Phthisis Pulmonalis, or pulmonary consumption.

Barker defines pulmonary consumption as a wasting disease with destruction of the lungs, explaining that the poor results of treatments by the ancients was due to medical instruction “destitute of anatomical knowledge.” He cites Thomas Reid and quotes David Ramsay, that from 1700 to 1800, thousands of dissections led to improved treatments. Barker’s experience includes his careful observations on consumption, having lost three wives and two children to the disease, when the nature of this disease was “involved in obscurity.” He knows that he had been called “an unskillful and unsuccessful practitioner in consumption,” but feels that he has learned from his own sad experience. He comments on consumption in pregnancy and parturition as well as in young females whose “customary evacuations” fail to take place, followed by a hectic fever and often death. “Exposure to evening air, in the parade of parties, and the ball room, clad in cobweb muslin, has laid the foundation for consumption in many fashionable young females, and consigned them to an untimely grave!” Phthisis pulmonalis frequently takes place in consequence of neglected pneumonia, influenza, and measles.

THE TREATMENT OF RICKETS, AS SUGGESTED BY BOERHAAVE AND GLISSON AND INTERPRETED BY DR. JOHN THEOBALD OF LONDON IN 1764

In 1764 the Duke of Cumberland asked Dr. John Theobald of London to compile a medical guide for the young wife to manage her children from the time of their birth to the age of 7 years. In about 49 pages, Dr. Theobald wrote a book containing "everything necessary to be known relative to the nursing of children, from the time of their birth to the age of seven years; together with a plain and full account of every disorder, to which infants are subject, and a collection of efficacious remedies, suited to every disease." This little book might well have been the "Spock" of its period. A good example of how Theobald presented the latest information about common pediatric diseases to young mothers—over 200 years ago—is this chapter on rickets. This distemper most frequently affects children from nine months old, to two years and a half. The child at the beginning is seized with an aversion to motion, or exercise of any kind; the joints grow feeble and weak, and the flesh soft and flaccid; the head is over large, and the child's capacity exceeds its years. The belly is hard and very prominent; the bones of the arms and legs, grow crooked and are knotty at the joints; a cough comes on and difficulty of breathing; the pulse is low and languid, and an hectic fever carries off the child. Take of the beet manna a drachm and an half, of dried raisins an handful, common ale a pint; infuse them together for twelve hours, and then strain them; let the child drink a draught of this frequently. . .

THE CLINICAL HISTORY OF A FOUR-YEAR-OLD GIRL WHO IN FEBRUARY 1793 SWALLOWED AN IRON NAIL

The report of a case is, as Fishbein reminds us, "the foundation of clinical medical literature." An excellent example of the literary style of an eighteenth century case report is that of Dr. Wilson, of Edinburgh, which follows: A girl in the fourth year of her age in the month of February 1793, by accident swallowed an iron nail, nearly two inches in length. In its passage, it wounded the oesophagus, which bled freely; and a soreness was felt there for some time. In about a fortnight, a trifling cough supervened, with thirst and general fever. This fever had remissions and exacerbations; but the cough and thirst became incessant, with occasional sickness and pain in the stomach and bowels. In the winter, the child began to expectorate much phlegm, particularly in the morning. This was invariably attended with distressing pain in the region of the stomach. Her appetite, however, during the remissions of fever, was somewhat improved; and she gradually recruited her strength a little. But during the fifteen months for which the nail was present in her stomach, her growth was almost entirely suspended. On the 5th of May 1794, I was consulted respecting the complaints of this child, on the supposition that she had worms. Not knowing anything of the former circumstances, I was ready to ascribe the above symptoms to the presence of worms; and I prescribed medicines with this view of the case. The child at this stage appeared to be in the last stage of a decline, having regular night sweats and hectic-fever.