Imagens das páginas
PDF
ePub

I do not believe, however, that the advance of consumption is positively incompatible with pregnancy, having myself seen more than one instance where the two progressed simultaneously, and even one in which phthisis apparently commenced about the middle period of gestation. There are, perhaps, few general rules open to so many exceptions as are those relating to this subject; but I am convinced that, should additional observations be made upon a sufficiently large scale, they will only serve to confirm the statements I have advanced.

Lactation is by no means uniform in its effects; sometimes helping to retard the appearance or progress of the disease; at others, promoting or greatly aggravating it. The latter, perhaps, is the most usual, it being far from uncommon to see phthisis both commencing and running rapidly onwards during the period of suckling. If, however, it should, like pregnancy, keep the disease, for a time, in check, the ultimate result is the same; the consumptive affection progressing afterwards only with increased rapidity. But of all things, perhaps the most energetic in arousing a phthisical predisposition, or even sometimes in giving rise to it, is, the evil practise of long-continued nursing,—one especially common amongst the poorer classes, in whom it is no very rare thing to find it carried on for a period of two years and upwards. To this cause I have frequently traced consumption; and this not only

H

in persons who had a previous tendency to it, but also in others who had hitherto enjoyed excellent health, and were, to all appearance, quite free from hereditary taint.

PART II.

THE SYMPTOMS OF CONSUMPTION.

CHAP. I.

GENERAL DESCRIPTION OF THE SEVERAL STAGES.

ALTHOUGH the course of phthisis is marked by a gradation as well defined as that of any other disease, it would be difficult to meet with its equal, in the almost endless variety of symptoms which accompany its several stages; in its career it simulates the most opposite maladies; and scarcely two cases are to be found strictly alike in their progress.

Consumption presents itself under two forms, viz., acute and chronic, both of which are subject to certain varieties; yet, in every instance, the disease is essentially the same, being only modified either by its severity, or by the varied conditions with which it is associated.

I propose giving, in the first place,' a general description of the ordinary or chronic form of the disease; leaving the varieties to which it is subject for after-consideration.

The symptoms may be conveniently arranged as

belonging to two periods: viz. (1), that preceding the formation of pulmonary tubercles; and (2) that subsequent to their developement.

(1.) The period preceding the formation of tubercle. At no time is the changeable character of phthisis more apparent than at its very onset. Sometimes

this, which we may term the preliminary stage, is so well defined, that to fail in recognising it would be inexcusable; at other times, it is either too brief, or too indistinctly marked, to be detected.

Although this early period of consumption has been but little dwelt upon by medical writers,* it is, I think, very often distinguishable by the presence, in a greater or less degree, of the following train of symptoms:-From some cause, for which no good reason can be assigned, there is a slow but marked diminution of bodily vigour, compelling the individual to abandon many of his accustomed pursuits: the spirits, nevertheless, are good, and not only is the idea of consumption never entertained, but any allusion to it is at once

*This preliminary stage does not correspond with what is commonly understood as the scrofulous diathesis, or the tuberculous cachexia so fully described by Sir James Clark. It is a more advanced condition of disease. There is at this time not merely a tendency to the construction of tuberculous elements, but these actually exist, and the system is under their influence, although there is no evidence, either by local signs or general symptoms, of their separation from the blood in the form of tubercle. It would probably include many cases of what are sometimes called threatened phthisis.

ridiculed. So general, indeed, is this hopeful condition, this almost instinctive blindness to the real cause of distress, that in its absence, however suspicious certain symptoms appear, these may, with much probability of accuracy, be pronounced unconnected with phthisis. The complexion is, at the same time, pallid or sallow; the expression is that of care united with animation; the features are somewhat sharpened; the movements of the body are hurried and anxious; the mental condition is irritable and capricious; whilst every act betrays an effort, sometimes instinctive, and at others, voluntary, to conceal the presence of disease. The appetite is uncertain, and there are frequent indications of imperfect digestion, as well as of a tendency to passive diarrhoea. The pulse is slow, small, and easily excited. The sleep is restless, unrefreshing, and occasionally attended by perspirations. Loss of weight is of invariable occurrence; sometimes the decrease is so rapid that it will attract the attention of friends; at other times, it requires the periodical use of the weighing machine to detect it ; the latter, perhaps, is the most usual, but I have met with examples of such rapid emaciation, that several pounds have been lost within a few days.

This preliminary stage is very uncertain in its course in some instances it will, under proper treatment, quickly subside; in others it will continue for a considerable period, and then disappear; but far too often it will resist the best efforts, both of physician and patient, and pass rapidly onwards

« AnteriorContinuar »