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By beginning his vade mecum with consumption and asthma, Osborn is starting with what is perhaps the most deadly disease he has had to witness and treat. Consumption is tuberculosis, a disease brought on the by infection of lung tissue by a fungus-like bacterium or mycobacterium known as Mycobacterium tuberculosis. Mycobacteria likes to reside upon moist dark surfaces, and can be spread to other people as sputum, through coughing, sneezing and even talking. Long term signs of consumption include the development of a chronic cough, which at times can go into remission along with the activity of the mycobacterium, night sweats, and weight loss. Untreated, about 50% of its sufferers die. The experiences leading up to death could have been worse during the colonial years due to lack of understanding of this disease and a tendency to engage in activities conducive to poorer outcomes.
Dr. Osborn relates Asthma to Consumption due to their shared relationship with the lungs. His treatment modalities focus on the elimination of excess phlegm, the humor related to these two respiratory conditions. His use of St. John’s Wort adds a peculiar color (very dark green to black) to an otherwise white to colorless phlegmatic disease with some biliary (yellow phlegm coughed up), or black biliary (pulmonary tissue expressed outward from the diseases lung), and sanguine presentations (coughing and spitting of blood) when in the worst of conditions. The fairly thick, syrupy lohock or electuary recipe is designed to faciliate the passage of the medicine down into the throat, but slow enough to influence and/or stay with the lung on its way into the body. Once consumption begins to afflict the entire body, making a patient much weaker, one major way to improve upon the therapy is to produce a diet drink with which the body is nourished. Pectoral expectorants serve to facilitate the expulsion of excess phlegm from the body through lungs.
Obviously there is a difference between Asthma and Consumption. Asthma is characterized by difficulty breathing, a feeling in the chest, possibly a sense or appearance of dryness in the throat and air passages, with facial to neck skin color changes and tissue changes suggestive of loss of energy, too much heat (if reddening occurs), and the sense of tightness. Colorwise, white and red tend to present. In terms of humours, we are talking about phlegm, and also blood should hemoptysis present.
Contrast this with consumption. In mild cases, there may be little more presentation than just some lost vitality, and some presentation of coughing and sputum (phlegm). In time, other humours present, such as the blood, then the yellow bile (due to bacterial infection inside actually–which they did not differentiate that well or know anything about), and finally, as the decay sets in–the black bile begins to present with sputum and cough. Even when the cough ceases and the problem seems to subside or become active, there is the likelihood that the disease will return, and the doctors know that a patient could remain fairly weak due to a slowly changing state of “decay.”
Now there are also several “betweens” that exist for this disease progression that Osborn may have believed in. There are the cases of bronchitis, bronchiectasis, and hay fever that he may have seen. Osborn would have probably interpreted these as simpler examples of the asthma, or a precursor to its onset, and/or assigned them a more corporeal status, claiming they were not induced as much by emotion and temperment as true asthma could be.
Brian Altonen, MPH, MS 
