By Horace Dobell, M.D. (From the "British Medical Journal," Nov. 22nd, 1873.)

Had not Mr. Heather Bigg brought forward my name as the originator of 'lung-splints' (Journal, November 1st, p. 530), I should not have thought it necessary, after all that I wrote on the subject in 1866-7, to join in the discussion on the importance of 'rest in pulmonary consumption,' just now excited by the interesting paper of my friend Dr. Berkart.

"My object in now writing is not to enter into the dispute on the question of priority, but to issue a caution to those experimenting, either with Dr. Berkart's bandages or with my 'lung-splints,' lest anyone should think he has my authority for running into dangers which I have been most careful to avoid.

It was in November, 1872, that, at my request, Mr. Bigg made the first 'lung-splint,' and I asked him to call it at once by this name, as conveying an unmistakable explanation of its objects. He arranged it with his usual skill; it answered admirably, and he has made many others since, adapting each to the special requirements of the case. Before this, I had been accustomed to procure rest for portions of lung by other devices, principally by keeping the arm of the affected side flexed upon the walls of the chest so as to restrain expansion by its weight and by the absence of muscular action; and it was the difficulty of sufficiently localising the pressure by these means to suit special cases that led me to suggest the 'lung-splint;' but whether it be partial rest of the whole of one lung, or more complete rest of a portion of one or both lungs that is desired, the greatest caution is necessary; because whatever local means secure rest to one part of the lungs, throw extra work upon the other parts, and may, therefore, easily do more harm than good.

For this reason, I have always used the greatest circumspection in selecting cases for this kind of treatment, and I trust that, if anyone is led to follow my example in one part of this treatment, he will most scrupulously do so in the other. With this precaution, nothing can be more satisfactory or more common-sense, in the treatment of lung-disease, than the use of lung-splints, bandages, and the like; whereas without it nothing can be more foolish.

The 'importance of rest in pulmonary consumption' was a necessary corollary upon my well-known hypothesis as to the nature and cause of tuberculosis, viz., that tuberculisation is peroxidation of albuminoid tissue; and in my work on that subject, published in 1866, and in my 'Lectures on the True First Stage of Consumption,' published in 1867, I brought this prominently forward. In enumerating the means of carrying out the 'second principle of treatment in advanced tuberculosis, viz., to save the albuminoid tissues from disintegration to the greatest possible extent,' I said, 'Let respiratory action be reduced to the lowest point consistent with maintaining what remains of appetite and digestive power.' ("Tuberculosis," 2nd edit., page 45); and again (page 47), ' until this point is arrived at - until the balance is turned in favour of the albuminoid tissues - everything which favours the reception of oxygen into the blood, everything which increases the wear and tear of the body, everything which calls for the generation of animal heat, directly favours tuberculisation, and precipitates the patient into the very catastrophe we wish to avert.'

When discussing the views of Dr. Pollock and of Dr. Edward Smith (" True First Stage," pp. 70, 71), I said, 'It will be seen how entirely I disagree with Dr. Pollock in his interpretation of the phenomena which he has so carefully observed. While fully admitting and appreciating the conservative action of the organism in disease, I fail to see an example of it in the wasting of consumption, which appears to me to be the unavoidable effect of an arrest of the supply of an essential material for combustion and for histogenesis - an arrest in the supply of that for which it is impossible to stop the demand while life continues. On the other hand I can see an example of conservative action in the attempt instinctively made by the patient to stop this demand by lessening respiration, abstaining from exertion, and seeking artificial heat - phenomena which Dr. Edward Smith interprets so differently. While fully admitting with Dr. Smith that, in early phthisis, respiration is diminished, I believe that he is totally wrong in his interpretation of its meaning. It is a law of animal nature to save a tender part, and I see, in the attempt at lessened respiration in early phthisis, an example of the operation of this law. The blood in the pulmonary circulation is deficient in the materials which the inhaled air seeks, the delicate tissue of the lungs is exposed to injury by the air, through deficiency in its usual protection of fatty blood, and nature comes to the rescue by attempting to diminish the quantity of air that is brought into the unprotected lungs, just as she shuts off the access of light from an inflamed retina by closing the iris or the eyelid.' In referring to climatic treatment, I said ("True First Stage," page 50), 'the second object of climatic treatment - economy of fat and carbon in the organism, and protection of the lungs from undue oxidation, i.e., provisional protection against tuberculisation - is of the greatest importance. We must look for an atmosphere sufficiently warm to save some of the demand for carbon to supply animal heat, and we must look for a place where this warm diluted air can be breathed with as little exercise as possible.' I recapitulate these statements, because it has been under the dictation of the principles to which they refer that I have been accustomed to prescribe rest in pulmonary consumption, whenever tuberculisation has commenced or is already imminent. First, rest of the whole body; secondly, rest of the whole of both lungs; thirdly, rest of one lung; fourthly, localised rest of diseased portions of lung.