porters, etc.—a class of persons, perhaps, worse clad than almost any other-are, nevertheless, not so frequently as might have been expected applicants at the Consumption Hospital. And I have generally observed, amongst the out-patients at that institution, that the sufferers from phthisis, so far from being persons who have been careless of themselves in this particular, are remarkable rather for their punctilious regard to protecting themselves from cold, frequently making it an occasion for boasting that they have always been the same. The greater liability to consumption amongst males, to whom custom allows, at all times, what to the other sex it denies, viz., a proper covering to the chest, is an additional argument in favour of the trifling influence of clothing. It would be wrong, however, to suppose that this subject is altogether unconnected with the origin of phthisis; because, it is evident, that in proportion as it affects the general health, and exposes the system to the chances of inflammatory attacks upon the chest, so must it lend its aid towards producing the disease. Yet, it is certain, that what might be deemed sufficient clothing is less necessary than many other conditions to the avoidance of this malady; and that, however scrupulously the covering of the body may be attended to, it will fail in preventing the inroads of consumption. The restraints of dress, especially that of tight lacing in females, have been accused of leading to tubercular affections of the lungs; but here again there is a want of anything like proof of their doing so; and the preponderance of such diseases in the male sex, appears, in a great degree, to contradict such a conclusion. A chest naturally healthy will often endure, with surprising impunity, the changes of form which fashion makes imperative; and when it is otherwise, the punishment for so absurd a homage to the world seldom appears in the form of consumption, but rather in some functional or organic derangement of the liver and abdominal organs, or of the heart. Mental Influences.-The operation of the mind upon diseases of every kind is too obvious to admit of doubt; and it is a question far from being settled, whether or not any sort of malady, even those which are known to be propagated by contagion, may not sometimes arise solely from mental impressions. I firmly believe that they may; and could quote many illustrative cases. The only instances which have appeared to me to give any sanction to a belief in the contagiousness of phthisis, have been those, where, in addition to some general cause of reduced health, the mind has been thoroughly impressed with a fear of infection. Numerous cases are within my recollection, where the closest attention which affection could dictate, has been given, for a long series of weeks and months, to a consumptive friend or relative, without producing the slightest ill effect to the survivor, simply because the idea of danger was never entertained. On the other hand, I could mention instances where the same kindly acts which had but lately been conferred, were shortly afterwards required; a strong belief having existed in the possibility of contagion. I have even thus seen the same form of phthisis exactly imitated; which the following case will tend to illustrate. A gentleman, in whom ulceration of the trachea had been the most prominent symptom, recently died of his disease; and the nurse, who was bound to him by ties of gratitude which the thought of her own safety could not sever, is now suffering with the early symptoms of laryngeal phthisis, and has repeatedly told me, that from the time she first tended her master, she was so firmly impressed with the certainty of contracting the same disease, that she looked upon her life as hopelessly sacrificed. In such instances as this, I firmly believe that the disease does not originate by the extension of a material poison, but is conceived mentally. A somewhat similar influence is now and then painfully exhibited in a consumptive family, where nothing but a separation of its members appears to have the power of checking the ravages of the malady. I have known cases in which nearly every child who has been retained under the parental roof, has fallen the victim of phthisis; whilst those whom circumstances had separated from the rest have been spared. It is probable that the change thus induced in many external conditions, may have contributed to the result; still, I believe that more has been due to the absence of that mental depression, and that trial to the feelings, which must ever be experienced in watching the fatal progress of the disease in a near relative. Depression of spirits, when long continued and severe, may, even of itself, generate the tuberculous diathesis. How frequently can we date the commencement of phthisis from some reverse of fortune or family affliction, or from something which has deeply affected the mind! We hear of the "broken heart" of affliction; yet this is generally but a metaphor, signifying that sorrow and worldly cares may be destructive of life;-the physician knows too well how easily these may develope a tuberculous state, and how unpromising are the cases thus originated. It is an interesting fact in connexion with this subject, that the mortality in our lunatic asylums is greatly attributable to phthisis; since it seems to afford additional evidence that peculiar mental conditions may be reckoned amongst the causes of consumption.* The circumstance, however, has * Those who are principally engaged in the treatment of mental diseases, would do much service by ascertaining whether phthisis is a more common attendant upon one form of insanity than another;-for example-whether it is oftener seen in cases of melancholia than in those of acute mania. been differently explained; some have thought that phthisis and insanity are closely related in their origin, so that the developement of one necessarily implies a tendency to the other. But to this opinion, I cannot help demurring, having, after much inquiry, come to the conclusion that insanity is anything but a common disease in families. afflicted with hereditary phthisis; which certainly would not be the case if the two affections proceeded from a common source. Dyspepsia is so common and early an attendant upon phthisis, that it is often difficult to say whether it is to be looked upon as a cause or a symptom. I shall have occasion to speak of it, as the latter, in another place, and have, here, only to consider how far we are justified in classing it amongst the predisposing causes. That dyspepsia, however chronic and obstinate, does not necessarily lead to phthisis, we have abundant proof; yet I have seen numerous cases, where it might reasonably be looked upon as the starting point of the malady. Persons of delicate health, but whose only real disease appears to be dyspepsia, are sometimes seen to become rapidly consumptive, although, perhaps, neither hereditary taint nor other predisposing cause is discoverable: in some inexplicable manner, the powers of assimilation seem to have been insufficient for properly organizing new materials, and lowly-vitalized or scrofulous substances have found their way into the circulation. G |