pectoration of a yellowish substance with a little blood, night sweats, pain in side, falling away, &c., with hectio fever; but it was active inflammation of the lungs, and was cured accordingly in a few days, but by a very dif ferent mode of treatment from what Consumption would have required. "A young gentleman was condemned by high medical authority to go to the island of Madeira, as “nothing else could save him;" but his business required his personal attention, and besides, he was going to be married. On seeking new advice he was counselled differently, got well in a month, and is now the father of a family. "Another person had consumptive symptoms; was shut up in a warm room, dieted and physicked, waiting for a vessel to go abroad. A different course was recommended. In ten days his cough disappeared, and at the end of five years had not returned." Dr. McDonnell, in the Lancet for April, 1844, gives a case which greatly perplexed the Dublin physicians. It had every prominent mark of consumption in its last stage. Its origin, its general symptoms and many of its physical signs were those of true tubercular phthisis. There were present emaciation, purulent expectoration, hectic fever and a blubbering of matter at every breath, at the top of the affected side of the chest, and various other signs, which would at once have led a superficial or ignorant investigator to pronounce it Consumption in its very last and most hopeless form. But a more experienced practitioner confidently declared that it was a very different disease, and treated it accordingly. The subsequent history and perfect cure of the case by means not applicable to Consumption, proved beyond all question, that it was not a case of phthisis. Other cases might be given, having quick pulse, night sweats, emaciation, and other hectic symptoms, all of which got well as above. Had these cases come under the examination of a common physician, they would have been declared hopeless cases, having no special experience in Consumptive cases, and that the only possible chance of recovery would be to go to the South. But whatever may have been the indifference manifested some years ago to lung measurement in reference to Consumption, I think that a change is occurring in public medical sentiment. The first instrument ever made in the United States, after the model, was made to my order, but I have never seen one in the office of an American physician, yet they are becoming so common in Great Britain, that their most eminent lecturers, in discoursing on Consumptive disease, give the capacity of a man's lungs for holding air as a matter of course, as much so as giving his pulse, and so will every reader of the standard current British medical publications find it, indicating that a change is taking place as to the points which are hereafter to determine, whether a man has Consumption or not, foreshadowing the comparative disuse of stethescopes, plessimeters and percussion, when the stripping of a man, turning him over and over, striking every inch of his breast, will be considered a useless labor and a useless infliction, when will become obsolete the words Ralé, soufflez, ronchus, sibilant, ægophony, &c.; when a world of professional perspicacity and hair-breadth discrimination, in determining the exact point where disease is located will be spared, for the simple reason, that it never made the slightest practical difference, whether the top or bottom, or side, or interior, or exterior of a lung was affected, the treatment being the same, but rather an injury is done the patient in designating the exact locality of disease, by causing his mind to revert constantly to it, and producing more incessant and unavailing disquietude. I here give two cases, practically illustrating the new method, which may be termed Spirometrical Diagnosis, that is, determining the condition of a consumptive per son, by means of measuring the lungs; one showing a gradual increase of lung capacity, ending in permanent health, the other, a constant decrease, terminating in death. 656. W. B., a merchant from Kentucky, aged 33, pulse 96, taking in at a full breath 170 cubic inches of air, instead of 254, that is, one-third of his lungs were useless to him, either because they were hopelessly decayed away, or collapsed, infiltrated with mucus, &c. The instrument which I use for measuring to the frac tion of one cubic inch, how much air a man's lungs hold at a full inspiration, does not indicate in any way the cause of inoperative lungs; it only shows the fact that they are inoperative, and the physician must determine by auscultation and other general symptoms, whether the lungs are decayed away or whether they are merely engorged, collapsed, infiltrated or the like; and this is a matter of vital importance, for if they are gone, their restoration is hopeless; if, however, they are within a man, and are merely rendered useless by the latter named class of causes, these causes of inaction may be removed; so that with the instrument which I employ for measuring the capacity of the lungs for common air, a man must be a finished auscultator, and must be most thoroughly acquainted with the whole catalogue of symp toms of diseases to which the human frame is liable. But before I give the opinion rendered in this man's case, I will detail some of his other prominent symp. toms. He was a tall, spare bachelor, with a white dry tongue, a great deal of pain in the small of the back for the last two years, constant pain in the breast, and frequent ill feeling between the shoulder blades behind; he had a great deal of general chilliness, (and no wonder when he had lost the use of one-third of his lungs,) burning feet and hands in the afternoon, costive bowels, linen generally damp from night sweats, a dry hacking cough night and day, always on getting up in the morning; had spit blood at different times for four years past; at one time he spat up clear red blood every day for three weeks; the cough was his greatest inconvenience. He thinks his ailment was brought on by having had the measles some years ago, they did not come out well. Complains of being always chilly, and looks as if he were almost frozen; he has fallen off, from his best weight, twenty-seven pounds. With these symptoms, I gave him the following opinion: "Your general constitution is much impaired by long standing disease, and your lungs have suffered much in consequence, so much so, that a large portion of them are useless to you; they are inoperative, inactive, and do not answer the purposes of life. A part of your lungs have decayed, but that was some time ago; that decay is not progressing at this time; your lungs are not decaying now; but they are in such a weak condition, that you are liable at any time, by any debilitating sickness, or by a succession of bad colds, to be thrown into a rapid decline. It is my opinion that your lungs can be restored to their full action, and your health placed cn a good foundation." said to me The reader will please notice the words above in italics. After he had read my opinion, he for the first time, that about five years ago he went to the South for his health, and the physicians told him that he was in the last stages of consumption; shortly after a running sore appeared not far from the socket of the thigh bone; he at once began to recover and got well. When he first came to me, his pulse was 96, and his lung capacity 170; on the 27th of June his pulse was as low as 90, and his capacity 186; on the 24th of August, pulse was 80, and his capacity 230. I have not seen him since, (some six weeks ago,) but I have no doubt I shall find a continued improvement, and a dimunition of six or eight for the pulse, and an increase of 24 cubic inches of lung capacity for air, would restore him to his healthy standard. The reader will here note the correctness of my opinion, not only in telling him that his lungs had been previously diseased; but that he could get well again, notwithstanding night sweats, constant chilliness, and an incessant cough. Not only his pulse and breathing improved, but he had a correspondent increase of strength, flesh and appetite, no sweating, no blood, bowels regular, and he did not complain of cough at all. On the 21st of June of the following year 1850, thirteen months after I first saw him, he called to see me, not for further advice, but as a kindly remembrance. His condition was satisfactory as detailed in the recapi tulation. I have not since heard from him. Pulse. Breathing. Lung measure. Date. May 23, '49 |