Observations on the treatment of phthisis pulmonalis / by John Hughes Bennett.

Bennett, John Hughes, 1812-1875.

Date:: 1850

Catalogue details

Licence: Public Domain Mark

Credit: Observations on the treatment of phthisis pulmonalis / by John Hughes Bennett. Source: Wellcome Collection.

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exceeding three ounces in amount, and sometimes only slightly tinging the sputa. He was treated at these times by means of quietude, opiates, and ace¬ tate of lead, none of which, however, appeared to me to possess any counteract¬ ing effect, as the haemoptysis was evidently the result of changes in the lung, in connection with the contraction of the tubercular ulcers. He always felt more or less constriction in the chest before any considerable hemorrhage, which was invariably relieved by it. Occasionally, also, he experienced considerable dyspnoea, and an intense longing for fresh air. On one of these occasions in April, he rushed out of his lodgings, and walked rapidly on the Calton Hill, when he found the dyspnoea left him. He insisted on repeating this on similar occasions, and he assured me it always produced the desired effect. As the season advanced, he prolonged his walks. A very common one with him was to the summit of Arthur’s Seat, and in June all haemoptysis and dyspnoea left him. He recommenced his studies also in the University at the commencement of the summer session in May. At the end of July, I again carefully examined his chest. Although dulness under the right clavicle still continued, I was satisfied it was not so intense as formerly. On auscultation, there were loud friction noises, which completely masked the respiratory murmurs. The vocal resonance continued. On the left side there was still slight roughness of the inspiration, and prolongation of the expiration, but nothing more. His general health, though far from good, was much improved. He was still pale and thin. There was occasionally cough and tough expectoration. The appetite, he said, was good, and the bowels regular. I again cautioned him to avoid all exposure to cold and damp —to live well—to take exercise—and apply occasional counter-irritation to his chest, and he left Edinburgh for the autumnal recess. In November 1844 he returned to Edinburgh. He was greatly improved in appearance, and described himself as being much stronger. During the holi¬ days he had used horse exercise frequently, and been much in the open air. There was still occasional cough and tough expectoration, not tinged with blood. The physical signs were much the same as when I last saw him, although the intensity of the friction-murmurs had somewhat diminished. He positively refused to confine himself the next winter as he had done the last, being convinced that he could not breathe the confined air of a chamber with¬ out injury ; and it was with some difficulty that I obtained a promise from him not to go out during wet, or unusually severe cold weather. Every other pre¬ caution to avoid exposure to cold, and all exciting causes of exudation, was to be carefully observed. He attended his classes regularly for six weeks, when, owing to the weather, he lost several lectures. This caused him great annoy¬ ance,—the more so, as he intended to present himself for examination in the spring. About the middle of January 1845, he sent for me. I found him with the face flushed, skin hot, rapid pulse, coughing violently, and expectorating a muco-purulent matter, tinged of a rusty colour. On listening over the apex of the right lung, there were heard crepitating and mucous rales, mingled with friction-murmurs similar to those which formerly existed. The rest of the lung was free. The apex of left lung was not affected. It was clear that a new attack of pulmonary congestion and exudation had taken place. He con¬ fessed that he had been very unwilling to send for me ; that he had felt him¬ self getting worse for the last week, and was conscious that the attack had been occasioned by his persistence in attending classes, and sitting so many hours probably in damp clothes and wet boots. The same treatment as was adopted on a former occasion was again put in force—-quietude, with tartar- emetic, and opium. In a week, the febrile symptoms had much abated, but the pulse continued quick; the appetite was destroyed, and his strength was again much reduced. All attempts to eat occasioned nausea and disgust—he could take no animal food. The tongue was loaded, and there Avere almost continued acid eructations. I ordered tartar-emetic ointment to the chest;