April 25, 1890.] 



SCIENCE. 



255 



disease be not too extensive, efPect an equilibrium between 

 the work required to be effected and the work effected, and 

 we shall have obtained an arrest of (he disease. 



The first step towards enabling the other organs of the 

 body to perform their ordinary functions has been already 

 taken by removing that which was the primary cause of 

 their derangement; viz., the presence in those organs of 

 substances that interfered with their normal work, and 

 altered, to a greater or less extent, the state of their nutrition 

 and that of the body as a whole. We shall supplement that, 

 where necessary, by appropriate means to secure the relief 

 of any organ that may have become involved by its com- 

 pensatory action, and to obtain the normal functional 

 activity of the others, so that the body may be placed in a 

 fit state for the reception and assimilation of suitable food. 

 The nature and quantity of the food, and the time for its 

 administration, must be carefully regulated according to the 

 requirements of the case, but care must be taken not to give 

 it too frequently or in too large quantities. I attach much 

 importance to the careful cultivation of the appetite, so that 

 the patient may be tempted to eat, and to the careful avoid- 

 ance of any dish or article of food to which the patient has 

 taken a dislike. Good new milk alone, or made up in 

 various ways, cream, butter, oliveoil, marrow (I have found 

 great benefit from a preparation of marrow and malt 

 immediately after the meal), hot bacon with its fat, eggs, 

 good beef-tea, soups, fish, fowl, cutlets, fillets, etc., with a 

 suitable supply of vegetables and fruit, must be freely drawn 

 upon for the patient's food. And we may add to this a good 

 bitter beer, stout, or a good, sound claret, or wine, when we 

 are sure we can get them. 



No attempt whatever should be made to apply the third 

 Xwinciple of treatment until the disease has been some time 

 arrested, as shown by a progressive decrease of the symptoms 

 of lung irritation, an increase in the area of breathing, in- 

 creased vital capacity, extent of movement and girth, a 

 nearly normal temperature, a steady improvement of the 

 general health, and increased weight. Then the following 

 measures may be gradually adopted and steadily increased, 

 great care being taken to avoid either strain (the lungs must 

 not be stretched) or overexertion, the state of the general 

 functions and temperature being carefully watched. We 

 place the patient under conditions that progressively make 

 increasing demands for the use of the lungs, such as slight 

 ascents on the neighboring hills, slowly performed at first, 

 and then gradually increasing both the elevation and the 

 time occupied in such exercise. Deep breathing is to be 

 regularly practised, commencing with three or four full in- 

 spirations, followed by deep expirations, in succession, and 

 increasing both their number and extent. I have found the 

 careful and regular use of a spirometer very beneficial, and 

 much regret that, as in the case of thermometers, no one as 

 yet supplies them at such a price as will enable the general 

 public to purchase them. Then the muscles of the chest 

 must be fully developed, and the patient should take part 

 in such exercises as will insure their full use. And this 

 process of lung development will not be complete until the 

 patient's vital capacity exceeds Hutchinson's so-called 

 standard of health. 



And we shall attain the object of the fourth principle of 

 treatment by carefully selecting appropriate measures to ef- 

 fect each purpose we have in view (and the medicines must 

 be prescribed precisely on the same principle; for instance, 

 if we desire to increase the functions of the skin, a dia- 

 phoretic is prescribed, and its use stopped when we desire 

 such action to cease), by using them at the right time and to 

 the right extent, and by carefully watching their effects, so 

 that if there be any indication of friction we may at once 

 effect the necessary modification, or adopt some other means 

 to attain the same object. 



Under this system of treatment, the chest symptoms are 

 immediately relieved ; pain, cough, and expectoration speed- 

 ily disappear ; the area of breathing, the vital capacity, the 

 chest-girth, and extent of movement, progressively increase. 

 The temperature tends towards that of health, the general 

 state improves, the weight increases, and there is a feeling 

 of health and strength. In fact, so real is this, that it has 

 been the source of one of the chief difficulties of treatment, 

 by tempting the patient to do something beyond his strength, 

 or to neglect some of the directions given him, till he finds 

 himself promptly pulled up by a cessation of his improve- 

 ment. Soon, in those cases in which the disease is not ex- 

 tensive, there is a complete arrest of the disease, no chest 

 symptoms, a good state of the general health, a fair weight, 

 normal temperature, a good breathing capacity, and eventu- 

 ally the patient makes a comj)lefe recovery. By this I mean 

 he has the appearance and possession of sound health, natu- 

 ral breathing from base to apex, a well-formed and fuUy 

 developed chest, and a good range of movement and vital 

 capacity. 



I have based this statement on the results I have invaria- 

 bly obtained in my experiments, and in the practical treat- 

 ment of the cases of which the following notes appeared in 

 the Lancet of Nov. 26, 1887, and Dec. 8, 1888, and in the 

 Illustrated Medical News of Oct. 26, 1889 :— 



"Case I.— In April, 1883, I saw H. O. M. E., a married 

 lady, in conjunction with the gentleman who had attended 

 her. We found the usual signs of phthisis of the right lung. 

 Family history good ; heights feet 2 inches; vital capacity 

 85 cubic inches. I accompanied the patient to Hastings, 

 and saw that she was carefully treated on the principles I 

 advocated in that paper.' June 13, much improved; vital 

 capacity 130 cubic inches. June 21, improvement contin- 

 ues; now able to walk a mile or two; vital capacity 162 cu- 

 bic inches. June 29, able to walk four miles; vital capacity 

 167 cubic inches. The patient was unfortunately obliged to 

 return to town. The improvement stopped, and after a few 

 weeks she began to lose ground. In September the patient 

 went to the Isle of Wight, the vital capacity then being only 

 161| cubic inches. Oct. 9, very much improved ; vital ca- 

 pacity 195 cubic inches. She continued in the south, and 

 was gradually accustomed to walk many miles daily; no 

 chest symptoms. Nov. 4, patient's appearance that of a lady 

 in good health; vital capacity 201|^ cubic inches. Nov. 25, 

 continues well; vital capacity 222^ cubic inches. Dec. 11, 

 patient has recovered ; angles of scapulse lie flat on back, 



^ "The Scientific Treatment of Consumption/' Manchester Meeting of the 

 British Association. 



