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the ulcerated surfaces, and be made to produce the effect which the individual case requires. Ulceration itself can also be prevented, for tubercles which are only in their incipient state may be so powerfully acted upon by the inhaled vapour, that a removal of them will take place without the usual softening down into ulceration at all ; whilst those which are so far advanced as to be broken out into a state of abscess, are assisted by the immediate access of the inhaled substances to heal more rapidly and soundly, precisely in the same manner as any external ulcer is cicatrized by the application of a proper ointment to its immediate surface. It may here be observed also that the effects of inhalation soon become manifest, and are of the most delightful description. It quickly improves the breathing, causes an easy expectoration, relieves the cough, and at once gives comfort to the chest by the removal of every sensation of oppression and pain. Another grand recommendation to those in the humble ranks of life is, that the glass apparatus employed for the purpose costs but little, the kind generally used being not more than a few shillings.
Not that we are to place our sole dependance on iuhalation alone, for disease in the lungs is generally complicated more or less with derangement of other parts of the system; the digestive functions are frequently much impaired; the liver is considerably enlarged or otherwise affected; palpitation of the heart, and great inequality of the circulation also increase the difficulty of the case by reflecting their morbid influence on the lungs, and thus aggravating the state of the primary disease. This makes it indispensable to call in the aid of other medicines, which are in many cases absolutely necessary, in order to render the effects of inhalation complete, Many and excellent are the articles of the Materia Medica which, as I be. fore said, our present knowledge of Chemistry has supplied us with, and which exert a powerful influence on the constitutional habit of consumptive patients. These then are at our disposal, and we must make use of them; for although we can by inhalation gain immediate access to the seat of the disease, as just observed, yet so great is frequently the general derangement of the system, that until this be duly regulated, it is utterly useless to apply a local remedy alone, for if the constitution remain vitiated or unimproved, the very cause which generates the tubercles still exists, and a cure is impossible. Hence we may see that a more extended view of the disease is necessary than that which confines itself to the pulmonary substance alone, and that our measures must be varied with discrimi. nation and judgment to suit the different requirements of individual cases.
Neither is it sufficient to prescribe one kind of medicine only for inhalation, for although we can depend in a great measure on that excellent means for the cure of Consumption, yet it must be evident to every sensible person that no one particular form will be suf. ficient for every variety of case-for to assert this would be at once to proclaim that we are in possession of a specific for the complaint-a desideratum which I fear will never be attained. In fact almost every case when examined closely by the stethescope, (which will enable us to form a more correct diagnosis than can be obtained by any other means) presents some peculiarity which requires us to vary our formulæ both for inhaling and for internal medicine. A preponderance of one particular ingredient might aggravate the morbid state of one patient's lungs, whereas that same ingredient might require to be increased considerably in the case of another. In short nothing but experience can determine the Practitioner how to act in so delicate and insidious a disease; and even he must not hastily decide upon any mode of treatment till he has well questioned the patient upon his state, and learned every particular that can be elicited.
The practice of inhalation was formerly much in vogue, so that it is no new invention of medical science, but the great advantage which it possesses now over all antecedent periods is derived from the efficacious medicines which are used for inhaling at this day, and which have been discovered since the times alluded to. The celebrated Dr. Mead, whose fame as a physician, from 1700 till the time of his death, could not be surpassed, was a great advocate for balsamic medicines being inhaled in diseases of the lungs, because then, as he said, they had not to travel so far before they reached the diseased surfaces, and did not lose so much by the way; but his power was limited by the low state of chemical science in his time. To this latter circumstance alone is to be attributed the abandonment of so rational a practice by succeeding physicians. The same reasons do not exist now for its neglect, but on the contrary every argument for its constant adoption. Many eminent men now acknowledge that it is their sheet-anchor for the cure of pulmonary complaints.
To the Stethoscope we owe the most extensive obligations, for it is by the aid of this admirable instrument that we discover whether the substance of the lungs be diseased or not, and although we cannot, in cases where disease really exists, say positively to what extent it has reached, and consequently whether we can unreservedly predict a cure, yet it so far shews us the nature of the injury which the lungs have sustained, that we can in most cases adapt our remedies with the greater certainty, both in the kind we ought to select, and the quantity we may venture to prescribe.
It is of consequence too, to the correct treatment of the disease, that the Practitioner should be able to distinguish with tolerable accuracy the various kinds of matter expectorated from the lungs, for by this criterion he may frequently determine whether tubercles exist at all, and if such be the case, whether they are merely commencing, or are advanced towards the softening stage, or have broken out into open ulcera. tion. Many plans have been proposed by authors for this purpose—some chemical, others mechanical. Among the number one only is certain; but one is all we want, and that which I allude to will most assuredly enable a careful experimenter to arrive at a degree of exactness highly advantageous both to himself and his patient. It would be useless to describe it here.
The regulation of the diet is a matter of the very highest importance to consumptive patients, and it may be laid down as a general rule that it ought to be as generous and nourishing as the powers of the di. gestion in each individual case will allow—the lowering system, depend upon it, will not answer in this disease, which is essentially one of wasting and debility. If the weakness of the Patient is extreme, he must undoubtedly submit to great restriction, to be determined by his medical attendant at the time, but in general we ought to aim at propping up the enfeebled energies of the constitution, and study to improve the strength by as much supporting food as can be comfortably received, without oppressing the stomach and digestive powers.
It unfortunately happens that poverty is the lot of too many who labour under the worst forms of this disease, and is in all probability, the exciting cause of it, from want of a proper quantity of food, clothing, and cleanliness. When such is the case, our exertions are sadly cramped, and we are unable to effect half the benefit that can be accomplished with those who can command the comforts and conveniences of life.
Something, however, like the following plan may be
pursued by one whose strength is not already too much exhausted, and whose circumstances will allow of his adopting it:—He must rise early, and take as much active exercise as he can for a short time before breakfast. After resting a time he may eat for his morning's repast, a boiled egg, with good mixed bread, one or two days old—or if he prefer it, let him take a basin of boiled milk and bread. In the forenoon, after having had more exercise in the open air, let him drink a wineglass of port or sherry, mixed with the same quantity or more of water. For dinner he must have good fresh animal food, a small quantity of potatoes, well made bread, and half a pint of sound draught porter. Ale is not so advisable, because it seems too heating for consumptive Patients. The inside of roasted beef or mutton, with its red juices, that is, not cooked too much, is most proper Animal food in this state, is not only more nutritious, but more easily digested, than when rendered brown by roasting or boiling. It is more quickly converted into chyme than vegetables, and the chyle formed from it is more rich, and consequently contributes more to sanguification and to the solid structure of the body. It is a remarkable fact, that butchers, who live chiefly on animal food, are more exempt than other persons from true pulmonary consumption.
Here I ought not to omit mentioning a fact of great importance in this disease, that when a young person is confined to a vegetable diet, which is now a fashionable practice, to prevent consumption, his body advances in height but not in bulk. His chest elongates, but not expands; his neck also grows proportionally long ; in fact he becomes of that form or shape which is termed “a consumptive make;" whereas, when he is allowed a proper proportion of animal food, his body does not attain so great a height, and his chest expands. Instead of the consumptive form, his body