Page images
PDF
EPUB

branes of the brain at the base were found unusually congested, and covered with a considerable exudation of recently coagulated lymph, here and there mingled with bloody extravasation. The apex of the right lung presented a remarkable cicatrix, consisting of dense, white fibrous tissue, varying in breadth from one fourth to three fourths of an inch, and measuring about three inches in length. The pleural surface in its neighbourhood was considerably puckered. On making a section through the lung parallel with the external cicatrix, the substance immediately below presented linear indurations of a black colour, together with fine cretaceous concretions, varying in size from a pin's head to that of a large pea. The surrounding pulmonary substance was healthy. The apex of the left lung was also strongly puckered, and contained six or seven cretaceous concretions, each surrounded by a black, dense, fibrous cyst."

The history was as follows:-" Keith, in early life, was in very indifferent circumstances, and supported himself as a writer. At the age of twenty-two or twenty-three he laboured under all the symptoms of a deep decline and his life was despaired of. About this time he was lost sight of by his friends; but it was afterwards ascertained that he had become a parish schoolmaster in the west of Scotland," not in Madeira or Egypt," and that his health had been re-established. He returned to Edinburgh six years before his death, and endeavoured to gain a livelihood by teaching Latin and French. He succeeded but very imperfectly, and fell into dissipated habits. Latterly he had become subject to attacks of mania, apparently the result of drink. It was

after an unusually severe attack of this kind that he was brought into the Infirmary, where he died in the manner previously described.

"This case points out the following important facts: 1st. That at the age of twenty-two or twenty-three the patient had a tubercular ulcer in the right lung, the size of which must have been very considerable when the contracted cicatrix alone was three inches long. 2nd. That tubercular exudations existed at the apex of the left lung. 3rd. After

receiving the appointment of a parish schoolmaster, after changing his residence and occupation, while his social condition was greatly improved, these symptoms disappeared. We may therefore infer that it was about this period that the excavation on the right side healed and cicatrized, while the tubercular exudations on the left side were converted into cretaceous masses, and so rendered abortive. It demonstrates, 4thly, That when at a more advanced age he again fell into bad circumstances, and even became a drunkard, tubercular exudations did not return, but that delirium tremens was induced, with simple exudations on the membranes of the brain, of which he died." So complete and permanent was the cure so far as phthisis is concerned.

Professor Bennett's views derived further confirmation from every case which came under his notice, some of the most characteristic of which are given in extenso in the work from which the above extract is taken. The results at which he arrived may be thus summarised. The characteristic lesion of pulmonary consumption consists in an exudation of low type into the lungs, which assumes the form of tubercle, being at first miliary, but, if long continued, exhibiting the "cheesy" form; this substance is incapable of self-reproduction, and hence only susceptible of increase by additions from without by fresh exudation of the impoverished liquor sanguinis; it may run any of the three following courses-(1) it may be absorbed to a greater or less extent, the residue becoming encapsuled in a firm fibrous sheath, the walls of which in process of time contract and coalesce, through absorption of the contents, until a cicatrix of dense connective tissue is all that remains to tell of the previous lesion. This is a favorable termination; or (2) the animal matter may be entirely absorbed, and the calcareous salts be left in the form of mineral concretions of larger or smaller size, which also become encapsuled as the preceding, and thereby innocuous; or (3) through fresh deposition of tubercular matter and its subsequent retrograde metamorphosis, the lung tissue may become deprived of its proper blood-supply, owing to pressure on the vessels

by the adventititious substance, and also be broken down and caused to suppurate by the presence of the products of retrograde tubercular metamorphosis. Thus cavities are formed which may either (a) increase in size, until the patient falls a victim to a prolonged and severe hæmoptysis, owing to implication of a large vessel, or more commonly succumbs to the hectic and debility engendered by prolonged suppuration; or else (b) a fibrous capsule may form around the cavity, which ere long contracts, leaving the patient perfectly well.

It is thus seen that of the four possible terminations of phthisis, viz. partial absorption and cicatrisation, calcification and cicatrisation, the indefinite extension and suppuration of pulmonary vomicæ, and the encapsuling and subsequent contraction of the same, one only, the third, is necessarily fatal, and the circumstances in which it is likely to occur are precisely those which give rise to the disease in the first instance; that is to say, a state of cachexia or mal-nutrition.

This cachectic condition Professor Bennett found to consist in a want of due assimilation of fatty principles. The fact that during the progress of phthisis fatty matters are frequently deposited in the liver and certain other viscera, in no way militates against this conclusion, because in these cases the adipose formations occur as a result of the secondary digestion, or of the specific secretion of individual glands, and, " as such, are, per se, incapable of being reabsorbed or of affording nutrition. In short, such fat must undergo those changes and that elaboration which the digestive functions produce before it can be made available for the formation of good blood, which in its turn is only a preliminary step to healthy nutrition," (Pulm. Con. p. 35). It is very important to bear this fact in mind in inquiring into the climatic treatment of phthisis, as this useless and even injurious form of fatty deposition is just the result most likely to ensue upon the administration of oleaginous principles in warm climates, as we learn from the common occurrence of " fatty liver in those who have resided in hot countries, and from the practice of those

[ocr errors]
[ocr errors]

who feed up Strasburg geese in order that rich gluttons, who do not care at what pain to others they gratify their own debauched palates, may be enabled to gorge upon diseased livers in the form of pâté de foie gras. Hence we see that a warm climate is likely to prove unfavorable to the proper assimilation of the oleaginous substances which form so necessary a part of the diet of a consumptive patient.

The ordinary articles of

Next, as to the treatment. diet supply all the necessary fatty principles, but not always in a form readily taken up. For instance, the oleaginous tissue are contained in a

particles in ordinary adipose

cellular sheath, which must first be dissolved before the contents can be assimilated. Besides, as either beef or

mutton fat remains solid at ordinary temperatures, it is likely to prove of a heavy and indigestible character, even although it may be liquefied at the temperature of the interior of the body. Expressed vegetable oils are free from these disadvantages, but such nearly universally exert a cathartic or other specific action. But in cod-liver oil, i. e., the oil expressed from the sliced fresh livers of the cod fish, we have a combination of all the required qualities, together with the presence of minute quantities of Phosphorus, Iodine, and Bromine, just the very drugs which are homœopathic to the disease. Professor Bennett, we regret

[ocr errors]

to say, in spite of his originality, is still pervaded with so much of the "odor quo semel est imbutus recens as to think the proportion of these elements too small to exert any influence one way or the other, but we know better!

The appropriate "analeptic" for phthisis having thus been found (we do not say that the "dynamic" action of other drugs may not be necessary, notwithstanding the Iodine and Bromine), the next desideratum is to order the patient's regimen in such wise that the oil may be best assimilated. Now, the circumstances universally favorable to digestion are pure air, sufficient exercise, and a mind cheerful and at ease. The last of these it is not in human power to minister, but it is hardly likely to be promoted by expatriating a patient to a distance of 1100 miles from his

friends, where a fortnight at least necessarily elapses between writing a letter and receiving a reply. Exercise is specially needful to the due assimilation of fatty aliment; a warm, equable climate, with a high saturation point, and consequently, par excellence a debilitating and enervating climate, is not very likely to predispose to exertion, and perfectly certain to produce copious and weakening diaphoresis if any exercise be taken. Further, as a liberal supply of oxygen is especially requisite in the case of persons on a fatty diet, it is reasonable to conclude that the condensation of that vital agent in a moderately cold atmosphere, by causing a greater amount, bulk for bulk, to be inhaled at each inspiration, must prove more beneficial than the smaller quantity which a respiration of equal extent inhales in a warm, and therefore expanded and rarefied, atmosphere. Lastly, a high saturation point prevents sufficient elimination of watery vapour from the lungs, and it is to be remembered that it is the actual, not the relative, humidity of the atmosphere which is here in question. For example: an atmosphere at 45° with a saturation point at 44 is very damp indeed relatively, having only 1° of dryness, but as respired air is raised nearly to the temperature of the body in its course through the air-passages, there will be 50° or more to be saturated before it leaves the lungs, and hence much more pulmonary evaporation can take place than in an atmosphere of 64° with a saturation point of 54°, although we have here 10° of dryness instead of only 1°, so that the relative humidity may be described as less. Furthermore, we find consumption all but unknown in Newfoundland and Labrador, and four times more common at Marseilles than at Stockholm; also, it is notorious that many if not most consumptive patients stand the dry cold of the Hudson's Bay territory perfectly well, often with actual benefit; so, as this question of temperature is shown to have nothing to do with the production of phthisis, and every process of reasoning, no less than observation, leads us to suppose that warmth is by no means conducive to its cure, we have no hesitation in ratifying the verdict which Professor Bennett has delivered as the result alike of his studies and of his extensive

« PreviousContinue »