Symptoms of Tuberculosis

Richard Morton (d. 1698), the author of Phthisiologia seu Exercitationes de phthisi tribus libris comprehensae (London, 1689) was perhaps first drawn to the study of tuberculosis due to his position as physician-in-ordinary to William III who was known to have respiratory problems. As Trail (1970) has pointed out, Morton’s text proved to be very influential during the reign of William’s successor, Anne. Morton was eager to stress that though the symptoms of consumption (a common name for tuberculosis) were similar to other diseases they could, even in their initial stages, be correctly diagnosed. Chapter III considers ‘Diagnostick and Pathognomonick Signs of the beginning of a Pulmonary Consumption’ and argues that the beginning of a consumption had no ordinary cough but rather that a ‘Consumptive Cough proceeds from a Glandulous Swelling, or Tubercule of the Lungs themselves, and that with the sense as it were of some heavy weight in the Breast, as also a difficulty of Breathing, and other Symptoms of the same Nature’. Such a cough in his view was different in nature and in cause from a ‘simple Catarrh’ which owed ‘its Original from a distillation of Rheum cast out as it were in continual dropw by the Uvula and Almonds, and the other Glands seated in the upper part of the Wind-pipe, yea, and by all the glandulous Coat of the Wind-pipe it self.’

Richard-Morton
Portrait of Richard Morton: Courtesy of the National Library of Medicine.

For Morton the beginning stages of consumption of the Lungs (as opposed to scrofula, the King’s Evil, which was a tuberculosis of the lymph nodes), was marked by three diagnostic signs: the first, as we have seen, was a particular type of cough. The second was a fever, which would often be seen in conjunction with ‘the loss of Appetite, some Thirst, a Urine somewhat high colour’d, a quick Pulse, want of Sleep, a heat of the Parts, especially the extream Parts, and other such-like Symptoms’. The third sign was more unusual: ‘a wasting, or extenuation of the Muscular Parts, which in the beginning of the Distemper is very slow, and almost insensible (the Parts at this time rather growing loose and flabby, than wasting) until from an Inflammation of the Tubercules, or from Apostemes, or some other Accident and Inflammatory or Putrid Fever comes to be joyn’d to the Hectick…’

A ‘confirm’d consumption of the Lungs was characterised by the following ‘Pathognomonic Signs’: ‘a new Fever added to the Hectick, and that first, Peripneumonical, afterwards Putrid and Intermititng; and a greater colliquation of the Blood, which is mightily increased by the new Fever, and discovers it self by Prodigious Sweats, a Catarrhous Cough, a Looseness, Dropsie, Thrush, and a particular soreness of the Throat in swallowing.’ Thus fever in turn led to sweating which in turn led to the production of ‘a thin and waterish Looseness, or else a Bloody-Flux’. A ‘Dropsie of the Breast, or else of the Belly’, the fourth sign followed on from this and led to the fifth sign: a great heat in the throat caused by aggravated tonsils.

Many of these signs are confirmed in Christopher Bennet’s ‘Observations relating to the Diagnostick Signs’ in Worth copy of the Latin text produced at Leiden: Tabidorum theatrum; sive, Phtisios, atrophiae et hecticae xenodochium. Item Vestibulum tabidorum … (Leiden, 1714), reproduced here from the 1720 English translation printed at London.

Tabidorum-title-page
Christopher Bennet’s Tabidorum theatrum (Leiden, 1714), title page.

‘We know this Distemper to be approaching when the Blood or bring Current is carried towards the Breast with a slower or quicker Motion.

Its slower Efflux is discernable:

1. By bloody and brackish Excretions brought up with Spitting at certain Periods, that is, in the Morning, or Afternoon, and continued for four, five, or six Hours, more or less, according to the irritations they occasion, or as they are determined by the Exercise of the Body…
2. By more frequent Spitting and Hawking.
3. By an interception of the cutaneous and other Excretions.
4. By Spittle of a light and frothy Substance.
5. By globulous Spittle rolled up like Hail-stones, and forced up at the forementioned Hours, by sudden Coughing or Hawking.
6. And the certainty of all this is confirmed, when from any Cause there happen a Defluxion of a brackish Matter upon the Joints or Extremities of the Body, and the Breath in that time gets Strength.

More vehement and plentiful Affluxes are known,

1. By more copious casting up a frothy Blood of a clay Colour, with Hawking and Coughing less painful, if from the Lungs; but of a blackish or deep red Colour, with a more painful Coughing, if from the Cavity of the Thorax; if from the great Arteries, regurgitating into the Mouth by Gushes and Intervals…
2. By a heavy Pain upon the Breast, and which is pungent by Fits.
3. By a periodical Difficulty of Breathing.
4. By a manifest Lightsomeness of the other Parts.

Selected Sources
Bennet, Christopher (1714) Tabidorum theatrum; sive, Phtisios, atrophiae et hecticae xenodochium. Item Vestibulum tabidorum … (Leiden).
Morton, Richard, Phthisiologia seu Exercitationes de phthisi tribus libris comprehensae (London).
Payne, J. F. (2004), ‘Bennet, Christopher (1617–1655)’, rev. Patrick Wallis, Oxford Dictionary of National Biography (Oxford: Oxford University Press), 2004.
Trail, R. R. (1970) ‘Richard Morton (1637–1698)’, Medical History, 14, 166–74
Wright, Stephen (2004) ‘Morton, Richard (bap. 1637, d. 1698)’, Oxford Dictionary of National Biography, (Oxford: Oxford University Press), 2004.