Speculations on the Nature of Tubercular Consumption. By
Dinwiddie B. Phillips, M. D., Assistant Surgeon, U. S. N.,
Member of Acad, of N. S., Philad.
If in offering for publication the following speculations re-
garding the nature of Phthisis Pulmonalis, the writer is suffici-
ently fortunate to engage the attention and invite the aid of
abler minds to the investigation of the subject, he will be duly
repaid for the time devoted to its examination.
lie does not pretend that he has undoubtedly discovered the
true pathology of this disease, or an infallible and ever-present
cure ; but having been induced to adopt his opinions, from what
to him seems a preponderance of evidence in their favor, he offers
them to the members of the medical profession, to be by them
received or rejected, as their wisdom may dictate.
The most which we can learn in relation to the pathology of
Phthisis, as treated of by the multitude of medical writers,
amounts to but little more than a candid confession of ignorance
upon the subject. We are told that it is the result of an abnor-
mal and morbid state of nutrition ; that its cause and nature are
alike unknown. And when we review the various and conflict-
ing plans recommended for its treatment, and behold the almost
innumerable host of heterogenous medical compounds which have
been from time to time lauded as the great elixirs of life to the
suffering patient, it would seem that any systematic attempt to
investigate the nature of the disease, and philosophically oppose
its invasions even, although visionary and erroneous, is at least
preferable to an entirely lethargic and empirical guesswork, and
should therefore claim an indulgent and charitable consideration.
Mr. John Simon, in his work entitled “ General Pathology,”
gives the following description of tubercle:
“ Microscopical examination of tubercle shows the following
principal ingredients: 1st, a substance which constitutes dis-
tinctively the bulk of the gray granulations, and which in its
general character is identical with the matter of condensed fibri-
nous concretion; namely, a dense, transparent, and almost homo-
geneous stroma, soluble in acetic acid and in the alkalies; 2d, granu-
lar material often in overwhelming abundance, especially in the
yellow tubercle, (where it is superadded to the former constituent)
and consisting partly of fibriniforra granules, partly molecular
oil; 3d, aborted cytoblasts, dark, condensed, mis-shapen, angu-
lar, insoluble in acetic acid.”
May we not assume, that the sum and substance of the tuber-
culous condition consists in a precipitation of unduly oxygenated
fibrinous elements from the blood, from immediately exciting
causes?
Let us sec what arguments or facts can be adduced to sustain
such an opinion. Mr. Simon, in treating of Cyanosis, uses the
following language:
“ There is one signal peculiarity which attends this chronic
venous condition of the blood, and which I must not leave un-
mentioned. Not only in extreme cases of Cyanosis, but in all
chronic diseases, where, from any causes whatever, there is de-
fective arterialization of the blood, the patient enjoys one privi-
lege. lie is exempt (perhaps absolutely, but, at least, all but
absolutely exempt) from tubercular diseases. And as the circum-
stances which interfere with due arterialization of the blood are
of the most various kinds (some of them acting merely mecha-
nically,) so wo are justified in inferring from the exemption just
specified, that the condition of the system in which tubercle is
deposited is incompatible with venosity of the blood.”
Now, there is one peculiarity of venous blood which alone can
account for the singular fact stated above. Venous blood is much
less prone than arterial to deposit its fibrin. This fact is demon-
strated by post-mortem examinations; which always, (or nearly
always,) exhibit fibrinous concretions or deposits in the arteries
and left side of the heart, whilst the veins and right side are free
from them. Mr. Simon also proves the difference in the facility
with which arteries and veins give up this clement of their com-
position. He says, (in the work before alluded to,) “I have carried
a single thread by means of a very fine needle, transversely
through the artery and vein of a dog, leaving it there so that it
might cut the stream, and I have done this repeatedly, sometimes
in the femoral vessels, sometimes with the carotid and jugular,
sometimes with the aorta and cava. I have suffered the thread
to remain during a period of from twelve to twenty four-hours.
My experiments have given me, as a uniform result, that the arte-
rial blood, with the utmost readiness, deposits its fibrin on the
thread ; the venous blood with the utmost reluctancy.”
Thus, then, the only condition in which the system seems per-
fectly exempt from the tuberculous deposit, is that in which, from
want of proper arterialization, or oxydation, the blood refuses to
part with its fibrin, or else does so with greatest difficulty. Again,
in noticing the favorite locality of tubercle, we find it originally
commencing on the lungs; here the blood is necessarily more
highly oxygenated than in any other portion of the body, and
here per consequence, its first attack is made; and not only in
the lungs, but, by preference, in the superior lobes of the lungs.
This arises from the fact that, as a general rule, the upper part
of the chest is less frequently exercised than the lower, and the
circulation in that particular portion, becoming languid and stag-
nated, as a matter of course fibrin is there first effused. Com-
paratively speaking, consumption rarely attacks individuals whose
occupations cause them to make free use of the muscles of the
upper part of the thorax, whereas, it is of common occurrence
with those who pursue sedentary occupations, and whose respi-
ration is carried on chiefly by the diaphragm.
It was formerly charged that tight lacing was a prolific cause
of tubercle in females. Dr. J. M. Allen, (Professor of Anatomy
in Pennsylvania College of Medicine,) has informed the writer,
that he has frequently examined cases where this evil habit had
been carried to very great excess ; and that although the subjects,
previous to death, presented every appearance of a scrofulous
diathesis, yet, to his astonishment, instead of finding the lungs
filled with tubercle, he has universally found them sound and
healthy. lie accounts for this upon the principle, that the stric-
ture upon the diaphragmatic portion of the chest, produced a
necessarily increased action of the muscles upon the upper
portion, and that through this means, the circulation there was
rendered more active, and tubercle warded off.
It is hoped that no one will infer that the pernicious and
abominable practice of tight lacing is for one moment advocated;
far from it, but, as it sometimes happens, that one evil may
point out a remedy for another, so in this instance, we are taught
that one of the best prophylactics against anticipated consump-
tion consists in moderate, but frequent, exercise of the arms and
superior portion of the chest.
Formerly, fibrin was thought to constitute the great pabulum
from which the healthy tissues of the body were nourished and
repaired; now, however, it is generally conceded to be a retro-
grade condition of albumen, and of but little use in the economy.
To those who still maintain the former opinion, a theory of the
kind here advocated will probably appear idle and unsatisfactory,
but to others, the views herein presented—defective and imperfect
as they are—may, at least, seem to claim some shadow of plau-
sibility.
In speaking of the treatment of Phthisis, it is proposed only to
hazard a few conjectures upon the influence of some of the most
prominent remedies which have been, and are still, recommended.
One of the most favored, and probably most effectual, remedies
in use is the Oleum Morrhuse. This probably acts by furnishing
fatty matter to unite with the oxygen of the blood in the genera-
tion of animal heat, and thus neutralize any excess; preventing
an undue accumulation of super-oxygenated fibrin, and prevent-
ing a consumption of muscular and nervous tissue; the iodine
and bromine contained in it also acting beneficially, by promo-
ting, softening and absorption of any concretions already formed.
The iodide of potassium and nitrate of potassa, with the other
alkalies administered, may also do good by rendering the fibrin
of the blood more soluble, and less liable to precipitation and
coagulation; but in order to produce this effect they should be
given in large doses, so that some portion of them may be re-
tained in the circulation, otherwise, they will soon be eliminated
and carried off by the kidneys, without exerting any salutary in-
fluence. Nutritious and unirritating food, by building up the
general system, serve also to lessen the quantity and improve in
quality the fibrinous elements of the circulation, and by contri-
buting tone and strength to the economy enable it for a longer
time to withstand noxious influences of any and every kind. Re-
moval to a warm climate may act in two ways: 1st, by creating
revulsion of excitation from the lungs to the liver; next, by
affording less oxygen than would be contained in an equal volume
of air respired in a colder atmosphere.
Exercise, as a prophylactic, has been before mentioned ; it is
also highly efficacious as a remedial agent. It should be of such
kind as to call into action the muscles of the superior portion of
the thorax and, in fact, all that are in anywise, directly or indi-
rectly, concerned in respiration ; and its beneficial influence is
much enhanced by making it of such a nature as to be agreeable
and pleasant instead of forced and obligatory. Riding on horse-
back has been most highly extolled by many, its action being
probably due to the partial fulfilment of the above recommenda-
tion, by using the hands, arms, and shoulders, in the government
of the animal, with the veins, and also by improving digestion
and increasing the general strength. Cases are on record, where
persons, who despairing escape from so hopeless a malady, and
perfectly reckless of consequences, have engaged in pursuits of
the roughest, and apparently, most injurious nature, and who,
after travelling on horseback or on foot, and performing real
manual labor, have, to the joyful surprise of theii' friends, en-
tirely recovered from theii' dangerous condition, and become both
strong and hearty. Sailors, soldiers and others, engaged in
occupations of similar physical necessities, although much subject
to inflammatory affections of the chest, are in general less prone
to tubercle than those whose condition in life would apparently
better protect them from its ravages.
There are many remedies prescribed and used of a palliative
nature, but it is scarcely necessary to mention them in an ar-
ticle of this kind; the limits of the treatise and time for its pre-
paration, both forbid a more extended examination of the sub-
ject. The ideas here advanced have been hastily (perhaps too
hastily) prepared and presented; but should they induce investi-
gation, or cast any light, however small, upon a disease as ob-
scure in its nature, as dangerous and fatal in its consequences,
the highest hopes of the writer will be more than realized.