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PREFACE.

In order that the reader of the following pages may not be disappointed with their contents, it is necessary to observe that they are not intended to introduce any newly discovered "cure for consumption", or to advance any speculative theory as to the origin of tubercular diseases; but, to present a practical exposition of phthisis, derived from personal observation.

It is becoming too much the custom, in treating of medical subjects, to indulge in theoretical discussion rather than in practical deduction; and thus to lose sight of that great end-the cure of disease, without which our art is a fruitless one. Chemistry and the microscope have certainly increased in a remarkable manner our knowledge of morbid conditions; but there is much in phthisis, as well as in other diseases, which neither the one nor the other can unravel; and hence it is that

when either of them is made the foundation of some ingenious hypothesis, which is afterwards to serve as a guide to medical practice, its use is misdirected and its service questionable.

Nothing but a comprehensive and practical view of any diseased action-assisted but not absolutely controlled by the discoveries of science— will ever enable us to gain such a knowledge of its nature as will lead either to its prevention or proper treatment. And since I have a peculiarly favourable opportunity of observing a particular malady—that of phthisis,-in which too many have a more or less direct and painful interest, it has seemed to me that its description, upon such a principle, might not be altogether unprofitable, and might serve in some measure to check those empirical, deceptive, and even dangerous doctrines which are now so frequently appearing in reference to that disease.

46, Clarges Street, Piccadilly,

October 1852.

INTRODUCTION.

It is probable that Consumption was one of the earliest maladies which visited the human race: it was well known to the physicians of ancient Greece and Rome, and since their days has continued one of the most destructive weapons of the Almighty.

All diseases attended by emaciation were divided by the early fathers of medicine into three classes, which they termed respectively, Atrophy, Cachexy, and Phthisis, but it was only in the last of these that the lungs were said to be implicated; and it is no little tribute to their skill and discernment, that, in these modern days, the same terms and distinctions should be revived. Physicians of succeeding years, neglecting the teaching of their professional forefathers, were in the habit of using the word phthisis or consumption, as a means of conveniently explaining away many chronic cases, the

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pathology of which was little understood; and this error still survives, to a great extent, in public opinion, consumption being popularly made to embrace a vast number of very different diseases, attended by a gradual wasting of the body. Simple emaciation is, however, nothing more than a symptom of some general affection, and is remediable or otherwise according to its cause, but is of itself very inconclusive evidence of consumption.

The term phthisis is now universally and exclusively applied to a peculiar and obscure condition of the whole system, in which the healthy materials required for the growth and reparation of the body are imperfectly supplied by the process of nutrition; whilst the elements of a morbid substance, finding their way into the blood, are deposited as tubercle in certain internal organs-chiefly the lungs, ultimately causing their destruction and death. This state of system is precisely identical with that known, by every one, as struma or scrofula. Phthisis and scrofula are, in fact, merely varieties in developement of the same malady; the difference between them depending upon the tubercular substance being, in the one case, principally deposited in certain internal and highly vital organs; but, in the other, more generally in glandular and super

ficial structures, the soundness of which is far less essential to the functions of life.

With a view of ascertaining, as nearly as possible, the relative fatality of consumption, I have consulted the records of the Registrar-General, as affording the best evidence upon the subject. It appears that in the year 1840, the mortality from all diseases collectively, amounted, in England and Wales, to 413,681, of which number 71,106 were attributed to phthisis; showing that more than one-fifth, and not much less than one-sixth, of the deaths in that year proceeded from this disease. It has been computed from these records, that one person in about every three hundred and ten of the entire population annually falls the victim of phthisis.

With such facts before us, it may certainly be said that the sword and the famine are, in their effects, comparatively insignificant to consumption; and that there is no other pestilence which has vanquished half so many.

The principles of treatment applicable to phthisis are sufficiently simple, however difficult they may be in practice, and may be said to consist in the endeavour to correct that deviation from health under which the tuberculous elements are formed

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