PHTHISIS. 



PHTHISIS. 





the average duration of the remaining cases ia IS months. ^Yith 

 regard to the mortality from phthisis, it varies in different climates, 

 aes, sexes, races, and occupations. In England and Wales, according 

 to the Keport of the Registrar-General of Births, Deaths, and 

 Marriages,' it is 20 per cent, of the total number of deaths, or 

 3'82 annually out of 1000 living. In France it is about the same. On 

 the eastern frontiers of the Cape of Good Hope, where the atmospheric 

 vicissitudes are sudden and great, the thermometer in summer some- 

 times varying from 110 to 64, and in winter from 75 to 32, in the 

 course of a few hours, it is only 3J. 



In cities the majority of the male labouring population is engaged 

 in the arts, trades, and manufactures, and generally for many hours 

 together hi ill-ventilated apartments, and in unhealthy postures of 

 body. In the country the pursuits of the same class of persons are 

 chiefly agricultural. In respect of age, the deaths are greatest between 

 20 and 30, and diminish gradually to between 60 and 60, after which 

 deaths from phthisis are comparatively unfrequent. 



Cautei of Phthisa. The causes of phthisis, says Sir J. Clarke, may 

 be divided into " the remote and the exciting, or those which induce 

 the constitutional predisposition, and those which determine the local 

 deposition of tuberculous matter after such predisposition is established. 

 The one class of causes operates by modifying the whole system ; the 

 other, by determining in a system so modified the particular morbid 

 action of which tuberculous matter is the product." Of the remote 

 causes, or those which induce the constitutional predisposition, 

 hereditary transmission is regarded as the most powerful ; not that an 

 individual born of consumptive parents will himself necessarily fall a 

 prey to the same disease, but only that, when exposed to those 

 influences which we are about to enumerate as determining the tuber- 

 culous cachexia, he will be more likely to become affected than one 

 bom of healthy parents. 



At the same time it must be remembered, that with a disease so 

 common as phthisis, a certain number of persons would be descended 

 from phthisical parents who might contract the disease independent of 

 hereditary descent. Dr Walshe, after the examination of 443 cases of 

 disease phthisical and non-phthisical, came to the conclusion that 

 " phthisis in the adult hospital population of this country is, to a slight 

 amount only, a disease demonstrably derived from parents," and it 

 would appear that this is generally true of the middle and upper 

 classes of society in Great Britain. 



Whatever may be the real amount of tendency to this disease given 

 by hereditary transmission, there can be no doubt that external 

 circumstances produce a powerful effect. Thus it is found that the 

 death rate from phthisis is much higher for towns than it is for 

 country districts, thus pointing to the fact that the circumstances by 

 which persons are surrounded hi towns are more favourable to the 

 development of phthisis than in country districts. Although much 

 may be set down to the wear and tear of a town life as compared with 

 the country, yet when we come to examine the class of persons 

 affected hi towns, we are driven to the conclusion that one of the most 

 powerful causes of the development of phthisis is a deficient oxygena- 

 tion of the blood. It is found that in London, the deaths from 

 phthisis amongst persons confined in shops is as 2 to 1 compared 

 with the gentry and professional classes. Taking the trades of London, 

 it is found that those which are sedentary favour the development of 

 phthisis much more than those where the occupation is more active. 

 Again, those who work in close and ill-ventilated rooms are more 

 liable to this disease than those who work in more open and better 

 ventilated apartments. In the case of persons who are exposed to the 

 open air, as found by the recent parliamentary inquiry into the state 

 of the barracks for soldiers in London, and nevertheless suffer from 

 phthisis, it has been discovered that they sleep in close and ill- 

 ventilated apartments. The immunity of some districts in Great 

 Britain, as the Hebrides and north-western district* of Scotland, may 

 be attributed to the almost perfect ventilation of the huts or cabins in 

 which the principal part of the population resides. As an illustration 

 of the influence of overcrowding, and the consequent elimination of 

 the oxygenation of the tissues, the following illustration may be given. 

 In the parish of St. James's, Westminster, there are three registration 

 districts; in one of these 134 persons dwell upon a single acre, in a 

 second 262, and in a third 432 persons live upon an acre. In 1858, 

 tin- "luath from phthisis in these districts was as follows : in the first 

 'ii one person in every 426 died of phthisis ; in the second, one 

 in every 422, whilst in the third and most thickly populated district, 

 one in tror/837 of the population died. There are however otlier 

 conditions which lead to the same deficiency of oxygenation in the 

 blood, and which act as occasional predisposing causes of pulmonary 

 consumption. Such are exhausting occupations, inactivity of body, 

 mental depression, insufficient food, and the abuse of spirituous 

 liquors. 



The more immediate or exciting causes of consumption, those which 

 determine the deposition of tubercles, have usually been attributed to 

 irritants acting locally on the bronchial tubes or on the lungs, whether 

 occasioned by inflammation of these parts or by the mechanical action 

 of irritating bodies upon tbem. The result of the latest investigations 

 on this subject leave no doubt that the influence exerted in this way 

 has been greatly exaggerated. Pneumonia and bronchitis, the two 

 dim-mo hitherto regarded as the most frequent forerunners and pro- 



ducers of phthisis, have been shown by M. Louis to exert no more 

 influence in its production than any other disease. They may indeed 

 occasionally hasten the development of tubercles, but they exert no 

 specific effect, and they act only as remote causes in impairing the 

 health generally. These conclusions of Louis, which have been 

 deduced from his own observations in hospital practice solely, receive 

 ample confirmation from the admirable Statistical Reports of the 

 Registrar-General and Major Tulloch, which wo have before referred 

 to. The popular error of attributing consumption to cold, the breaking 

 of a blood-vessel, &c., has probably originated from mistaking the effect 

 for the cause. We have shown in a former part of this article that 

 cough and haemoptysis are among the earliest symptoms of tuberculous 

 lungs. 



With regard to mechanical irritants, aa dust of various kinds, noxious 

 gases, smoke, &c., " no opinion has been more prevalent," observes Dr. 

 Cowan, " than that those who are exposed to the inhalation of the dust 

 of vegetable, mineral, or animal substances, are peculiarly liable to 

 phthisis ; and in the supposition that consumption was essentially a 

 disease of the lungs, and in the great majority of instances the result 

 of bronchial inflammation, no conclusion was more natural or more 

 probable. But once remove from the mind the impression of a neces- 

 sary connection between bronchitis and tubercles, and we feel per- 

 suaded that the examination of the evidence brought forward on the 

 subject of dust will terminate in the conviction that this agent exerts 

 at most but a very secondary and unimportant influence in the pro- 

 duction of phthisis." The mortality among the workmen in some of 

 our manufacturing towns is usually brought forward in support of the 

 doctrine of mechanical irritation. Dr. Knight, of Sheffield, informs us 

 that there is not an example of a polisher of forks reaching his 36th 

 year, nor do the artisans in other departments attain a much greater 

 age. But it must be recollected that many of these men work sixteen 

 hours a day in a close atmosphere and confined posture of body, two 

 conditions which contribute perhaps more than any other to the 

 increase and production of phthisis. Nor has the mortality been 

 diminished by the use of magnets, wire masks, currents of air, and 

 moisture, which have been successively tried for the purpose of arresting 

 the metallic particles. In the cases of 887 quarrymen, 557 stone- 

 cutters, and 160 marble-workers, all of them occupations involving the 

 Inhalation of dust, M. Benoiston found the proportion of phthisis was 

 less than the general average ; but then these are employments carried 

 on hi the open air. Dr. Lombard, whose researches are founded on a 

 total of 4300 deaths from phthisis, and 54,572 individuals, exercising 

 220 different occupations, found, by a comparison of all the professions 

 carried on in the open air and in workshops, that the proportion of 

 deaths from phthisis was doMe among the latter ; and this propor- 

 tion increased as the apartments were close, narrow, and imperfectly 

 ventilated. 



Mr. Watson, a surgeon of Wenlockhead, a mining district, informs 

 us that, out of 74 men working during four or five months for sixteen 

 hours daily in a mine where a candle burnt with difficulty, not one was 

 attacked with any pulmonary affection. 'But whether from the inhala- 

 tion of any noxious gases or from other causes, it is certain that in the 

 majority of the mining districts of this country the mortality from 

 phthisis is high. The number of males attacked by this disease in 

 Cornwall exceeds that of the females in the ratio of 170 to 140, and in 

 the mining parts of Staffordshire, Shropshire, and Worcester, in the 

 ratio of 203 to 191 ; while in the non-mining districts of Staffordshire 

 and Shropshire, and in the county of Cheshire, the ratio is 656 males 

 to 796 females. 



The influence of smoke, when uncombined with other agents of 

 injurious tendency, may, we think, fairly be called in question. In 

 Leeds, which is certainly the most smoky place in the whole kingdom, 

 the mortality of females from phthisis is below that of most of our 

 large manufacturing towns, and is not much above the average for the 

 whole of England and Wales. In London likewise this is the case, and 

 in nearly the same proportion. 



A moist and changeable climate was long regarded as among the 

 most active causes of consumption ; and Great Britain, whose climate 

 combines these two conditions in a remarkable degree, has been 

 looked upon as such a nursery for phthisis, that cur facetious neigh- 

 bours on the other side of the Channel have styled it " La Maladie 

 Anglaise." Indeed the notions of atmospheric vicissitudes, dampness, 

 and consumption, seem almost inseparable. However, these opinions 

 have been and still are undergoing a severe scrutiny ; and the evidence 

 which we at present possess on the subject tends very strongly to dis- 

 prove their correctness. Moisture and climate, like all other agents, 

 act either locally or generally ; popular belief has attributed their pro- ' 

 sumed prejudicial effects to local action. They tend, it is said, to 

 produce catarrhs and coughs, and consequently consumption. We 

 need scarcely allude again to the fallacy of this opinion. We are in 

 possession of little information on the mode in which climate operates 

 to the production of phthisis. That the disease prevails to a much 

 greater extent in some climes and localities than in others, is an indis- 

 putable fact j but it is no less certain that its prevalence is not confined 

 to countries of variable temperature, for many of such countries sufier 

 in a much less degree than those whose theruionietrio range varies 

 little throughout the year. Is phthisis contagious 1 This is a question 

 which has been often discussed, and numerous are the testimonies both 



