Wednesday, June 22, 2016

1819: Laennec remedies for consumption

Consumption was the most common disease seen by physicians during the 19th century.  Rene Laennec, in his 1819 book "Mediate Auscultation," gives us a list of common remedies during his time.

He said bleeding was a common remedy for consumption, although he believed it was neither a cure nor a preventative for the disease, and doing so only results in a "useless loss of strength."  (2, pages 387-388)

However, Laennec did support the application of leeches in the upper part of the thighs. (2, pages 387-388)

He described the use of issues and cautery by the ancients.  He said:
Hippocrates directed four eschars with a red hot iron below the axilla, on the breast or back.  Celsus recommends six -- one beneath the chin, one on the throat, one under each nipple, and one at the lower angle of each scapula.  (2, page 388)
However, Laennec said he...
...repeated the application of the searing iron as many as twelve or fifteen times.  It is, however, only a very small number of patients that will submit to a mode of treatment so horribly painful. Small moxas, of only a line in diameter, applied two or three at a time, and repeatedly, have appeared to me more useful than the searing iron; as under their employment I have sometimes se'en a very striking suspension of all the symptoms. At all events, I have now almost entirely renounced the use of the actual cautery. Measures so painful ought not to be had recourse to, unless they are found by experience to hold out a reasonable hope of success. For this reason, I now restrict myself to the application of the caustic potass, in the places above mentioned, so as to form eschars of eight or ten lines in diameter; and I do not even insist upon this, if the patient is very averse to it. (2, pages 388-389)
To promote expectoration, he recommends: (2, pages 389-390)
  • Lime-water
  • The natural and artificial sulphureous lime-water
  • Natural and artificial sulphureous
  • Hydrochlorate of lime
  • Preparations of mercury
  • Hydrochlorate of barytes
  • Preparations of antimony (2, pages 389-390)

To cause the cicatrizing of the internal ulcers, a physician might try: (2, page 390)

  • Plants of an anticorbutic and aromatic kind
  • Purgatives
  • Balsamics, particularly the balsams of Tolu, Peru, and Mecca
  • Terpentine
  • Camphor
  • Sulphur dissolved in volatile oils
  • Vapors from decoctions of plants of an emollient, aromatic, narcotic, or balsamic kind
  • The fumes of different kinds of resins burned on a hot iron or a brazier, particularly of myrrh, benzoin, and petrolium tar
  • The air of cow houses
  • The air produced by the sublimation of zinc, lead, sulphur, etc. 
  • Inspiration of gases such as oxygen, hydrogen, 
  • Etc. (2, page 390-391) 
All of these above were generally thought to provide benefit to the consumptive by one physician or another since the days of Hippocrates.  Laennec said:
I shall content myself with merely enumerating several others, the inefficacy of which has been sufficiently demonstrated. Of this kind are— mercurial salivation; emetics frequently repeated, or continued for a long period in doses sufficient to excite nausea merely; acorns, roasted or raw; charcoal; different kinds of mushrooms, and among others, the boletus suaveolens and the agaricus pifratus and deliciosus ;red cabbage; crabs, oysters, and other shell-fish; frogs; vipers; chocolate; the conserve and sugar of roses in large doses; wine and spirits; sudorifics; electricity; millepedes; opium; cicuta; wolfsbane; cinchona; the seeds of the phellandrium aquaticum; the preparations of lead; hydrocyanic acid; the swing, formerly recommended by Themison (apud Csel: Aurel.) and revived by the moderns, &c. &c.
For those whose consumption was not curable, he offered various palliative treatments.

Emollient drinks, and alimentary matters of a mucilaginous nature, have been always in use,—such as milk, (woman's, ass's, cow's, goat's, mare's,) saloop, sago, gum, Iceland moss, potato-starch, arrow-root, barley, rice, sugar, and the infusions of inert mucilaginous plants, properly sweetened. When the cough is dry, and the expectoration difficult, also when there is a want of sleep, opium in small doses, or any other narcotic extract, is added with advantage. The hydrocyanic acid also sometimes succeeds very well in relieving the cough and even the dyspnoea; but its effects are less certain than those of opium. Antimonials, although at different times much cried up, have never appeared to me of great efficacy, even in aiding expectoration. The diarrhoea must be also treated by mucilaginous drinks, and the milder preparations of opium. However, when it depends on the presence of tuberculous ulcers in the intestines, as it almost always does, we can only hope at best to suspend its violence; and we cannot always even effect this. The acetate of lead appears sometimes to moderate this symptom; but it is much more efficacious in lessening the perspirations: indeed it is almost the only means we can oppose to these. Dyspnoea must be combated by the preparations of opium and other narcotic plants. The hydrocyanic acid and musk are also sometimes beneficial in this respect. I speak not here of pulmonary congestions, whether terminating in inflammation, haemorrhage, or serous effusion. I shall merely remark, that, in these cases, we must not take away more blood than is absolutely necessary to relieve the symptoms, since bleedings, either too copious or too frequent, have an evident effect in accelerating the progress of the disease. (1, page 395)
However, while all of these could be trialed by a physician, the one remedy he found to be most useful was that of relocation.  He said this was a trend the English recently picked up, and which he found to be quite effective, particularly relocation to the seaside, or a voyage at sea.   (1, pages 243-394)

  1. Ramadge, Francis Hopkins, "The Curability of Consumption: the reprint of a series of papers, presenting its most prominent and important practical points in the diagnosis, prognosis, and treatment of the disease," 1850, London, Printed by W. Clowes and Sons
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