Monday Series: A Disease with no Remedy II

 

 

Jan Steen (1626-1679). The Doctor's Visit (1658-1662). Oil on panel. 49 × 42

 

The word “tuberculosis” was not introduced as a classification term until 1834 by the German physician Johann Lukas Schönlein (1793-1864),[1] though it was first used by the British physician Richard Morton (1637-1698) in 1689. Commonly named by the medical community as “phthisis,” or “consumption,” signifying the wasting characteristics of the chronic disease, this “white plague” was the single largest killer of all adults in the eighteenth and nineteenth centuries and served as a representation of the heightened sensibility idiosyncratic of an enlightened culture of “high-living.”[2] Often at odds with reality, phthisis was a chronic, symptomatic disease without a distinctive cause, and as a result, “its nonepidemic nature also increased its appeal for the enlightened, since the patient was able to die individually, not amidst the countless dead.”[3] However, as David Barnes points out, the illness was not merely a metaphor, “not just a sign through which social relations or anxieties expressed themselves.”[4] It was a real disease that killed real people and despite descriptions of romantic imagery and snobbish aspirations towards sensibility, it was a disease that doctors struggled to cure.

In 1720, English physician Benjamin Marten (1704-1782) wrote, “of all the Distempers that afflict Mankind, there’s not one, for the Cure of which more Remedies have been appropriated and invented than a Phthisis, or Consumption of the Lungs.”[5] In the search of remedies, William Lambe (1765-1847) agrees “the treasures of nature have been exhausted by the experiments of benevolence, or the audacity of empiricism.”[6] Thomas Beddoes (1760-1808) echoed similar words in 1803: “For the treatment of consumption…a great deal more remains to be done than to add to the mass of unexceptionable evidence, lately produced. No uniform method, and no single medicine is capable of effecting a cure in all the cases, referred to any denomination of disease.”[7] The long incubation period and occasionally asymptomatic nature of phthisis, along with its flexible and complex etiological model, led physicians to concentrate on developing cures for visible symptoms.

A mixture of medicine and dietetics were advised for consumptive patients, with an emphasis on proper diet, since “the patient in general should…eat food of easy Digestion”[8] to limit any obstructions in the bodily fluids. Edward Barry (1696-1776) advocated a popular milk diet, which he believed to be the “most fit to repair the great Decays of Consumptive Persons.”[9] Although Marten agreed with the theoretical benefits of a milk diet, he noted that he not “been able to discern such good Effects from it, in a true Phthisis, as to merit its being rely’d on for Course.”[10] Other physicians were more particular about outlining a dietary regime for consumptives. Philip Stern, for example, outlines a diet that allows a consumptive to “eat as often as he has an appetite, but never much at a time.”[11] No eggs or other animal foods were allowed, although a small quantity of veal or chicken broth was acceptable if the patient was weak. In addition, “potatoes, turnips, carrots, parsneps, beans, spinach, broccoli, fallets, bread and rice” was to constitute the general bill of fare, along with almond milk, barley water, or milk and water.[12]

Combined with diet, medicines were recommended to promise relief for the consumptive, “as they defend the Blood from the purulent Matter mixed with it and are mild and penetrating, as not to obstruct or irritate the Lungs in passing through them.”[13] Samuel Foart Simmons (1750-1813) advised the use of the elixir of vitriol, Peruvian bark, balsams, and periodic bleeding, and notes that “the use of blisters and issues, opiates, a milk and vegetable diet, exercise, and change of air, are pretty generally recommended by all.”[14] Other symptomatic cures, such as emertics, catharites, sorbefacients, epispastics, sudorifics, expectorants, demurcents, narcotics, suppuratories, astringents, tonics, angostura, lichen, were also advised. Beddoes in particular was fond of the foxglove. There were also other unique treatment methods. Many physicians advised Thomas Sydenham’s recommendation of country air and horseback riding. Lambe was fond of distilled water,[15] and Simmons wrote about “earth bath,” an old and common remedy in Genada and some parts of Andalusia.[16]

NOTES 


[1] E. Lomax, “Hereditary or Acquired Disease? Early Nineteenth Century Debates on the Cause of Infantile Scrofula and Tuberculosis.” Journal of the History of Medicine and Allied Sciences 32 no.4 (Oct. 1977), 357. Prior to the closing decades of the nineteenth century, phthisis was commonly believed only to afflict in pulmonary forms; the presence of the tubercule bacillus in other parts of the body proved that tuberculosis was prevalent as other diseases, particularly in scrofula, or King’s Evil.

[2] Historian Margaret DeLacy explicates that though there was a large numerical increase in deaths from consumption, this does not mean that more deaths were statistically attributed to consumption due to any fundamental change in the concept of the disease; one does not suggest the other, though it may raise questions for historical analysis. M.DeLacy, “Nosology, Mortality, and Disease Theory in the Eighteenth Century.” Journal of the History of Medicine and Allied Sciences 54 (April 1999), 266.

[3] C. Lawlor and A. Suzuki, “The Disease of the Self: Representing Consumption, 1700-1830,” Bulletin of the History of Medicine 74 (2000). 465. Roy Porter also provides an excellent description of the effect of Enlightenment ideology in the social perception of consumption, in particular, the ways in which the culture of sensibility affected diets and social habits. See his paper,. “Consumption: Disease of the Consumer Society?” in Consumption and the World of Goods. Eds. John Brewer and Roy Porter (London & New York: Routledge, 1993), 58-81.

[4] D. Barnes, The Making of a Social Disease: Tuberculosis in Nineteenth-Century France (Berkeley: University of California Press, 1995), 19.

[5] B. Marten, A New Theory of Consumption: More especially of a phthisis, or consumption of the lungs…(2nd Ed.) (London: Printed for R. Knaplock, 1722), 75.

[6] W. Lambe, A Medical and Experimental Inquiry into the Origins, Symptoms, and Cure of Constitutional Diseases; Particularly Scrophula, Consumption, Cancer, and Gout (Illustrated by Cases) (London; J. Mawman, 1805), 8.

[7] T. Beddoes, Observations on the Medical and Domestic management of the Consumptive: On the Powers of Digitalis Purpurea and on the Cure of Schrophula (New York: Penniman and Co., 1803), 4-5.

[8] Marten, A New Theory of Consumption, 142.

[9] E. Barry, A Treatise on the Consumption of the Lungs with a Previous Account of Nutrition, and the Structure and Use of the Lungs (London: Printed for William & John Innys, 1727), 260.

[10] Marten, A New Theory of Consumption, 145.

[11] P. Stern, Medical Advice to the Consumptive and Asthmatic People of England (16th ed) (London: J. Almon, 1776), 29.

[12] Stern, Medical Advice to the Consumptive and Asthmatic, 30.

[13] Barry, A Treatise on the Consumption of the Lungs, 262.

[14] S.F. Simmons, Practical Observations on the Treatment of Consumptions (London: J. Murrary, 1780), 31.

[15] Lambe, A Medical and Experimental Inquiry, 21.

[16] Simmons, Practical Observations on the Treatment of Consumptions, 78.

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Latest Comments

  1. marc arnold says:

    Have followed your blog with interest over the past year or so. Thought you might be interested in my recent publication that focuses on the history of tuberculosis
    http://www.c-s-p.org/flyers/Disease–Class-and-Social-Change–Tuberculosis-in-Folkestone-and-Sandgate–1880-19301-4438-3967-1.htm
    best wishes,

    Marc

    Like

  2. marc arnold says:

    It is a 335 page book Jai, exploring the changing medical and social perceptions of the importance of heredity, infection, poverty and sanitation as causes of tuberculosis

    Like

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