PATHOLOGY. 
2S6 
fequent formation of tubercles, we cut only confider 
the above difeafes as a (lifting the production of, rather 
than entirely producing, phthilis. 
The caufe of the frequency of confumption in Eng¬ 
land has been varioufly accounted for. It evidently can¬ 
not be the coldnefs of the climate; for in fofne of the 
more northern regions of the globe phthiiis is fcarcely 
known: nor, when we confider the fudden hurricanes 
and chilling blafts which occafionally alternate with ex- 
cefiive heat in hot climates, where the difeafe is equally 
unknown, are we jullifiedin referring it to the viciflitudes 
of our clime. Some have endeavoured to prove that the 
ciampnefs of our atmofphere is the caufe of confumption ; 
but in Holland, and other humid fituations, the mortal¬ 
ity of confumptive patients does not equal that of our 
own country. It Will not therefore feem improbable, 
that we muft look for the caufe of confumption in a mor¬ 
bid ftate of the blood; and that the adlion of cold and 
moifture merely determines, byincreafing the circulation 
through the lungs, the elimination of its morbid mate¬ 
rial to thofe latter organs. What feems to bear out this 
explanation is, that the fame fort of temperaments moft 
difpofed to phthilis are alfo difpofed to tubercular depo- 
fitions in other parts of the body, if circumftances ope¬ 
rate to increafe the afflux of blood to thofe parts. The 
fame propofition receives further proof from the known 
connexion betwxen long-continued impediment to the 
fundlions of the liver and phthilis ; and no one can 
doubt, that inaction of the largeft gland in the body 
muft deteriorate the blood. Still further proof is derived 
from the well-known circumftance, that the abforption 
of venereal virus does, under certain circumftances, pro¬ 
duce confumption : an inftance of this we have now un¬ 
der our care. 
We confider, therefore, deterioration of the blood one 
caufe of phthilis; debility of the fundlions of the lkin 
another. That the functions of the lkin are injured by 
cold and moifture, and ftill more by changes of tempera¬ 
ture; that coldnefs, moifture, and frequency of change, 
are the adlual conditions of the Englilh atmofphere ; and 
that the determination of blood to the lungs is in direct 
ratio to the inaction of the lkin; are propofitions which 
no one will be inclined to doubt. Whoever views, 
therefore, the exanguious lkin of the perfon difpofed to 
dbnfumption, and contrails it with the rough rednrfs of 
thofe who, through fullering the viciflitudes of climate 
and the privation of wholefome diet, are neverthelefs 
wholly exempt from its attacks, cannot fail to learn a 
wholefome leifon as to a mode of preventing confump¬ 
tion. This is, to increafe the adlion of the cutaneous 
veflels until a permanent vigour of the lkin is acquired. 
As to the means of doing this, much care will be requi- 
lite. It will fometimes be neceflary to ufe the warm bath 
or fridlion : but, where fymptotns approaching phthilis 
are entirely abfent, the cold bath, followed by fuch fric¬ 
tion as will enfure powerful re-adlion, would be moft 
lifeful. In doing this, however, we muft be careful that 
the bather does not flop long in the water; and that it 
be never ufed except rednefs and heat of lkin follow the 
immerfion. Regular mufcular exercife is alfo indifpenfi- 
ble, always taking care that expofure to wet be avoided. 
The clothing fliould be warm, but not heavy ; and fliould 
be fo regulated, that, while the lkin is prevented from 
fullering the evil influence of moifture, it is not rendered 
morbidly fenfible by extreme heat. The filthinefs of the 
cuftom would ever prevent its ufe in a civilized ftate ; 
elfe, conlidering the ftimulating influence of oil on the 
lkin, we fhould conceive that inundlion muft be a very 
powerful agent in ftrengthening this important covering. 
To this practice, however, many northern lavages pro¬ 
bably owe their ability to refill the rigour of their climate. 
To return to the fubjedt. The above meafures fhould 
of courfe be aflifted by an attention to the food of the 
phthifical patient. The reader will obferve, that the 
iibove remarks apply merely to the bringing up of chil¬ 
dren born of a confumptive ftock, or difplaying the 
marks of the confumptive diathefis at an early age. 
The treatment of phthilis is now to be difeuffed ; and 
it naturally arifes out of the above defeription of caufes 
and fymptoms. In altnoft all deteriorations of the blood, 
fome excels of it will, we believe, be generally found; 
and indeed moft authors have feemed to confider bleeding 
neceflary to the treatment of phthilis. Even if plethora 
did not exift generally, the inaction of the lkin would of 
courfe throw a greater proportion of blood than ordi¬ 
nary into the larger veflels, and confequently into the 
lungs. At all events, the propriety of bleeding is pret¬ 
ty generally allowed. This evacuation Ihould therefore 
be made in fmall quantities at a time, and according to 
the degree of pain, the rapidity of the attack, and the 
hardnefs of the pulfe. In the earlieft periods of the 
dileafe, the bleeding will require to be regulated rather 
by the fulnefs of the pulfe than by any other fign. If 
we are called in atthis period of the difeafe, ourattention 
fliould be carefully diredled to the removal of all diftant 
irritation ; for often the difeafe of other parts of the 
body, efpecia’ily of the liver, is the caufe of phthilis. If 
this be not the cafe, and the malady we have to treat be 
ftridtly idiopathic phthilis, the lkin muft be excited, the 
regulation of diet very clofely attended to, and the pa¬ 
tient placed in a fituation in which the debilitating in¬ 
fluence of cold and moifture is carefully excluded. The 
warm bath, the flefli-brulli, and a regular ufe of antimony 
in fuch dofesas not tonauleateor produce fweating, are 
all the means we are poflefled of for fulfilling the nrft 
indication. The fecond muft be the bufinefs of the pa¬ 
tient. It is impoflible today down any exadl rules as to 
what food, or what proportion of it, fliould be ufed by 
the confumptive patient. There is no doubt in our 
mind, that much, very much, may be effected by what 
we have before called the dyfpeptic treatment, in curing 
phthilis. Not indeed that we are fanguine enough to 
fuppofe that this will bring about the abforption of the 
tubercles ; but certainly, if it improves the morbid con¬ 
dition of the blood, it will prevent their increafe, and it 
will exert a very beneficial influence on the curative pre¬ 
cedes which the tubercles undergo in their progrefs to 
excavation and cicatrization. A concentrated form of 
diet, as jellies, milk, and mucilaginous preparations, has 
obtained a popular fame as a regimen for confumptive 
patients, but probably without deferving it. Indeed, 
conlidering that in phthifis the adlien of the ftomach 
does not feem much impaired, we fliould rather advife 
fparing quantities of meat or vegetables, fince with them 
the natural juices of the ftomach and bowels would be 
mixed, and confequently the quality of the blood moft 
probably improved. We are doubtful whether abfti- 
nence fliould he carried merely to the extent of improv¬ 
ing the digeftivd and aflimilative powers, or whether it 
fliould be fo far enforced as to produce emptynefs of the 
fyftem. The latter pradlice, lleadily perfevered in, has 
certainly fucceeded in removing a variety of morbid 
growths on the outfide of the body ; and, from the re- 
lult of foine few cafes which have come to our knowledge, 
we are inclined to favour its adoption in phthilis. The 
excellent Broufi’ais alfo fpeaks well of it. Dry feeding 
has alfo been recommended by fome ; and, as it is pretty 
well afeertained that nutrition goes on but (lowly, even 
from large quantities of food, unlefs a certain proportion 
of'drink be taken, this may have operated in the fame 
way as rigid abftinence, but it is by no means fo effedlual 
as adlual abftinence. It is needlels to add, that ftimula- 
ting drinks fliould be forbidden in confumptive cafes. 
The third indication, i. e. that of placing the patient 
in a favourably-conftituted climate, is next to be attended 
to. A variety of places have been recommended for 
confumptive patients: thefe have generally been feledted in 
warmer climates, on the fuppofition that the caufe of 
confumption was the coldnefs of our atmofphere. But 
an high temperature is by no means enough to enfure 
i alleviation 
