that is, in its earlier stages. For certainly it is in the earlier stages that a stand must be made against the inroads of this disease, if it is ever to be made successfully. And yet how often is this opportunity lost! The patient, it is true, applies to a medical man for aid ; but too many have neither the ability to judge between the symptoms they ob- 3* 58 Sanborn on Diseases serve, nor the quick perception to detect symptoms that are pres- ent. When it is too late to afford assistance, the physician cries out, " There is no cure for consumption!" and this is the patient's only satisfaction. Truly, there is no cure for any disease after the health has been wasted and the constitution destroyed. For rem- edies to produce any curative effect, it requires some basis of constitutional power to work upon. Fig. 4. In de ectmg dzseases of the lungs, the instrument most frequently employed by me * Camma^. Stkxhoscop. (fig. 4, «), which I consider LperlTIo any other ever mvented. Sometimes use is made of the common stethoscop wrth a flexible tube (b). The areit a,]™^,^ n* n , . bieinoscoPe> «.el,r one show, in f.j_^. j££££ ™* 2 £"* " face of the chp*t t*, „ • ±i • , - & easny ntted to the sur- bare, the person quie" ^t f^ *" ^ mUSt be C°mPlet^ the trachea and laryL ™ ^ *** bel°W the cla™les> and about The symptoms thus far named are called rational symptoms There - another class of symptoms, generally termed the p^^ OF THK LnNliS AND T II R O A T. 59 of the disease ; but as these require study and practice in order to ar- rive at their true indications, and as this book is written for the instruc- tion of the unprofessional reader, I shall not be able to dwell on the physical signs at the length that would be required to make the subject intelligible. It will be sufficient to say that the air, in passing into and out of the bronchial tubes and air-cells, produces different sounds ; that these sounds are changed in diseases of the lungs ; and that by these changes in the sounds, together with the rational symptoms, the skillful physician is enabled to distinguish more clearly than he otherwise could the different forms of disease of those organs. In making this examination, it is necessary to compare the sounds, as heard on the two sides of the chest ; and thus the diseased, or most diseased, lung is easily detected. Besides this, the effect of percussion, in bringing out a dull or a hollow sound, assists the physician in forming his judgment of the nature of the case. Such is the catalogue of symptoms which attend the first three stages of consumption. They are warnings to the patient that he can hope for no escape, if the disease is allowed to advance beyond the point of virulence it has now attained. Symptoms of the Fourth, or Last Stage.—Here all is plain ! Disease gives full evidences of its ravages. There is no longer a mask of health covering up the decay within. There is no appearence of strong constitutional power resisting the in- roads of disease. The patient sees the end of his way truthfully, but mournfully, presented to his view: on the right or on the left there seems no escape, and hopeless and sorrowful, he at last wraps the mantle of death about him and steps into the tomb! There has been no saving power at hand ; tampered and trifled with, by those who have attempted to alleviate his sufferings, he finds he has but borrowed a delusive hope, and beheld the lamp of life flicker for a moment, only to go out in eternal night! The encroachments of disease have been successful. The lungs, broken down and destroyed, are being actually raised from the throat in softened masses, mixed with fragments of tubercles ! There is apt to be, at this stage, a burning fever, which consumes the body during the day, and this is followed by exhausting and terrible " night-sweats," which drain away the feeble remnant of 60 Sanborn on Diseases strength that is left. Blood now tinges the expectoration, perhaps for the first time. It may be poured forth in quantities, and then the patient feels terribly alarmed; for blood from within always sends a chill to the heart. The poor invalid abandons hope. The symptoms increase in severity as well as in number; the expec- toration becomes thicker and more adhesive, or it has the look of soft cheese, and emits a disagreeable odor; or, again, it is watery, with bodies like kernels of boiled rice floating in it, and of a sweet- ish, sickening taste, or it is yellow and heavy, like pure pus. In the young, diarrhea is often a formidable symptom, and greatly aggravates the disease. This difficulty is liable to give place quickly to constipation, and it is very troublesome in its treatment. ffidema, or swelling of the limbs, is commonly present. If the breaking down of the lungs occurs near the pleura, or covering of those organs, the ulceration sometimes perforates this mem- brane, and the matter is discharged into the cavity of the chest. This difficulty is termed empyema, and it is liable to produce severe inflammation of the pleura, or even suffocation, by pressure upon the lung. Sometimes a collection of water or of air takes place in the cavity of the chest; the former difficulty being known as hydrothorax, and the latter as pneumothorax. Tubercles may form, or water may collect on the brain, resulting in moroseness, aber- rations of the intellect, and stupor. There may be falling off of the hair, great thirst, and hoarse- ness, or entire loss of the voice. The pain produced by inflam- mation of the pleura, whether from tubercles lying beneath it in the lung, or from pus poured into the cavity which it lines, is usually very severe; and often this inflammation amounts to a serious attack of pleurisy, which may be repeated two or three times in the course of the disease. Besides the complica- tions of consumption now named, there are many others, such as ulceration of the intestines, inflammation of the membrane lining the abdomen, fatty deposits in the liver and heart, and, in females, derangements of the function of menstruation; but the reader is referred for further light on these subjects to larger medical trea- tises In conclusion it sometimes happens that, though all these symp- of the Lungs and Throat. 61 toms may make their appearance, and though softening has occur- red extensively in the lungs, yet the tubercles, which are the offend- ing agents, may be discharged; those which remain may become quiet, or even be transformed into harmless chalky masses, the lung may heal by cicatrix, or scar, and the patient, snatched from the very jaws of death, may recover. Such is rarely, however, the fortunate issue of a case of con- sumption. Under the action of the disease the lungs are com- monly destroyed, and by continued suffering the power of the con- stitution is broken to such an extent that recovery is generally impossible. Too often the patient still pleases himself with delu- sive hopes, while the rose-blush grows richer on the cheek, and the death-stroke is stilling the heart; while the fever burns higher, and the " night-sweat" wastes away; while the pulse increases in rapid- ity, and the eyes take a bright, unnatural glare; while the figure becomes a skeleton and shadowless, the flesh flabby and " doughy," and the finger-nails long and curved like birds' talons; while di- arrhea is more importunate, pain pierces the chest, and the features become distorted and wan, until at last the limbs swell unnatu- rally, the patient can no more raise himself to cough, but strug- gles for a breath as for life, growing still weaker and weaker in the useless conflict, and wasted to a living corpse, when the spirit at last takes its flight from a protracted scene of suffering, and the curtain drops on the wreck of another human life! Duration of Consumption.—Dr. Swett, in his work on "Diseases of the Chest," p. 276, speaking upon this subject, says, "The mean duration of phthisis (consumption) has been estimated by a celebrated French physician at about two years, for the class of patients admitted into hospitals. This estimate is probably too favorable. Two thirds at least, of this class of patients, die during the first year, and one third during the first six months of the dis- ease. * * * I have seen the disease in the highest class of society terminate fatally in less than three weeks from the first devel- opment of any symptom." On the other hand he adds : " I have known.a case which was under the care of a medical friend during the long period of thirty-five years, before it terminated fatally from a recent and abundant deposit of tubercles." 62 Sanborn on Diseases It is certain that the^ duration of consumption has been very much shortened even within the period of the past thirty years. This change in our own country is within the recollection of very many now living. Formerly, the disease ran a tedious course of from ten to twenty or thirty years. Now, it hurries its victim to the grave in less than as many months. Yet there are a few cases of the slow form of the disease still to be found; and in almost every community there is some one who has had a racking cough and free expectoration, with all the evidences of consumptive decline, for very many years. I am acquainted with the case of a gentle- man in the northern part of Ohio who has had consumptive cough and expectoration, constantly, for the last fifty years, and who seems no nearer the grave now than he did a score of years ago. But for one such instance a hundred can be named who have coughed through but a single winter, and whose graves have been covered with the first verdure of'the opening spring. It is not my object to attempt to account for this remarkable change in the general character and course of a widely prevailing disease, but simply to call attention to the fact. The deductions that should be drawn from this fact by the consumptive invalid are too obvious to need mention. ON THE DIAGNOSIS OF CONSUMPTION. By the diagnosis of this disease is to be understood the means of distinguishing it from other diseases, which resemble it in some of their symptoms. It is a matter of the greatest importance to the patient to know whether his difficulty is in fact consumption, which implies a deposit of tubercles into the lungs, or at least that the blood contains the elements of such a deposit, or whether he has a throat-disease, bronchitis, or tonsillitis, asthma, chronic pleurisy, or rheumatism. Any real knowledge on these points is ever of interest. I have often been astonished at the incapacity of physicians who thought themselves quite capable of determining the presence of this disease, and of distinguishing it from other affections of the same parts. The mistake most commonly made is in asserting that consumption is not present when it does actually exist OF THE LUNNS AND THROAT. 63 and calling it by the milder name of bronchitis, or disease of the throat. By this course, if the patient has confidence in his physi- cian, his fears are somewhat allayed; and he is too apt to neglect the means and the time for a cure, while the secret enemy steals slowly, but too surely, into the vitals of his victim. Now, if the physician is not capable of judging whether a per- son has consumption, bronchitis, or throat-disease, and can not dis- criminate the one from the other, he may do the patient a fatal wrong if he attempts to express an opinion, either one way or the other. Let him honestly confess his ignorance of the matter, and recommend the patient to one who understands the subject, if he knows such a one. But let him not wrong himself and his patient bv trifling with a disease of which he knows perhaps little more than the untutored savage who roams the forests. He may be unaware a daily murderer—adding to the long catalogue of those who too soon go down to the tomb—digging the graves and erect- ing the monuments of those whose lives should have been saved ! As a general rule, it may be laid down that those who received their medical education twenty or more years since belong to the old calomel, bleeding, and blistering clique, and know little of the means of distinguishing or treating consumption. Age is generally associated with wisdom ; but it is to be feared there are exceptions to the principle. Almost every medical man, whether he be old or young, wise or simple, will be found to have great confidence in his own discriminating powers in regard to this disease, particularly if he be surrounded by industrious rivals. Doctors are too liable to disagree; and while the poor patient is vacillating between opposing theories, death steps in and the dispute ceases. It is to be feared that physicians are, as they ever have been, ready to make professional capital at the expense of their patients. I pro- pose therefore, to lay down such rules as will enable the patient to judge to a good degree, of the nature and character of his own disease. Few persons, I think, can have a disease of the lungs or throat without knowing the fact. The symptoms of these difficulties are very well and generally known. But these symptoms are often supposed to have their origin in the condition of other organs; and 64 Sanborn on Diseases it is very common with both physicians and people to refer them to the liver or stomach. These two organs have charged to their account more infirmities than are justly their due. "Liver com- plaints" and "dyspepsias" grow common just in the same propor- tion with ignorant physicians and credulous old ladies! I wish particularly to impress it upon the minds of patients, that it is sim- ply a, popular error that consumption is likely to be caused by dis- eases of the liver and stomach. In a large majority of fatal cases of consumption the stomach is found to be the most healthy organ in the system, and this is a wonder when we consider the amount of so-called " medicine" that is poured into it. The lungs exert a more important influence upon the stomach than the stomach on the lungs. Cough and irregularity of breathing may be produced, once in a thousand cases, by disorders located in the stomach. I have seen, in the case of a strong, fleshy girl, a severe cough produced purely by hysteria, and which lasted in spite of treatment for a long time. Let the patient bear the fact in mind, that when there is a cough which has continued for some time, with or without expectoration, shortness of breath, pain in the side, and wasting of the flesh, the difficulty is in the lungs or air-passages. Now that this cough proceeds from the tubercles in the lungs can not be definitely and certainly known to the patient, and he can only judge of the fact from various attending circumstances. Sometimes tubercles are coughed up in fragments, resembling pieces of cheese. These should be distinguished from the round yellow masses coming from the mucous surface of the throat, which are comparatively harm- less. But when whitish or yellowish masses of an irregular or broken shape are expectorated, floating in thin or heavy mucus, there can be no doubt that the substance is that of tubercles, nor that these are deposited in the lungs. Such expectoration is not, however, a common occurrence. If the symptoms above described appear and continue for some time in a person, who has reason to believe that he has inherited a tubercular tendency, it may be considered as almost a certainty that tubercles are being deposited in the lungs. To the patient under such circumstances I would say, " Do not deceive yourself— of the Lungs and Throat. 6'5 do not suffer yourself to be deceived—into the belief that your dis- ease is simply bronchitis, or disease of the throat, and that there need be no fear ! It matters little if either or both of the latter diseases do exist, for a deposit of tubercles can hardly take place in the lungs without producing one or both of these complaints, in connection with the symptoms proper to tubercles themselves. Bronchitis may exist without consumption ; but consumption with- out bronchitis, almost never." When the throat is affected, the symptoms are usually soreness, and redness immediately back of the tongue; and this often in- volves the vocal chords, producing an alteration in the natural tones of the voice. Sore throat is one of our most common win- ter complaints; and few persons escape it. When sore throat is not symptomatic of consumption it usually passes off in a few days; although it may seat itself on the tonsils, and then may continue for weeks, affecting the voice to some extent and interfer- ing with swallowing. In either case it is apt to be accompanied with cough and difficulty of breathing. If the person attacked has been previously in good health, hav- ing at no time manifested disease of the lungs, the disease appear- ing suddenly and with considerable severity at the first, and grad- ually subsiding, as in the case of a " cold," it is very certain that the difficulty is confined to the mucous membrane of the throat or windpipe. Sometimes this difficulty takes a chronic form ; cough, expectoration from the throat, and slightly labored breathing being present, but with little or no wasting of the flesh. I have known hundreds of persons who had these symptoms during an entire winter, but disappearing at the approach of spring, and re-appear- ing at the return of cold weather. The disease in these instances may be local, and confined to the throat, the lungs being mean- while healthy. I have known many inexcusable blunders committed by physi- cians who have pronounced the lungs seriously diseased from the simple fact of a shortness of the breath. Now this symptom alone is utterly worthless in deciding between diseases of the throat and those of the lungs, for the physiological reason, that in- flammation of the lining membrane of the throat (that is, of the 66 Sanborn on Diseases rima glottidis) always lessens the natural diameter of the orifice by producing swelling and thickening of the parts, and thus preventing to a certain extent the free ingress of air into the lungs, no matter how healthy the latter organs may be. Nature, ever provident in time of emergency, increases the number of respirations, in order to compensate for the loss of air in each inspiration. I have known blisters, and croton-oil sores that ulcerated even to the ribs, produced upon the chest to relieve shortness of breath, in the idea that the difficulty was in the lungs ! Let me repeat, that shortness of breath does not in itself indicate disease of the lungs. Disease of the throat (rima glottidis) is but too often mistaken for consumption, and is cured by a local application, which is in fact the only satisfactory and rational mode of treatment. The success attending the local treatment of this disease points as an index to the true method of treating the same form of disease when located farther down in the bronchial tubes. I may say of throat-disease what has already been said of bron- chitis, namely, that although a disease of the throat may exist without consumption, yet in nine cases out of ten where consump- tion is present, the throat will be found at the same time more or less diseased. is consumption curable? No doubt exists in the minds of the best pathologists of the day, nor among physicians who have had the largest opportunities for observation, in regard to the certain curability of consumption. It is true that we find this fact asserted by some medical writers and others, whose testimony we are compelled to receive with a great deal of caution, from the fact that their observations have been made upon the cases of patients medicated according to the old plans of treatment, and therefore of all that occur the least likely to be blessed with a perfect recovery from the disease. Such phy- sicians, in maintaining the curability of consumption against a large body of their professional brethren, have without doubt been driven to record as evidence cases which, in themselves, are of very questionable value, such as instances of convalescence from protracted and severe colds, bronchitis, and the like. Such "false facts" are not rare, by any means, in medical science; and they of the Lungs and Throat. 67 would be particularly likely to accumulate a few years since, before the discovery of auscultation and percussion was made to aid the really inquiring physician in distinguishing consumption from all other diseases, no matter how closely resembling it. But, making all necessary allowances for the results of incorrect observation, there are still numerous and well-authenticated in- stances of recovery, which prove beyond a question the cheering fact that consumption is, and can be, cured. Such instances are within the memory of almost every physician and careful observer, and that even after all the symptoms of the disease were present, and after ulceration and breaking down of the lungs must have commenced. Yet such recoveries do not take place as the result of drug medication, but, as really candid and well-informed mem- bers of the medical profession have always been free to confess, "in spite of the medicines" used. They will be found to be, in most instances, the fortunate but perfectly natural results of the laying aside of drugs and other bad habits, of taking up a life of activity in the open air, and adopting the generous use of nutritious, blood-forming food. Thus they are examples of the "healing power of nature," acting unassisted and alone; and they are illus- trations of what might be accomplished by the aid of a suitable course of treatment, in the cure of a much larger proportion of all the cases of this dreaded disease. There are many so skeptical in regard to the curability of this disease, that they are in the habit of saying in every case of re- covery, " If the patient has got well, then he did not have consump- tion." Such persons, by a gratuitous assumption, have placed themselves entirely beyond the reach of argument, and we can not of course expect them to be convinced. According to the same authorities, cancer is never cured; and the fact of recovery is the strong point in their diagnosis that the disease could not have been cancer! Now, besides the glaring absurdity of supposing that any form of disease whatever must be universally and absolutely incurable, those who take such ground should be capable of perceiving that, in placing themselves where they do, they stand in their own light by assuming the very point to be proved. And it would not be 68 Sanborn on Diseases surprising to learn that they are driven to make this assumption by the entire want of evidence under which they must of necessity labor. And yet, while I would be far from allowing my name to stand among those of the positively skeptical on this point, I am equally averse to being classed with those empirics, in this' city and else- where, who, for the sake of gain (for surely no other motive could induce men to falsify the truth in a matter of so much moment to the afflicted), give assurances of a speedy and certain cure to all indiscriminately who come to them for examination or advice; and who would bid the patient "be of good cheer," and rely im- plicitly on the virtues of their vile compounds to effect a cure, even though the lungs were full of open abscesses, and the powers of life were like the wasted lamp flickering in its socket, before it expires ! I warn patients against trusting with their lives those who thus hold out prospects of a cure in every case, no matter how desperate the symptoms that may be present. Fortunately, the good sense of the people can not long be blind to the springs of such " zeal without knowledge." But, on the other hand, we have the testimony of some of the brightest lights in the medical profession, and among them the most distinguished writers on pathology, to the fact that consump- tion is curable—not in all cases, but in some ; and in very many, it may be added, if the treatment employed be rational and in accord- ance with the indications of nature. Among the authorities which may be cited in favor of the curability of consumption are such names as those of Laennec, Louis, Andral, Carswell, Watson, and in America those of Rush, Eberle, Dunglison, Wood, and Swett. The London Lancet, the British and Foreign Review, and many other medical publications of the highest character, have taken the same ground. The authorities here presented are very high, and their testimony is clear and unanimous. They are men who have been actuated by no selfish motives in making the declaration, but by a be- nevolent wish to secure the good of the race. Yet I am sorry to add that we must, on the very score of their exalted benevolence, make some deduction from the very confident assertions of the of the Lungs and Throat. 69 curability of consumption which they have left us. Not that I would argue that consumption is incurable, for such is far from being my belief. But I am convinced by actual observation of the course of this disease under all forms of treatment, and under no treatment at all, that when the disease has advanced to its last stage, the proportion of cases cured is not so great as that stated by the authors whose names I have given. But it will be well to inquire by what means, and from what con- dition, a cure is possible. First, then, the medical authorities whose names we have given do not claim that consumption is curable by the use of medicines given by the stomach. The hope of the profession, in consumption, has long been confined to the known tendency of unaided nature often to work a cure where all medication has failed, to a change of climate, to strict employment of pure air, vigorous exercise, and a supporting diet, or to those " fortunate accidents" of which every physician can detail instances that have come under his observation. If consumption has been cured, it has not been by the power of medicine; for it is absurd in the nature of the case to suppose that by acting on the stomach or the blood we can affect tubercles that have long since passed beyond the reach of both the stomach and the blood! Secondly, the cure of consumption, when it takes place, can not be by the restoration of parts that have been lost. If a portion of either lung has been destroyed by ulceration, and spit up as it must be, in that case, in the expectoration, it can never be reproduced again. The substance of the lung once destroyed, can no more grow again than an arm after amputation. All that has been lost by the disease remains lost; and as this may be an entire lung, or a large part of both, it may follow in such cases that the patient must gradually perish for want of breakeven though all the tubercles in his lungs might have been previously removed by expectoration. There are instances, however, in which it is prob- able that life is sustained by the use of one lung alone for many years, the air-cells of this lung probably becoming enlarged after the destruction of its fellow. Thirdly, I have reason to doubt whether cavities of considerable 70 Sanborn on Diseases size, once formed in the lungs, are ever healed. Cavities of small size may close up, and of this we seem to have evidence in the scars found in the lungs in many post-mortem examinations. Yet I am inclined to believe that many of these supposed scars, instead of being in the substance of the lung, are really situated on its sur- face, and are instances of adhesions and contractions of the pleura covering that organ. These contractions may be produced by inflammation or irritation of the lung, independent of tubercles; and they are present in a large majority of all the cases in which examination is made after death. But although larger cavities are seldom, and perhaps never healed, yet it seems very certain that the discharge from them may in great measure cease, the cavity may diminish in size, its sides may become healthily moist, or dis- charge very slightly, like an old ulcer upon the limb which almost heals; and if in this condition the patient takes sufficient air and exercise with nutritious food, and other crops of tubercles do not ulcerate, life may be prolonged with a good degree of comfort and strength, and that for many years. Fourthly, tubercles are never absorbed. This is certain from the facts that few, if any, absorbent vessels can be formed in the lungs, and that tubercle once deposited so soon takes on a solid form, and its material becomes of so heavy and dense a nature, that a return into either absorbents or blood-vessels becomes impossible. Finally, there is abundant evidence that tubercles in the lungs may remain dormant or asleep for many years, in some cases through an ordinary lifetime. They are there, but the particular circumstance or combination of influences not occurring to call them into activity, they remain passive, and, if not very numerous, produce no sensible effect on the general health. Besides, as we have seen, tubercles may sometimes soften and be discharged with- out producing large cavities, and the lung may regain a healthy state. And again, there is a transformation of tubercles that some- times takes place in the lungs, and by which they are rendered en- tirely harmless. This fortunate change is a conversion of the tubercles into small round lumps of a chalky material, which, strange to say, no longer irritate the lungs; and hence this may be consid ered as one of nature's methods of curing tubercular consumption. of the Lungs and Throat. 71 For myself, I am prepared to affirm that consumption is curable. Not that we can as certainly predict a cure in every instance as in many other diseases, but if the right treatment be commenced at an early enough stage of the complaint, and the patient be sub- jected/to the right influences, in connection with the many ways in which, as we have seen, tubercles may be removed or rendered harmless, the chances of a cure are very considerable, and they should encourage the patient to unremitting and judicious endeavors to secure the return of health. The error of treatment in the past has been first, in the means, and secondly, in the mode. When the former have been correct, the latter has been erroneous; and more commonly both have been so at the same time. But consumption is better understood now than it was a few years past, although it is true that all con- troversy respecting the disease is not yet settled*. I have been thus explicit in regard to the curability of consumption, in order to show the solid ground of facts on which I base the hope of success under a rational system of treatment. The reader is thus pre- pared to enter understanding^ upon a consideration of this treat- ment and its results. €\it €mtmtnl nf Cnwrnptinti. In the preceding chapters I have carefully described the office of the lungs, the composition of the air and of the blood, and the in- fluence of certain agencies in altering or deranging the action of the lungs. I have considered also the causes, symptoms, and mortality of this disease, and have examined the question of its curability. I proceed, next in order, to speak of the means adapt- ed to its alleviation and cure. That consumption is a curable disease, the most eminent patholo- gists of the day allow; but the means whereby a cure can be effected have proved the stumbling-block that has rendered their teachings futile. The whole Pharmacopoeia has been searched— medicines of all varieties and of every degree of strength have been 72 Sanborn on Diseases administered, voyages to all parts of the world have been ordered and made—the sunny isles of the Indies have received their thou- sands of invalids, anxious for a cure; Florida, with her pleasant promise of flowers and orange groves, lakes and mountains, valleys and seas, have all been invoked to the aid of the physician; but, alas! to no purpose. Death has been the great remedy in the end ; and the same sad tale has been told and re-told for centuries. Parents have seen their idols snatched from them, and no hand was nigh to help. The orator, with his commanding influence and greatness of purpose—the poet, wearing his laurel wreath and crowned with immortal honor—the poor student, haggard and pale from his books, pored over by "the midnight oil"—the humble sewing girl, who with dimmed eyes has worked the health out of her frail body—the bright beauty that flashed, meteor-like, through halls of pleasure, her cheeks flushed with the hectic hue of a smold- ering fire—the miser, moping and clutching his yellow hoard with a hand of vice-like strength—all, all have sunk before the march of dread consumption! The warrior, who withstood the fiercest charge of a living foe, has fallen when consumption laid its bony hand upon him. There has been no help for the dying—little hope for the living, when the fearful sentence had been once pro- nounced. The family circle has been broken, the chain of love sundered forever; the stricken ones linger and hope, but onward they must still move, to swell the catalogue of death! And yet medical science is not wholly unprogressive ; something is added each year to its curative means and measures. I think that in this chapter I shall be able to convince the world that the remedies for consumption have always been at hand; but in the mode of combining and administering them has been the fatal error. In this has consisted the great want of knowledge. In my opinion there is no disease for which remedies may not be found; and certain I am that, like all other diseases, consumption can be cured. To the patient, procrastination is a fatal error. Time is life ; and life is everything. The first cough, the first symptom, is the alarm-bell of approaching disease, and bids the patient beware ere it is too late. How often have patients come to me who have been almost drugged to death, who have lived on cod- of the Lungs and Throat. 73 liver oil, who have sailed to distant lands, have spent a fortune, and at last, when it was too late for assistance, have come home to die! I shall lay it down as an axiom in the outset, that a direct appli- cation to any diseased part, of suitable remedies, must of necessity act more efficiently to control and remove disease, than those means which are applied to and expend their energies on remote parts. Consumption is a local disease—a disease having its origin in a deficiency of the air-cells of the lungs, and having its seat also within and immediately about the air-cells. Yet we find that physicians have continued, year after year, to pour medicines into the stomach, in the hope of thereby reaching and curing diseases of the lungs. It is well known that the blood becomes impure in consequence of breathing an impure atmosphere, or of partial clos- ure of the air-cells, preventing the proper purification of that fluid. But the blood that has become impure by reason of bad air or im- perfect lungs must certainly become pure by means of wholesome air and vigorous lungs, or not become pure at all. In fine, it is only by enlarging the air-cells, so that they may admit more air, by invigorating the lungs, by dissolving those tubercles which fill a portion of the air-cells, and then by furnishing to those organs a pure air, and supplying healthful, nutritious blood, by means of proper food, that we can hope to cure consumption. And independently of proper air and food, it is evident that all the results to be aimed at for the cure of this disease are best secured by the inhalation of suitable remedies, thus bringing them to act directly on the parts diseased. Are not the diseases of the eye treated by local application 1 Are not external injuries treated with promptitude and success? And why, but that we are able to make our applications of remedies directly to the parts involved in the difficulty. How strange, then, that we persist in introducing medicines into the stomach, in the hope of curing diseases in the lungs! I object more strongly to the method of using the remedies employed for these diseases, than to the remedies themselves. Many of the remedies possess virtues of the highest importance, but they have been sadly misused. 74 Sanborn on Diseases And how easy it is, by the use of a suitable inhaler, to bring the proper remedies into the lungs themselves, and in direct con- tact with the seeds of consumptive disease, and with the surfaces that are inflamed by their presence ! Fig. 5. The Inhaler: Method of Inhalation.—In the method of inhalation which I have adopted, the articles to be inhaled are first dissolved in pure deodorized alcohol, and diluted to the proper point with the same fluid. The inhaler (fig. 5) consists of a small glass globe (a) with two openings, to one of which is attached a flexible tube (b) with an ivory mouthpiece (c). A fine sponge, moistened with about two teaspoonfuls of the liquid to be used, is introduced into the globe of the inhaler. The patient inhales through the sponge successive inspirations of air, which has become perfectly saturated in its passage with the vapor employed. From five to fifteen or twenty slow, deep, and full breaths are thus drawn, each being retained a short time before expiration. The strength of the vapor can be perfectly regulated for each case; and it is uniform through each period of inhalation. The inhaler now described is entirely new, both in principle and in details. It is convenient, and may be carried in the pocket, to be used when walking, riding, or traveling. Its greatest excel- lence, however, consists in the fact that the vapors inhaled through of the Lungs and Throat. 75 it always enter the lungs at the natural temperature of the sur- rounding atmosphere. The medicinal vapors coming in contact with the lungs are thus neither cold nor hot, but of the same tem- perature (whatever that may be) with the air which the patient is breathing at the time. Hence these vapors have their full effect medicinally, without being liable at the same time to weaken or irritate the lungs by unnatural coldness or heat. And this is a great point gained, as every reflecting mind will at once perceive, in the treatment of all pulmonary diseases. It is a point which has never before been attained, or if attained, has never become known to the profession and the public. The advantages of this method of inhalation in almost every instance, over that by hot water, must be at once apparent. This method gives us the ordinary process of breathing, with the addi- tion of stimulating, soothing, or healing qualities to the air in- spired. For proofs of the efficacy of this treatment, if any are desired beyond the rationality of the method itself, the reader is referred to cases reported in this book, and to the testimony of hundreds of physicians throughout the country who have witness- ed or tested its success. General Indications of Treatment.—From the views which I have laid down respecting the causes of tubercular con- sumption, and the manner in which these causes act to produce tubercles, and finally ulceration of the lungs, it will be seen that when the ytage of breaking-down has occurred, the oxygen of the atmosphere is combining too rapidly with both the lungs and the fatty and other tissues of the body. So surely, then, as we can introduce into the system a sufficiency of combustible material, or carbon, in a volatile form, for which oxygen shall have a greater affinity than for the tissues of the body, while at the same time vapors which possess solvent or other medicinal powers, according to the state of the diseased parts, are introduced into the lungs, so surely can we stay the destructive progress of consumption. And this, as I shall proceed to show, can be done. The three main' features of my treatment are, therefore—first, that the remedies on which I rely chiefly for a cure, are applied directly to the seat of the disease; secondly, that no drugs are pre- 76 Sanborn on Diseases scribed or allowed to be taken into the stomach ; thirdly, that in the later stages a free supply of carbon is constantly introduced into the system. And a further principle which is never lost sight of, may be stated in three words : support, not reduction. Two objects are kept constantly in view: first, such remedies are used by inhalation as by their chemical affinity for the sub- stance of tubercles, help to dissolve these bodies, and so favor their removal by expectoration ; secondly, measures are adopted to pre- vent the further deposit of tubercles. That alcoholic vapor will act upon the matter of tubercle as a solvent, there can be no doubt when we consider the chemical na- ture of the two substances. And besides, when the substance of tubercle is placed in alcohol, a gradual solution of it really takes place. To prevent the further deposit of tubercles, I rely upon increas- ing the capacity and power of the lungs by the mechanical effects of inhalation, upon the stimulating effects of the vapors inhaled, and upon the invigorating qualities of a generous diet, combined with active exercise, pure air, and the use of alcoholic drinks. The Remedies Employed.—The vapors prescribed in my treatment are chiefly of four kinds—expectorant, anodyne, astrin- gent, and asthmatic; of each of which there are different varieties, to meet the indications of particular forms and stages of pulmo- nary disease. To give special directions in this place for the use of these vapors would occupy too much space ; and besides, this can not well be done, except in the particular cases, as they present themselves. For the inhalation of these vapors, pure deodorized alcohol, as already mentioned, is the menstruum invariably employed. The advantages of this medium are many. In the first place, alcohol is more volatile than hot water, and those substances which it dis- solves are more easily volatilized than any aqueous solution can be. Besides, alcoholic vapors are lighter, and more easily penetrate the air-cells of the lungs. Alcohol is itself of such a nature as to act as a solvent for tuberculous matter, and it is one of the best forms in which carbon can be introduced into the system. And finally, there are many substances which are valuable when used by in ha- of the Lungs and Throat. 77 lation, but which only imperfectly yield their virtues to hot water, while they are perfectly soluble in alcohol. Among the remedial agents administered in the form of vapor, in connection with the vapor of alcohol, are the following: nitric, benzoic, acetic, and tannic acids; the oil of bitter almonds, the tinctures of tolu and sanguinaria, Donovan's solution, spirits of ammonia, gum camphor, arsenic, balsam of fir, creosote, and chlo- roform. Among these articles I have found the vapor of dilute nitric acid to be, in cases of advanced consumptive disease, the most potent and effectual. Indeed, the same may be said of this agent in almost all forms of pulmonary and throat diseases; and this is, accordingly, my chief reliance in inhalation. The solution em- ployed is from twenty-five drops to one drachm of the officinal acid to from six to eight fluid ounces of alcohol. The employment of nitric acid in the way of inhalation I believe to be entirely new. The benefit derived from the nitrate of silver, used as a caustic, constitutes a strong argument in favor of the nitric acid, since the cauterizing effects of the nitrate {lunar caustic) are undoubtedly due, to a great extent, to the acid contained in it. This opinion I have verified in practice, by obtaining more marked and successful results from the application of dilute nitric acid to ulcerations of the throat, than from the popular caustic, the nitrate of silver. Thus, by the inhalation of nitric acid vapor, I introduce to the surface of cavities in the lungs the same caustic applications that I find most effectual when applied to an ulcerated throat. It will be acknowledged by the candid reader, I think, that the mode of treatment here laid down is not mere routine. As carried out by me in the New York Lung Institute, it applies to each case remedies adapted to the particular form and stage of the disease present. Nor do I claim that local remedies, necessary as they are, will alone effect a cure. The " vis medieatrix naturae" (heal- ing power of nature) is the great reliance of every intelligent phy- sician • and in applying remedies locally, -I only claim that they are such as to aid in the very work which nature is striving to perform. Hence active treatment of any kind is not the sole reliance of my system of treatment. The cases here presented are, almost 78 Sanborn on Diseases without exception, those of a long-standing chronic character, and in tuberculous subjects, too often in the last stages of the disease. In all these cases, I insist particularly on hygienic measures, such as the free use of active exercise, pure air, and a nourishing and generous diet. In a disease so wasting and debilitating as consumption, a large supply of the nourishing principles of food must be furnished to the patient, in order to sustain the strength, and to assist Nature in her struggle against disease. I accordingly advise the free use of beef-steaks and brandy, and such other highly supporting forms of food as are in general use. In regard to the efficacy of brandy and other spirituous liquors I shall speak in a separate section devoted to that subject; but in support of their use I may here call attention to the facts, that very few habitual drinkers are ever found to die of consumption, or upon examination made after death, to exhibit tubercles in the lungs. I take from the excellent treatise of Pereira on " Food and Diet," the following list of highly nutritious articles of food, in accord- ance with a promise given in a previous part of this work. The really nutritious part of food (that which goes to furnish blood and muscle, and not that which supplies carbon for the fuel of the sys- tem) is supposed by the physiologists of our day to consist of the following substances: fibrin, albumen, and casein. These are to be met with in the articles of food below named, and in the proportions given in the table : In Beef...........20 parts in 100 " Mutton........22 " " " Pork...........19 " " Chicken........20 " "Eggs..........17 " " Codfish........14 " " " Cows' milk ..... 5 " " " Goats' milk___ 4 " " "Cabbage....... 8 " in 1,000 In Wheat flour .. 9 to 25 parts in 100 "Rye........ 8 to 10 " " Oatmeal___14 " " " Peas & Beans 14 to 22 " " "Rice........ 4 " " " Indian corn... 3 " " " Potatoes___ 3 " " "Beets....... li « " " Onions(dried) 25 " " Lobsters, oysters, and other shell-fish are also highly nutritious. Some of the articles named in the table are not desirable food for the consumptive, on account of their indigestible character. Among these is pork; and from the fact of its tendency to pro- F of the Lungs and Throat. 79 duce scrofula it should be wholly discarded. The most eligible forms of food in the above list for the consumptive invalid are, beef and "mutton, when lean and tender; chickens, oysters, and eggs; milk, if it does not occasion fever ; bread, home-made, and not too stale ; beans, potatoes, and onions. Vegetables can not be entirely dispensed with, from the fact that, although not so nutri tious as flesh and eggs, their use helps to keep the stomach and blood in a good and vigorous condition. When we consider the unfavorable character of the cases on which this system has of necessity been tested, and those who have tried the whole round of the prevailing modes of treatment without benefit, and often with direct injury, we shall be prepared to appreciate the merits of a system so often successful (as the cases yet to be reported will show) in arresting the progress of consumption, and restoring the invalid to a state of health. The fruits of this method of practice are the most unanswerable argu- ments in its favor. It will be seen that the remedies employed by me in the treat- ment of this disease .are numerous; and it may be added that they are never prescribed- without a full understanding of the his- tory of the case presented, nor otherwise than in strict accordance with its symptoms. In the early stages of consumption, and before softening has occurred, inhalation and the other agencies already named are employed with some modifications. The vapor of arsenic is pre- scribed, and also that of nitric acid, but of less strength than in the later stages. The chief reliance at this period of the disease is, however, on the constant inhalation of alcoholic vapor from a sort of jacket worn upon the chest, and kept constantly wet in diluted alcohol, day and night. Dr. Marshall Hall, who has given to this application a persevering trial, is very enthusiastic in its praise, and declares that he has witnessed greater benefits from its use in the early stages of consumption than from all other remedies com- bined. Alcoholic drinks are also recommended, but in more mod- erate quantity. Active and thorough physical exercise is insisted on, and no internal use of drugs is allowed. A generous diet is ree- ommended, with the rejection of all forms of fat. 80 Sanborn on Diseases I have thus laid before the reader a brief view of the principal features in the treatment I have adopted in the various diseases of the lungs and throat. This treatment I have, up to this time, applied in hundreds of cases, and with the most gratifying results. It is a mode of practice which relies on remedies acting in har- mony with the known laws of human physiology ; and it is not strange, therefore, that a more marked success should attend its use than has fallen to the lot of any previous method of treatment in these diseases. It has been seen that the remedies named are such as aim at a radical cure, instead of being, as too many pretended remedies have been, mere palliatives; and yet, where the relief of urgent symptoms is required, or palliation is all that can be hoped for, the medicated vapors, properly modified and applied, prove to be all the physician could desire. Every needful effect, too, ordina- rily sought by means of medicines introduced into the stomach, ^;an be much more directly and satisfactorily secured by the inha- lation of the medicated vapors. Thus, an expectorant, anodyne, stimulant, tonic, astringent, or relaxant effect is directly and speed- ily obtained, without the delay consequent on the passage of med- icines from the stomach into the blood. dDf akmtrjntt*. Bronchitis is, strictly speaking, an inflammation of the lining membrane of the bronchial tubes, and hence has its seat within the lungs. It is nothing more nor less than a " cold on the lungs," a complaint which is very common in winter and spring in tem- perate climates, so much so that few persons escape without hav- ing one or several of these attacks in the course of the cold months. Thus the disease is simple in itself, and from being common is generally well understood. The nostrils, the throat, the windpipe (or trachea), and bronchial tubes are lined throughout by one continuous membrane, similar to that which may be seen lining the inside of the mouth ; and it is of the Lungs and Throat. 81 this large extent of membrane that is almost always the seat of a " common cold." When as we say the cold settles "in the head," the difficulty is called catarrh; when it affects the upper part of the throat, and especially the tonsils, it is termed quinsy, or tonsil- litis; if seated upon the lining of the larynx, or upper part of the windpipe, it is known as " sore-throat," or laryngitis; occupying the lower part of the windpipe, tracheitis ; and when confined to the lungs, bronchitis. Yet it is very common to term the disease bronchitis, even in cases where it extends throughout the throat, windpipe, and lungs. My subject in this place is bronchitis; the other diseases named will be described subsequently. The first symptom of a cold seating itself on the throat or lungs is generally a sense of chilliness, or perhaps a severe chill, attend- ed with sneezing and cough, and with a feeling of dryness in the nose and throat, and followed by more or less fever. The natural secretion from the membranes involved is checked at first; and hence the sensation of dryness. If there is cough at this stage, it also is " dry ;" that is, there is no expectoration. There is often at the same time a feeling of heat and soreness in the throat. But soon the inflamed membrane begins to throw off an increased amount of secretion, at first a thin, acrid fluid, or a tough and transparent mucus which can not be dislodged without severe coughing. After from four to seven days the expectorated matter begins to change to a yellowish and heavy appearance, owing to the fact that it is now mixed with pus, or " matter," which forms and is raised freely during what is called the " breaking up" of the cold. The cough is now said to be " loose;" and with proper care the disease generally progresses favorably from this point, and in from one to three weeks the patient is restored to his usual health. In this complaint there is seldom much pain in the chest, unless it be a feeling of dull pain or soreness after severe coughing. Owing to the inflammation present, however, the lining membrane of the parts involved swells or becomes thickened, and by this swelling, as well as by the collection of mucus in the smaller bronchial tubes, many of the air-cells become closed. Hence the shortness of breath that often attends this disease; while if the patient attempts to relieve this by taking a full breath, the swelling 4* 82 Sanborn on Diseases rl of the membrane obstructs the passage of air, and the difficulty may thus resemble a severe attack of asthma. It is by this closing of the air-cells with mucus, as I have elsewhere explained, that an attack of bronchitis, especially if long continued, often produces in the end a deposit of tubercles in the lungs. In the acute form, bronchitis seldom proves fatal, unless from improper treatment; except in the case of very young children, who can not always clear the lungs by expectoration. No disease is more liable, however, to become chronic; and in the chronic form it may continue for years, giving place on any slight expo- sure to an acute attack, or finally growing unmanageably severe, and ending in death. In very old persons this result is particularly liable to occur, the disease being attended with excessive expec- t#ration of a watery or frothy mucus, which finally accumulates until the patient is literally strangled by it. The causes of bronchitis are well understood. Exposure to se- vere cold or to a draft of air, wet feet, and various excesses, are the most frequent. Other diseases may produce or favor an attack of bronchitis. Such are some heart-diseases, dyspepsia, but espe- cially tubercles in the lungs, as has been already explained. The treatment of bronchitis is simple. In the acute form of the disease, food and exercise should be almost entirely laid aside. Thus no more fuel should be added to the fire, and it will burn more quietly, and go out the sooner. The inhalation of the vapor of warm water proves beneficial in this stage, by soothing the in- flamed surfaces of the bronchial tubes. But evidently the best way to cure a cold is to take no addition to it, to preserve quietness, and to keep down inflammation by eating little. w Chronic bronchitis, however, requires a thorough and energetic course of treatment. In this form of the disease the inhalation of the " medicated vapors," suitably modified, proves efficacious and satisfactory. Pure air, exercise, generous diet, and cheerfulness are necessary auxiliaries. Long-continued bronchitis is always a source of danger. The membranes go on thickening under the influence of continued in- flammation ; the air-cells become more and more obstructed ; the blood consequently is not properly purified; an excess of carbon is of the Lungs and Throat. 83 retained in the system; the complexion becomes pale or livid; the strength fails; feverishness toward evening or in the night becomes a common symptom, and this may be followed by hectic and " night-sweats." All the conditions necessary to the production of tubercles are present, and in the end a deposit is very certain to take place, and consumption is the finale of a scene of suffering. Thus we have seen that bronchitis may be merely a symptom of consumption ; and that where the latter disease does not exist, the former almost certainly establishes it. The importance, therefore, of giving early attention to a chronic cough, of whatever nature it may be, is always pressing. Patients are often deceived by their physicians, perhaps innocently, into the belief that their cough is merely a "stomach-cough," or arises from irritation of the liver. But let such remember that the stomach never coughs, nor does the liver. The lungs only cough, and when cough is present one of three conditions must exist to account for it. Either the lungs themselves must be diseased, or the difficulty exists in the throat, and the lungs are affected through sympathy (and in the end they are almost certain to become dis- eased themselves, through the same medium); or, lastly, as all organs are more or less under the control of the. nerves, in a very few cases the cause of cough may be wholly in a disordered state of the nerves, and the patient may have what should properly be termed a " nervous cough." This will chiefly be found to be pres- ent in the case of hysterical females; and yet even here it may be associated with an actually diseased state of the lungs. The simple lesson which we learn from all the facts that can be brought to bear on this important subject is, never to rest quiet under a continued cough. Innocent as it may appear, we can with no more safety allow it to linger about the seat of life, than we could with impunity harbor an assassin in our bed-chamber or cherish a viper in our bosom! 84 Sanborn on Diseases ur pamphlet on application, I take the liberty of asking you for a copy. Having, to some extent, tried inhalation, and becoming satisfied that the cold inhalation is every way preferable to that by hot water, I would be obliged to you if you will forward to me the price, per dozen, of your inhalers. Your early attention to this will oblige, Yours truly, C. G. M'Knight, M.D. Milledgeville, Geo., Oct. 2±th, 1855. Dr. G. D. Sanborn : Sir—I have read a series of letters written by you on Inhalation, and also the letters published by Drs. F—h and II__r. Your views strike me forcibly, and [ am impressed with the idea that your plan of treatment is the best. Please send me the pamphlet of the Lungs and Throat. 113 which you have announced, as I wish to inform myself more care- fully in regard to the use of the cold, medicated vapors. I am, sir, yours most respectfully, S. Russell, M.D. Burns' Depot, Alleghany Co., N. Y., Nov. 4, 1855. Dr. Sanborn: Dear Sir—I take pleasure in complying with your request. I consider the mode of treatment by inhalation as the only way of treating consumption with any kind of philosophy or reason, or with any hope of success. This method carries the medicine stniight to the seat of the disease. I now would as soon treat a burn by giving medicine by the mouth, as I would consumption in any of its forms; for I have tried medicine to perfection on myself in the form of syrups, solutions, and the different alteratives, such as mercury, iodine, and iodide of potassium, with the addition of epispastics, but all to no purpose, for I continued to go down until I could see in at Death's door. Then I left off all kinds of med- icine, and tried the inhaling mode, and in two months I was able to resume my practice as usual. All I used in the jar or tubes was some thirty grains of gum myrrh, say about twenty grains iodide of potassium, and ten grains of nitrate of silver in half a "pint of fluid. When I first used the apparatus I put the tubes in hot water, and then used the vapor in a hot state. But after reading your views in the Tribune, 1 used it without heat, and it is the best way by far. I have treated a number of cases of consumption, and some of them severe cases, with hemorrhage from the lungs, by your method, and they now enjoy good health. One, in particular, has since labored by the month for two years without a return of the cou^h. If it is your wish, I will forward to you the different cases I have treated in this form, with one severe case of spasmodic asthma. I have not yet received a pamphlet from you, and I wish you would forward another to me, if you please. I would have written sooner had not sickness prevented. I wish you success in your course in curing disease, Respectfully yours, A. G. Prior, M.D. 114 Sanborn on Diseases Montreal, C. E., Oct. Qth, 1855. Dr. Sanborn : Dear Sir—Will you be so kind as to forward to me your treatise on Inhalation. I have become much interested in your method of applying remedies, and I shall hope to meet with the same success in adopting cold, medicated inhalation, as that which has crowned your labors. Truly yours, H. Chapman, M.D. Delphi, 0., Sept. 27, 1855. Dr. Sanborn: Dear Sir—I consider your Theory of Consumption, being prima- rily a local disease, the most reasonable one ever published, and it agrees with my views exactly. Your system of " Cold, Medicated Inhalation," by adding the various remedies to pure alcohol, and breathing them at the natural temperature of the air, is certainly a new system of practice, and unknown heretofore, as far as I am ac- quainted, to the profession. I can see no reason why the remedies you use, which you have given to physicians throughout the country, are not scientifically selected, and I confidently believe that your theory and practice will be generally adopted. It differs so ma- terially from the old hot-water plan of medicated inhalation that it must attract the attention of the public; and physicians, I have no doubt, will give it a thorough investigation. Yours, etc., S. H. Pearse, M.D. ^ Mount Blanchard, Hancock Co., 0., July 15, 1855. Dr. Sanborn : Dear Sir—I noticed in the New York Weekly Tribune of July 7, your letter on the treatment of diseases of the lungs and throat by inhalation of cold, medicated vapors. Now this I look upon as a decided improvement in the treatment by inhalation, as it can be administered in every situation and under all circumstances. Who- ever makes one step of improvement in the treatment of this hitherto incurable class of diseases may well be considered as a benefactor to the world. As you have the kindness to offer Vour of the Lungs and Throat. 115 discovery to the medical world, I wish to avail myself of its ad- vantages. Yours most respectfully, Samuel S. Clark, M.D. Sherwoods, P. 0., Cayuga Co., N. Y., Nov. 8th, 1865. Dr. G. D. Sanborn : Dear Sir—I have read many letters of yours, as well as H—r's and F—h's, published in the New York Dispatch, on Medical In- halation, and I have examined them all, and become satisfied that your mode of inhalation and your medicines for the same are far better than those of any others. So far as I could learn of them they are no quack's compositions.. As to the remedies of H—r, I think but little of them, although they may be good in some cases. F—h, of New York, I consider a perfect quack ; he has cheated the people out of a great amount of money by selling his nostrums at enormous prices. I am knowing of several cases of consumption where his poisonous medicines have helped the patient out of ex- istence, and, therefore, I have no kind of confidence in him. I am desirous of informing myself more upon this subject, and I see by the Dispatch of the 4th inst., that you offer to send to physicians a copy of your pamphlet containing your mode of treatment and the names of the medicines used. I think this very liberal in you, and, besides, it shows to the world that your practice is no imposition or speculation on your part. I must say that no reasonable man can condemn your course, and I trust it will be a source of great profit to you in the end. I am one who is willing to build up your system. As I have not seen your valuable pamphlet, I am desirous of obtaining a copy, for which I am willing to compensate you. Will you be so -kind as to send it to me by return mail. I have talked with a friend who says your work is good and worthy of the notice of physicians; therefore my anxiety concerning it. I am, dear sir, with respect, G. A. Thomas, M.D. In addition to the foregoing letters, I might publish many others containing testimony to the originality, efficacy, and success of my mode of inhalation, equally as decided, plain, and satisfactory as 116 Sanborn on Diseases that contained in these. Such a course is not necessary. The judgment of an enlightened profession and public is here sufficiently indicated ; and farther evidence would be superfluous. I will, however, add in this place a letter, as a sample cf a challenge to those who practice the old systems of inhalation in this city, and to which, although repeated in a variety of forms, and on many occasions, I have not been able to induce the physicians, to whom reference is made, to reply. Venturing the opinion that it must be a poor cause that will not bear advocating, I subjoin the letter, and leave the reader to draw his own conclusions. DR. SANBORN ON COLD, MEDICATED VAPORS. physicians' opinions—continued. To the Editor of the New York Daily Times: Sir—I have frequently expressed, through your columns, a de- sire to have my system of Medicated Inhalation thoroughly tested by physicians, that the public might be enabled to judge whether it is of practical value in the treatment of lung diseases. I have presented to them the remedies I use, and their method of use, and have explained the objects which I expect to accomplish by their employment. No physician has accused me of secrecy, and no one can, in regard to the system of inhalation which I practice, and which I claim to be entirely distinct in every feature from the old hot-water plan, which is well known to the profession. All I ask now is, that others, who practice the last-named method of inhalation in this city, shall do as I have done, and let phvsicians and the public know what they use, and why. It is a familiar adage, that " Any subject which will not bear investigation is founded in deception and falsehood." I continue to-day the opinions of physicians regarding the merits of Medicated Inhalation as conducted with really new and valuable agents, and in the form of cold, and not hot and stifling vapors. Yours, etc., G. D. Sanborn, M.D. To the many who have not studied the science of medicine, and who are liable when they approach medical subjects to be over- whelmed with a mass of learned wordiness, or to be deceived by OF THE LUNGB AND THROAT. 117 plausible but fallacious theories, let me say before bidding adieu to the readers of this volume, look back over these pages and judge whether the knowledge here intended to be conveyed is vailed from your view by a pretentious web of technicalities, or whether the folds of false argumentation are woven about the uncautious judg- ment of the reader, like the coils of the terrible boa about the body of its victim. Question these pages again, and let them answer to your judgment, whether the facts here laid down are not as repre- sented, and whether the reasoning based on them is not simple, clear, direct, and incontrovertible. The theory of consumption detailed in this work is believed to be as lucid and valuable, as it is undoubtedly new. The summary of the causes and symptoms of consumption has cost much labor and pains-taking ; but nothing less could have been made to answer the obvious needs of a large portion of the community, who are, or may be, the subjects of this dreaded complaint. The treatment here given is not of a hidden and obscure, or burdensome and im- practicable character. My object in detailing it has been to tell the patient and the friends of the invalid what they must and can do on their own part. The inhalation of remedies into diseased lungs is a point of too much delicacy and importance to be trusted to the judgment of the medically uneducated. Had I given the formula for the vapors to be inhaled in a single instance, or in sev- eral, it would not have availed ; for the remedies laid down would, probably, have to be changed to adapt them to the next case that presented itself, and no one but the physician who has studied the operations and susceptibilities of the different organs of the system, and the effects of various remedial agencies upon their action in states of health and disease, could with safety undertake to change the nature or proportions of the ingredients of the vapors to be employed. Instruction has been my leading object. But there are fields of knowledge in which it is every way true that "a little learning is a dangerous thing;" and this is more the fact in regard to medi- cine where human life is often staked on the issue of an hour, than in any other pursuit. I repeat it distinctly, then, I have not given recipes for preparing the medicated vapors which are to be used, 118 Sanborn on Diseases because in the hands of the community at large such recipes could not but prove impracticable, and often mischievous. But the remedies which Nature holds out to every one diseased, I have dwelt on earnestly and at great length. Let the invalid but learn and live up to what has been said on these points, and he may reap rewards that will call for perpetual gratitude to one who has aimed to be to him a faithful monitor, and perpetual thankfulness for the triumph of his own resolution. The treatment which I employ for the cure of tubercular con- sumption has been fully detailed to the medical profession of this country, and from very many I have received in reply their opinions of its merits and success. Some of their letters have been laid before the reader; and the emphatic adoption and support which they publicly give to the theory and practice set forth by me, may be best appreciated by a statement of the fact that very many, outside of as well as among the number of those who have written me, have applied the system in their own practice, and learned its value by witnessing its beneficial effects upon the invalid within the range of their own daily duties. How strong the contrast, allow me to suggest, between such a system of treatment as I have now laid before you, which has been openly published, impartially scrutinized, cheerfully recommended, and, moreover, attested by its fruits, and those off-shoots of the most barefaced quackery which are heralded through the land, and the medicines of which are even peddled from door to door, in the shape of nostrums that are concocted in secret, their ingredients unknown to the user, and above all else absurd, from the fact that one, two, or three such compounds are dealt out to all purchasers at so much a bottle, without regard to the nature, stage, or charac- ter of the disease, or the age, strength, or habits of the patient. But besides cautioning the reader against these transparent de- ceptions, I shall do him a kindness to put him on his guard con- cerning those systems of inhalation which either follow the same quackish course with a single bottle of some secret mixture, or which are nothing but a revival of the old plan of hot-water in- halation which was practiced by English physicians of the last cen- tun, until it w>s absolutely abandoned for its woifh^-i.e^ of the Lungs and Throat. 119 There are even now lengthy and flaming advertisements of such a medical humbug circulating through the length and breadth of our country, whose foreign advocate has not imported with himself, nor originated one new or useful improvement either in remedies or in the method of using them, and who stands, therefore, publicly con- demned as a plagiarist and impostor. Others make a great ado about " combining inhalation" with medicines which, when the truth is known, will be found to neutralize and destroy every good effect which the remedies inhaled might produce. It is fortunate that this is a day when medical truth is not only progressing, but becoming popularized and diffused among the people. No man is pardonable, in this day of light and knowledge, who submits to be duped by such false and groundless representa- tions. Let every man examine whatever, in the way of medical treatment, is proposed for his acceptance, and especially if he ex- pects to take it as the anchor on which to moor his hopes of health, life, and happiness. " Prove all things; hold fast that which is good." Save yourselves from contributing to fatten the impostures of the day. Learn that in obedience to Nature, and in simple, natural remedies is the only sure reliance of the afflicted; and above all, that prevention is almost always possible, and always far more agreeable than the pains of disease, and the hazards that encompass the struggle after its cure! CONCLUSION. The duty of writing a plain and readable book for the enlight- enment of the public, has long impressed itself upon my mind, but the labors and anxieties of an arduous professional life have, until the present, forbidden its accomplishment. The success which I have met with in my treatment of con- sumption has given me incontestible proofs of its value, and has served to sustain me in my labors. And it is with gratification and a just pride that I now announce to the world my views, as herein set forth, and with a trust that the evidences of their worth here presented will rekindle hope in many an abode of gloom, and cause rejoicing where fear alone has long reigned. 120 Sanborn on Disk asks, etc. In writing this book I have been actuated by two important motives—a desire of extending a knowledge of the theory it sets forth, and also the wish to be instrumental in remedying disease. I must leave the fruits of my labors in the hands of a discrimina- ting public. " What I have written, is written; would it were worthier!" I hope that those who read will do so with an impar- tial judgment and an unbiased mind. Weighing well the argu- ments set forth, and examining the evidences adduced, let each determine for himself, whether the premises on which I have built do not afford a sure and firm foundation, and one that is impreg- nable to all hostile attacks. To those members of the profession who have kindly aided me by their co-operation, I return the thanks and acknowledgment due to their liberal course. With such feelings I finish my task, yet not without regret that haste has unavoidably left in it some errors which time might have corrected. To the Reader: Let me inquire, what is your duty to those suf- fering from that terrible malady, consumption ? You have pre- sented to you the certain means of relief—the most promising means of a cure. Thousands are now suffering from this disease —thousands hurrying away from the living world into the land of shadows—thousands praying for relief, and hitherto vainly calling for aid, while no aid was at hand ! A thousand vivid pictures might be drawn of the course of the Arch Destroyer; but I will riot claim your sympathies. I appeal to your sense of justice in view of the fact that the Nineteenth Century has at length unfolded a means whereby consumption can be cured! < I NATIONAL LIBRARY OF MEDICINE NLM 032772bM 1 »----■^?-^rr*:A,.-t*<~fft£.Tj;l«.i.,rj NLM032772641