26 



MEDICINE. 



Praciiw. states, where the system in exhausted by long continued 

 disease, probably possess no specific power in counter- 

 urtiiia the scrofulous action, and eetrm but little adapt- 

 ed for the constitutions which are the most disposed to 

 its attacks. Tn a chronic affection, and in one of so ge- 

 neral an operation, we are naturally letl to regard the 

 effect of diet as an important agent in the re-establish- 

 ment of the health ; yet on this point very opposite 

 jjl.ins have been adopted in the disease now under con- 

 sideration, for, while a strict antiphlogistic system has 

 been strongly enforced by some practitioners, others 

 have equally insisted upon the importance of a nutri 

 live and even a stimulating regimen. Both these ex- 

 tremes we believe to be injurious, and on this point, as 

 well as respecting the articles of the materia medica, 

 we have perhaps no more explicit rules to guide us 

 than that every thing should be directed towards the 

 establishment of the general health; if the patient be 

 languid and emaciated, we are to supply him with as 

 much nourishment as the digestive organs will admit ; 

 but if, on the contrary, he be of an inflammatory habit, 

 we must proceed, although with caution, on the oppo- 

 site system. The use of sea air, of sea bathing, and 

 of the cold bath generally, respecting which so much 

 has been said in Scrofula, may all be referred to the 

 same principle. To the inhabitants of large towns, 

 who generally pass their time in close apartments, and 

 are immersed in smoke and impure air, the freshness of 

 the sea breezes must be highly salutary ; but we appre- 

 hend that there can be nothing of a specific nature in 

 the air of the sea, and that many inland situations are 

 even preferable, as being less liable to dampness and 

 moisture. For bathing, however, salt is perhaps al- 

 ways preferable to fresh water, and it has been sup- 

 posed that sea-water has a beneficial effect upon scrofu- 

 lous ulcers as a local application, although the evidence 

 for this opinion be not very decisive. In speaking of 

 the remedies for Scrofula, we must not pass by in si- 

 lence the alleged virtues of mercury, and especially of 

 calomel, which has been held up as a kind of specific 

 in that variety of the disease, where we suspect there 

 to be a schirrous state of the mesenteric glands. How 

 far mercury, in any form, possesses the power of resolv- 

 ing glandular tumours, we are scarcely prepared to de- 

 cide, but we are much disposed to refer a great share 

 of the benefit which has been gained by the use of this 

 medicine merely to its power in promoting the opera- 

 tion of the purgatives with which it is usually combin- 

 ed. With respect to all the specifics that have been 

 proposed for Scrofula, the acids, alkalies, earthy and 

 metallic salts, and various vegetable extracts, we con- 

 fess that we are extremely sceptical as to any benefit 

 that has ever been derived from them. The manage- 

 ment of the local affections, whether schirrous glands, 

 ulcerations, enlargement of the bones, or in whatever 

 form the disease makes its appearance, falls under the 

 especial province of surgery ; we shall only remark 

 concerning it, that their treatment appears as difficult 

 and uncertain as in the constitutional form of the dis- 

 ease; and that notwithstanding the numerous plans 

 that have been brought before the public with so much 

 confidence, the cure of these complaints must still be 

 considered as one of the great desiderata of the art. 



SECT. V. Phthisis pulmonalis* Pulmonary Contumption, 



w .have already referred to this complaint in the 

 preceding Section, aiid have noticed its probable con- 

 exion with Scrofula ; but whatever be our opinion on 



5 



this point as a pathological question, it is a disease Practice, 

 which amply deserves to be made the subject of di- T"""' 

 tinct consideration. It is characterized by pain in the 

 side or the chest, attended with cough, dyspnoea, and 

 with expectoration, which, as the disease advances, be- 

 comes purulent. A febrile state is induced, which ul- 

 timately terminates in acute hectic, while in the latter 

 stages there is colliquative diarrhoea and profuse per- 

 spiration, attended with excessive debility and emacia- 

 tion. Although persons of the sanguine temperament 

 are the most subject to this affection, yet it shows so 

 powerful an hereditary tendency, that the children of 

 phthisical parents, whatever constitution or tempera- 

 ment they may possess, and whatever may be their ap- 

 parent vigour, are always liable to its attacks. Its ex- 

 citing cause is in most cases to be traced to some cir- 

 cumstance which produces inflammation in the lungs, 

 although where there is a decided hereditary dispo- 

 sition, it is often very difficult to assign any imme- 

 diate cause for its invasion. A great proportion of all 

 the cases appear to originate from Catarrh, so that, in 

 our moist and variable climate, where the excess of ci- 

 vilization and refinement has tended to diminish the 

 vigour of the natural constitution of the inhabitants, 

 and where many of the modes of life are peculiarly 

 adapted to render the body liable to suffer from the 

 state of the atmosphere, Phthisis may be regarded as 

 the great scourge of the island. It lias been calculated 

 that not less than 5.5,000 persons are annually destroy- 

 ed by it, which, if we estimate the total population of 

 England at 12,000,000, will not be very far short of 

 isVtf P ar t f *he whole population. When the disease 

 exists in its fully formed state, its character is too well 

 marked to admit of much doubt or uncertainty ; but as 

 it often comes on in a very gradual manner, and super- 

 venes upon the affections of the chest, it is sometimes 

 difficult to decide upon its presence. The circumstance 

 which has been usually had recourse to, as forming the 

 diagnosis, is the state" of the expectoration, whether it 

 be mucous or purulent ; but as this is a point which 

 cannot itself be, in all cases, very easily decided, va- 

 rious tests have been employed for this purpose. Upon 

 the whole, however, we conceive that an attention to 

 the general condition of the patient, to his previous 

 constitution and hereditary disposition, are more im. 

 portant than any one symptom, and will generally en- 

 able us to form a correct judgment. Although the state 

 of the lungs in Phthisis has been carefully examined^ 

 and the appearances which they exhibit very minutely 

 detailed, there still remains much uncertainty respect- 

 ing the nature of the proximate cause, or of the man- 

 ner in which the exciting causes produce the change 

 of structure which the parts experience. When we 

 examine the lungs after death, we find them to be filled 

 with hard tumours, called tubercles, which seem to be 

 composed of indurated glands ; these are at first of an 

 indolent nature, but they acquire the inflammatory state, 

 and proceed to suppuration, when the hectic fever 

 comes on, and the disease assumes its characteristic 

 features. We have already spoken of the connexion 

 which there appears to be between Scrofula and Phthisis, 

 and the morbid appearances in the lungs may seem to 

 confirm the idea of the connexion ; it must, however, be 

 acknowledged, that the two affections do not bear any 

 exact ratio to each other in the same individual, and 

 even that some whole families are more disposed to- 

 Scrofula and others to Phthisis. 



With respect to the treatment of Phthisis, we have Treatment, 

 little to oft'er, except a melancholy narrative of the 



