Supplementary Appendix: Consumption, tuberculosis in the early 19th century

Consumption, Tuberculosis in the Early 19th Century

Robert Hooper, A Compendious Medical Dictionary Containing an Explanation of the Terms (London 1801), s.v. “Phthisis”:

Phthisis ([Gk.] Phthisis, is, f[rom] from φϑιω, to consume). Pulmonary consumption. A genus of disease in the class pyrexiæ and order hæmorrhagia of Cullen; known by emaciation, debility, cough, hectic fever, purulent expectoration, hæmoptysis, diarrhoœa. Species: 1. Phthisis incipiens, incipient, without any expectoration of pus; 2. Phthisis humida, with an expectoration of pus; 3. Phthisis scrofulosa, from scrofulous tubercles in the lungs, &c.; 4. Phthisis exanthematica, from exanthemata; 6. Phthisis chlorotica, from chlorosis; 7. Phthisis syphilitica, from a venereal ulcer in the lungs.

G. Gregory, A Dictionary of Arts and Sciences, 3 vols. (London 1816), vol. 2 s.v. “medicine” (unpaginated): [*]

Phthisis pulmonalis, consumption of the lungs.

Symptoms. Emaciation, weakness, cough, hectic fever, and for the most part an expectoration of pus.

Dr. Cullen has introduced pulmonary consumption into his nosology, as a sequel of hemoptysis. This common and fatal malady, however, often, and indeed for the most part, originates independantly of hemorrhage from the lungs. Its origin and progress are most usually exceedingly insidious. The persons chiefly obnoxious to phthisis, are those of a scrophulous habit [glandular swelling], who have been disposed previously to suffer by lymphatic tumours, who are of a slender make, have long necks and narrow chests, who have been liable in their earlier years to bleeding at the nose, who have had frequent catarrhal affections while children, and in whom cough has remained or been ill-treated after the eruptive diseases of infancy, more especially the measles. These predispositions ordinarily break out into actual disease, at or shortly after the period of puberty. It is at this time that the pulmonary circulation becomes altered; and the seeds of the disease, hitherto latent, are expanded and developed.

In any constitution then at this period, and more especially in those that are characterised by a scrophulous tendency, a short and generally dry cough, succeeding perhaps to a trivial cold, attended with emaciation in the smallest degree, and more especially if the pulse be rapid, and the cheek be marked by hectic redness, alternating with more than usual paleness of countenance, the patient is to be assiduously watched, and the disorder earnestly combated.

Causes. Phthisical ulceration of the lungs, or confirmed consumption, is ordinarily produced through the medium of tubercles, or small bodies, in the cellular texture of these organs, which by repeated and gradual irritation, at length come to ulcerate and destroy the fabric of the lungs, and produce the symptoms of fully-formed phthisis. The origin and actual nature of these bodies are not perhaps very evident; they were formally erroneously imagined to be indurated lymphatic glands.

The more immediately exciting cause of pulmonary consumption is generally an exposure to cold, which operates in the manner described under the section Catarrh. Consumption, however, may be brought on by amenorrhoea, lues venerea, unseasonably repelled eruptive action on the surface, mental affections, &c.

M. M. “The facility,” says a modern author, “of repressing the primary symptoms of phthisis pulmonalis, is proportioned to its difficulty of cure when the characters of the disorder are fully confirmed, and the texture of the lungs almost wholly destroyed.” (Reid on Consumption.) In no case, perhaps, is neglect or early mismanagement of disease more pregnant with irremediable evils, than in the instance of consumptive affections. Venescetion in the inflammatory stage, and low diet. Blisters to the chest. Digitalis properly and timely had recourse to is “the anchor of hope.” “In families where this fatal disease (phthisis) is hereditary, the use of this remedy as a prophylactic, will, I have no doubt, save many lives that would otherwise have been cut short.” (Dr. Currie.) “Digitalis is a remedy in pulmonary consumption in its earlier periods, which under due regulations, and with sufficient attention to other circumstances of regimen and diet, may be employed with a prospect of almost invariable relief.” (Dr. Reid.) Other testimonies, equally decided, might be adduced in favour of this valuable remedy. Warm bathing. A regular temperature in the air that the person breathes. Warm clothing. Avoiding currents of air. Assiduously guarding against damp, and especially cold application to the feet, as by sitting with the feet on a stone floor, or an oilcloth. Milk diet, of which Hoffman elegantly says, “Qua perplures phthisicos, in cymba Charontis quasi hærentes, sanatos, pristinæque redditos valetudini, novi.” Avoiding all spirituous liquors, and spiced or high-seasoned meats. Keeping the bowels gently open by manna, castor-oil, senna, &c. Uva ursi has recently been recommended by Dr. Bourne.

These are the remedies of the first stage, or, more properly speaking, the menacing symptoms of consumption. When the lungs have actually become ulcerated after gradual and protracted irritation, very little expectation of recovery can remain. Griffith’s mixture, composed of steel, myrrh, and alkali. Digitalis in larger doses, and combined with the above tonic. Uva ursi, opium and vitriolic acid. Digitalis combined with calomel. Change of climate. If a tendency to absorption from the surface of pulmonary ulcer could be induced greater than the deposition of it, we might have some prospect of curing the disease in its advanced stages. In order to produce this absorption, sailing so as to occasion sea-sickness has been had recourse to. Swinging, riding in a carriage, and other modes of occasioning a degree of vertiginous affection, and consequent nausea, have likewise been recommended and practised. Inhalation of a lowered atmosphere, of other modified gases, and even volatile astringent substances, have been also proposed and tried, but not with decided benefit. Bath waters and cold seabathing are improper in every stage of the complaint.

N. B. If consumption be symptomatic of other diseases, while the symptoms are subdued by the above remedies, the attention must necessarily be turned principally towards the original affection.

Caution. All the signs of consumption may be present without the presence of the disease. Debility, emaciation, and cough, may be brought on by nervous, independant of organic disease, as well as by worms and intestinal viscidities. Hectic fever may be occasioned in certain constitutions by mental affections alone; this likewise is sometimes induced by worms. Purulent expectoration, indeed, is decisive; but the nature of the sputa is not with facility, in every case, to be decided upon.


[*] It may be noted that this article from 1816, sometimes abbreviated, sometimes ampflied, appeared in several different medical dictionaries, guides, and general encyclopedias during the first quarter of the nineteenth century, the earliest of which seems to date to 1807. Back.

Translation © 2020 Doug Stott