do they yet spread! In commenting upon these, I shall, in a trifling
degree, invert the prescribed order and arrangement. Into this group
are concentrated pulmonick hemorrhage, pulmonary phthisis, the various
species of hectick, atrophy and tabes, nervous, sciatick, dorsal, and
icterick; also asthma, dyspnœa and cough, catarrh, hooping cough,
croup. Inflammation of these organs and spurious peripneumony, have
already been described. These, therefore, constitute nearly the whole
combined pulmonick host, and likewise some of those diseases closely
connected with the pneumonick machinery, or with several of its general
morbid symptoms.
Behold here one of the great caravans of dead to the stygian ferry; and
tottering myriads crowding to the same shambles. View the innumerable
multitude of fable mourners and weeping relations attending them in
the last melancholy offices of friendship, to that eternal bourn,
the grave! Every introspection of general morbid registers, and
the unanimous observations of the medical profession, concord in
proclaiming the notoriety of the consumptive throng, and their ruinous
uncontroulable domination. Notwithstanding the prodigious improvement
in the alphabet, subordinate rudiments, and appendages of the medical
science, consumption as yet is one of the great oligarchy of morbid
and remorseless tyrants. He would be intitled to every terrestrial
honour, and to posthumous apotheosis; he would rival and eclipse the
most celebrated tyrannicides, and expurgators of monsters, whether
demi-gods, heroes, or saints, who could dethrone or controul this
stationary monopolizer of human sacrifices, and sheathe his deadly
sword.
From one fifth to one sixth of all the mortality in London, is from
consumption; which is nearly double to that even of small pox. But
consumption is a term too lax and indefinite. Into this gulph, no
doubt, are thrown many febrile and slow hectick emaciations, from
infancy to old age, in both sexes; and there are few diseases from
acute and chronic sources, especially in their fatal termination,
without emaciation. Consumptions and dropsies are the final wreck of
a great variety of human maladies. In no two other diseases are, what
pathologists term _Morbi a Morbis_, more apparent: and in multitudes
of such cases, morbid dissections often detect the effect, and not
the original cause. How many of the genuine pulmonary phthisis are
consociated with this miscellaneous crowd, is difficult to guess; but,
from the concurrent testimony of physicians, and of experience, we
may safely affirm a very large proportion. There are few families in
this kingdom whom it has not, one time or other, plunged into tears.
Physicians on the continent alledge, that phthisis is more prevalent in
Britain than in any other kingdom of Europe.
The next inquiry is, in what age, sex, rank of life, season of the
year, and whether in city or country is consumption most predominant?
It has been, from the earliest chronology, the universal echo and
monotony of medical writers, to mark the principal consumptive age
between 18 and 35. But, with submission, I would considerably enlarge
its limits, including from birth to 5, and from 20 to 60. No age or
stage of life is exempted; but we might “_a priori_,” and from viewing
the great and general scale of mortality, assert, that between 5
and 20, a considerable number cannot possibly be swept away in the
phthisical torrent. Nor do we mean to invalidate the general aphorism,
that in the blossom and full maturity of vigour and comeliness,
phthisis is superlatively deleterious. Between the sexes no distinction
seems to be made. I conceive, however, that amongst the lower orders
universally, and more especially those penned up in the foul atmosphere
of cities, that phthisis is more fatal than amongst those who browse
in the pure air of the country. In accommodation, cloathing, noxious
trades, &c. the indigent have the disadvantage; and during sickness,
from the same causes, their recovery is more desperate. With respect
to seasons, winter and autumn in our climate is the most pernicious to
pulmonick maladies.
_Pulmonary Hemorrhage_, hæmoptysis, sputum sanguinis. The lungs spungy
pneumatick and hydraulick organs, in themselves passive; but by the
contraction of the diaphragm and intercostal muscles enlarging the
capacity of the thorax, this ventilator is alternately distended with
atmospheric air, and this sonorous fluid again quickly expelled, with
either some noxious emanation from the body, or decomposition of
its own vital principle. Half the blood of the human body circulates
thro’ this organ: its blood-vessels are numerous and large, and rise
immediately from the heart; and it is incessantly in motion and
agitation. When the body has nearly attained its ultimate extension and
altitude, pulmonary hemorrhage is most predominant; more especially in
those of narrow thorax, prominent scapulæ, red cheeks, and acute tone
of voice. Before the hemorrhage, there are shivering, horror, heat,
fever, weight, oppression, pain and heat in the breast, difficulty of
breathing, titillation of the fauces, dry cough, exspuition of florid
blood in various quantity, and slowly or suddenly, from ounces to many
pounds, or even quarts, in a few days; but the latter is rare. It may
soon totally cease, or only intermit, and again return at irregular
intervals. Relapses are frequent on any irregularity or intemperance;
on acceleration of the circulation, or expansion from heat.
This hemorrhage is very seldom in such quantities to prove
precipitately fatal, unless mismanaged. From Bleeding, at least in the
London registers, there is petty spoliation. Pulmonary hemorrhage is
more frequently the consumptive precursor. Malign omens are an eruptive
torrent; ulceration in the lungs; fever renewed; pain in the breast;
difficulty of breathing; cough, hoarseness; night sweats; peripneumony;
visceral obstructions; cachexy; old age; relapses. But pulmonary
hemorrhage from temporary obstructions of the menses, or in pregnancy,
or periodical, or without load in the thorax, or fever, are much less
mischievous.
_Pulmonary Phthisis._ Not one hundredth part of pulmonary consumptions
commence with hemorrhage. Phthisical lineaments are emaciation, diurnal
hectic fever, obstinate rebellious cough, difficulty of breathing, and
usually some change in the voice. In the beginning, phthisis often
resembles a catarrh, or stubborn cold; and in this insidious disguise
is too frequently slighted, or neglected: but continuing longer than
the usual catarrhal period, without any considerable intermission, and
especially if in summer, are sufficient grounds of alarm. In that, from
tubercles, there is frequent teazing dry cough, exasperated at night;
some difficulty of breathing, and panting on ascending any eminence or
stairs, or on exercise; some emaciation and weakness. By degrees, there
is more or less expectoration of viscid, yellow, greenish purulence,
intermixed, however, with natural mucus, and in the progress streaked
with blood. Sooner or later, uneasiness in the breast, inability to lay
on one side, pain in the side, or under the sternum, and aggravated by
inspiration and coughing.
The consuming hectic fever has generally two exacerbations during the
twenty-four hours, about noon and night; with some degree of chilliness
and shivering, and increased sensibility to cool air, notwithstanding
the skin is preternaturally hot; the palms of the hands and soles of
the feet burn; a florid redness, or circumscribed spot is perceivable
in the cheeks; the other features are partial sweats about the neck
and breast, particularly in the morning; disturbed sleep; slender,
hoarse, and obscure voice; quick pulse; sometimes vomiting after
meals; thirst; salt taste in the mouth; cough and expectoration, in
frequency and quantity, varying in different persons; in some, there
is a very considerable discharge of purulency from the lungs. Various
ordeals have been proposed for the distinction of mucus from pus, or
pulmonick ulceration. Mucus is naturally more transparent, viscid, and
cohesive: pus always opake, more yellow and greenish; the odour more
disagreeable, and the expectoration accompanied with a hectick fever.
The sinking or swimming in water of the expectorated matter, is a
precarious symptom, as it depends on the quantity of entangled air.
In this island, phthisis, especially from tubercles not suppurated,
may continue one, two, or more years; appearing during the winter and
spring, and disappearing during the summer. Other consumptions are
much more rapid; in the vernacular phrase, galloping the patient to
a skeleton in a few months. Phthisical patients are rarely confined
to bed, until near the deplorable stages and fatal termination. Some
have even a tolerable appetite; and the generality are cheered with
adulatory hopes of recovery to the last extremity. The progressive
encroachment is evident, by increased debility, emaciation, and
partial sweats; edematous ancles; diarrhœa; depilation; consumption
and melting away of the fat and muscular flesh: at last sapless, and
macerated into ghosts, the twinkling vital snuff is extinguished. It
is, as yet, impossible for me to apportion the comparative mortality
and recovery in real confirmed phthisis; nor could I depend upon any
of the general registers which I carefully consulted with this view.
We may, however, venture upon a gross estimate, by negative proof.
Exclusive of individual evidence, and medical attestation, we might,
by a simple algebraic process out of any specified number, with their
mortal diseases, and probable proportion of sick in each, sift out the
consumptive. At all events, it cannot possibly be thought exaggeration
to alledge, that not one out of seven consumptive recover. From
hereditary entail, or tubercles, it is still more desperate.
_Species of Consumption_ are, hectick fever, atrophy and tabes;
nervous; icterick; dorsal. Hectick fever and atrophy is described as
a very frequent and fatal disease of infants, especially in cities;
accompanied with emaciation, often short dry cough, hot skin and palms
of the hands; quick pulse, thirst, diurnal exacerbations, sickly
countenance: in some the abdomen is tense, tumid, and considerably
enlarged. In simple atrophy the fever is not so acute; with tumid
belly, irregular fecal discharge; voraciousness, indigestion, thirst,
nocturnal sweats, unhealthy countenance. Atrophy and nervous tabes are
confounded in medical diagnosticks: in both there is emaciation; but
no considerable fever, cough, or difficulty of breathing; impaired
appetite and digestion; leucophlegmatic sickly appearance, partial
sweats; general debility, and proneness to faint on any exertion.
Sometimes atrophy is circumscribed to a particular part or member. The
icterick tabes is accompanied with symptoms of jaundice; and probably,
under several disguises, is more frequent than medical authors have
represented.
Dorsal, or spermatick, is a particular tabes; miserable spectacles
of which are recorded by the celebrated Tissot. Its symptoms are,
emaciation, yet good appetite; pain and weakness in the back and loins;
disturbed sleep, and frequently interrupted by nocturnal dreams and
pollution, either with or without pleasure; weakness of the knees and
trembling of the muscles on the least exercise; sometimes a sensation
as of thorns pricking the skin, and descending down the spine; pale
sickly countenance, livid circle under the eye-lids; the feces and
urine excreted with some difficulty, and often either with semen or
prostate liquor. By degrees, the appetite decays with indigestion,
hypochondriasm, melancholy; pains in various parts, headach, lumbago,
universal debility, wasting of the penis, impotency and blight of
future progeny. Females are not exempt from this disease; but it is
much more frequent amongst the male sex, from the age of puberty
through various adult stages of life: the foundation of it is often
laid at schools; and in those seminaries of vice, large cities: and in
some countries it is a more general habit of licentiousness than in
others.
Of the predisposing and occasional _causes_ of pulmonary hemorrhage,
pulmonary phthisis, hectick, atrophy and tabes. Of pulmonary
hemorrhage; hereditary; narrow thorax; weak pulmonary blood vessels,
small capacity; plethora; suppressed natural or habitual hemorrhage, as
nasal, hemorrhoidal, menstrual; amputation of a considerable extremity;
luxurious living and indolence; violent exertion and exercise of the
lungs and voice in various trades and professions; also violent efforts
to cough, to exonerate the excretories; parturition; lifting great
weights; violent exercise; furious passions of mind: external injuries
on the thorax; wounds; confining the thorax by writing-desks, by strong
whalebone stays; suppressed perspiration and exhalation of the skin
and lungs by cold; light atmosphere, especially on high mountains;
pulmonick inflammation; scrophulous lymphatick glands and tubercles in
the lungs, or calculous concretions; polypus concretions in the large
pulmonary blood-vessels; schirrus and obstruction in the abdominal
viscera.
The predisposing and occasional _causes_ of pulmonary phthisis are all
the preceding causes of pulmonick hemorrhage; hereditary; scrophulous
tubercles; suppuration in the lungs, and not with laudable pus; calculi
in the lungs; consequence of pulmonick inflammation and suppuration, of
small pox, measles, hooping cough, rickets; and of various acute and
chronic diseases; venereal, icterick; chlorosis; worms; rheumatism;
chronic asthma; internal abscesses and ulcers; catarrh and neglected
colds; sudden suppression of perspiration, especially when the body is
heated; pulmonary exhalation suppressed, and cold damp air inspired;
irregularity and coldness of the climate joined to moisture; various
noxious trades and occupations; noxious fumes and effluvia inspired;
foul atmosphere of cities, coal fires; broken ribs and blows on the
thorax; indigence; cold habitations; want of sufficient cloathing and
fuel in rigorous seasons.
The predisposing and occasional _causes_ of hectic, atrophy and tabes,
are many of the causes just now enumerated: scrophulous obstructed
mesenterick glands, and course of the chyle; colds; damp habitations;
foul atmosphere of cities; moist cloudy atmosphere; unwholesome air;
coagulated milk in the stomach and intestines; foul stomach; diseased
stomach and abdominal viscera; improper diet; gluttony, sloth,
uncleanliness, bad nursing, insufficient exercise; worms; repelled
cutaneous eruptions and ulcers; cachexy; intoxication and intemperance;
depressing passions of mind, cares, and vexations; intense study;
insufficient nutriment, poverty, and want of food; frequent vomiting
of food; faults in the organs of digestion; digestive fluids defective
or depraved; profuse evacuations, as hemorrhages, diarrhœa, diabetes,
fluor albus, salivation, seminal emission; delicate women suckling;
sweats; rupture of the thoracick duct; diseases of the spinal brain;
weakness of the solidum vivum; general defect of fluids, or of oil in
the cellular texture; fever and absorption of the subcutaneous oil; old
age and contraction of the small vessels; broken constitution, from
various causes; frequent manustupration; libidinous books, prints;
consequence of venereal gleets, and improper treatment.
_Asthma._ In the London bills, Asthma and Tissick are forced into a
connubial link: formerly it was consumption and tissick, the Italian
name for consumption, and without any mention of asthma. It would
appear by the London registers, that about one fortieth part of the
_memento mori’s_ in church-yards is from asthma; and its proportion
to consumptive mortality as 1 to 8. I have every reason to believe
that the funeral catalogue in London is not, in any outrageous degree,
preternaturally overcharged with consumption or asthma. As both these
diseases are properly excluded from in-patients of our hospitals, I
applied to one of the largest dispensaries in London, the Aldersgate;
in which there is necessarily an overflow of both these distempers;
and with the intention of confronting and irradiating the bills of
mortality. Almost every page of these books presented Asthma in no
inconsiderable number; and above all, Phthisis, phthisis, phthisis,
towering with gigantic bulk.
There is, unfortunately, in medical books such an exuberance of
postulata, that I endeavoured to ascertain from facts and numbers, the
sex and age in which asthma is most predominant; and also its absolute
mortality. For this purpose I extracted and winnowed out of all the
patients in the Aldersgate Dispensary during seventeen years, from
1770 to 1788, all the cases of asthma and dyspnœa: the result is as
follows. Out of 70,000 patients, asthma and dyspnœa were 3,192; or one
twenty-third of all the diseases; of which there were of males, 1613;
females, 1536: dead, 169; relieved, 575: discharged, 569: cured all
the remainder. The sundry ages of these were,—From birth to 10 years,
36; from 10 to 20, 25; from 20 to 30, 161; from 30 to 40, 429; from 40
to 50, 882; from 50 to 60, 949; from 60 to 70, 596; from 70 to 80, and
upwards, 114.
From the preceding valuable records, and which, in this instance,
happen to chime with the gross of medical observations, we may draw the
following inferences: That in infancy and adolescence there are very
few cases of asthma and dyspnœa: that these diseases chiefly occur in
middle age and the decline of life: that more than one half of them
are reported as cured; the relieved and discharged forming a neutral
list, numbers of whom were either surfeited with medicines, or were
discharged by their physicians when despairing of a radical cure, or
fearful of their swelling the dead catalogue: in sinking of which there
is a universal rivalship throughout our dispensaries and hospitals.
Some of them, probably, were palliated, vamped, and amended; and indeed
many were aged, for whom it would be unreasonable to expect a radical
cure. I conceive, that with a part of them we may venture to double the
dead list; which would raise asthmatick mortality to one of ten. But in
the above estimate, what proportion legitimate periodic asthma bears to
the other anhelations I could not fathom.
The term Asthma has been misapplied to every species of dyspnœa: it
strictly denotes a chronic periodic difficulty of breathing, recurring
and exasperated in paroxisms; and, at least in the intervals, without
fever. Authors have subdivided it into several species; the spasmodic,
convulsive, and periodical; the dry, humid, continued, flatulent: and
from the gradations of difficulty in respiration, dyspnœa, orthopnœa.
The periodick and spasmodick is the true disease. Generally, the day
preceding the paroxism there is fulness of the stomach, impaired
appetite, flatulence, eructation, tightness, and stricture about
the breast, and difficulty of respiration; sometimes dry cough; the
diaphragm descends with difficulty in inspiration: these are all
increased by wine, fires, bed, and heat: the head is stupid, heavy,
with slight pain, drowsiness, languor, yawning, restlessness of
spirits; profuse excretion of colourless urine.
Asthmatic paroxisms commonly invade suddenly, or are greatly aggravated
during the night, with constriction in the breast, anhelation and
struggling in breathing, so that all the muscles of the thorax and
shoulders are roused into action to enlarge the capacity of the lungs:
this difficulty is greatest in inspiration: the patient is compelled
to sit erect, or recumbent in bed, panting for breath, cool air, and
drink; and can with extreme difficulty cough, expectorate, or speak:
the respiration is slow, laborious, wheezing, and sonorous; with
painful propensity to cough: from the interrupted circulation of blood
through the lungs, the face and eyes are turgid and livid, in some
the face is pale and bloated; with headach, somnolency; palpitation
of the heart; weak and intermittent pulse; internal burning heat, and
often cold extremities; eructation and flatulence, sometimes vomiting;
difficult and sonorous deglutition; sweats; limpid urine; restlessness,
or disturbed sleep. Some lay easier on one side than on the other. Many
are under the necessity to sit erect in a chair during several days
and nights, gasping for breath, not daring to repose in bed. Should
both lobes of the lungs be equally constricted, the compound offices
of this pneumatick and hydraulick organ will be obstructed, with more
threatening symptoms of suffocation and strangling. A loaded stomach,
close chambers, fires, beds, wine, noxious smells, all aggravate the
paroxism.
In the duration, recurrence, intermission, and remission, asthmatic
paroxisms vary. A few hours, or a few days, are the usual limits of
this pulmonick tumult. In the beginning it continues only a few hours,
with a diurnal remission and nocturnal renovation: in the chronic
state, from two to five days is the usual duration. As the paroxism
mitigates, there is flatulent explosion upwards and downwards, often
with fecal discharge, and expectoration of mucus. The intermissions
are proportioned to the duration of the paroxisms: the longer the
paroxisms the longer the intervals, and _vice versa_: with a copious
expectoration they sooner terminate, and are less severe. Some have
had as many paroxisms in winter as in summer; and in the country as
in town. Floyer had sixty in winter and twenty in summer: the latter,
as usual, were more violent, and longer. During calm frosty weather
asthmaticks are most secure; but at all points of the compass the
paroxism may invade. Some find more ease in the city than country;
others, in low ground than mountainous. Some are never entirely
liberated from dyspnœa, and with periodical aggravations. Few,
comparatively, die immediately in the asthmatic paroxism: numbers
survive many years, even to the goal of longevity, and, emaciation
excepted, without considerable diminution of strength, spirits,
or appetite. After long continuance, it seldom admits of a radical
cure; but only alleviation and respite. Its fatal terminations are
suffocation, apoplexy; pulmonick inflammation; consumption, cachexy,
partial or general dropsy; polypi in the heart and the large vessels.
The predisposing and occasional _causes_ are hereditary; original
structure of the pneumonick organs; narrow thorax; plethora;
suppression of habitual or natural evacuations, and cutaneous
eruptions, as menses, piles, old ulcers, sweat of the feet; consequence
of catarrh and colds, and sudden suppression of perspiration: serum,
pituita in excess; cachexy; dregs of fever, small pox, measles, and
pulmonick inflammation; pulmonick tubercles; spasmodic stricture of
the diaphragm and bronchiæ; smoky rooms and houses, especially with
wood fires; noxious mineral and metallic fumes, arsenical, nitrous,
sulphureous, saturnine; smoky atmosphere of cities; pulverulent trades,
as stonecutters, lapidaries, millers, flax-dressers, chimney-sweepers;
fetid offensive smells; sudden changes of weather and winds from heavy
to a light atmosphere, portending storms, and especially snow; easterly
winds; fogs, with unsteadiness of weather and seasons; possibly some
secret alterations in the electrick fluid, and affecting electrometers;
warm and moist air; errors and intemperance in food and drink, and
ingurgitation; violent motion and agitation of body and of mind;
symptomatick in various diseases, as hystericks, hypochondriasm, gout,
pectoral dropsy, empyema, polypi in the heart or aorta; wounds of the
lungs; diseases of the liver and spleen.