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of circulating fluids, for we think the changes which these undergo, are subordinate to, and consequent upon, other changes in the organization. The above experiments, however, would seem almost to force upon us the inference, that the blood of scrophulous individuals has in it something of peculiarity, which pulmonary inflammation of a particular kind has the faculty of withdrawing and depositing in the cellular substance of the lungs, Or is it, that this kind of inflammation is peculiar to scrophulous habits, and that, provided it did take place in other subjects, the effects would be exactly similar?
We have enlarged on this head, rather more, perhaps, than is consistent with the limits of a review; and we have done so from the conviction, that towards the prevention of pulmonary consumption, in those whom nature has disposed to it, much depends upon keeping a careful watch over those slight and apparently trivial affections of the chest, which shall appear in the sha of cough; and which, though scarcely, perhaps, deemed of sufficient moment to attend to, will be depositing tubercle after tubercle; till, in process of time, and at a phthisical age, a slight exciting cause will be sufficient to make the malady break out with all its formidable, and now irremediable and fatal force. It cannot, we think, be too strongly impressed upon the public mind, that much preventive power is in the hands of intelligent and attentive parents. Let these, then, never forget, that in those who are consumptively disposed, a ‘little coughi,' even at an early age, may, if neglected or ill-treated, become the cause of a great disease ;' and that the mischief of protracted affections, though it may not shew itself immediately, may come to do so eventually.
Dr. Southey, at the end of this chapter, alludes to an instructive case which came under his care, and which terminated fatally, after almost every usual symptom of the disease had shewn itself, excepting that the expectoration was never puru
lent.' Pus was formed in this case; but in consequence of the abscesses from which it proceeded not having communicated with the air-cells, it could not be expectorated. We call this an instructive case, because the absence or presence of purulent specta, is too apt to be received by medical men and others, as an infallible criterion of the degree in which danger exists. It had already been remarked by the Author, that a purulent discharge might take place while the disease was confined merely to the membrane, lining the air-cells of the lungs, forming the catarrhal phthisis of Dr. Duncan ; and by the last mentioned case it is shewn, that a true tubercular and purulent state of the lungs may exist, and the patient be nevertheless expectorating only common mucus.
We now pass on to the predisposing and exciting causes of consumption.'
Dr. Southey, in this chapter, presents us with the result of an investigation, conducted with a great deal of labour and nicety, for the purpose of ascertaining the parts of the world which are more or less exempt from, or obnoxious to, phthisical affections. Next to our own country, some parts of Germany, Vienna in particular, France, and the south of Europe, seem to be the regions inost frequently visited by the disease ; while other parts of Europe, in a more northern latitude, and a colder climate, enjoy a comparative freedom from its ravages. What has always appeared to us deserving of especial notice on this head, is, that the Dutch, with an otherwise sickly climate, are proverbially free from consumptive ailments. This circumstance, connected with the statement, that in Canada, where intermittent fevers are pointed out as prevalent, while consumption is not noticed, might seem to favour the inference of Dr. Wells, who has conjectured and endeavoured to establish the fact, that in parts of our own country, where agues are common, consumption is infrequent. This hypothesis, however, of Dr. Wells, is not supported by the experience and observations of others; and we are left to look out for another reason of the comparative immunity just referred to.
Τινες αι των κακων πηγαι ; Scrophula it has already been said is the grand germe of the complaint in this country; and in the seeds of Scrophula we are to look for the predisposing causes of consumption. The great object of inquiry then is, how to trace the origin of, and obviate the tendency to, the scrophulous diathesis. We shall here make a rather long extract from Dr. Southey's book, bearing upon this point.
· Whoever has attended much to the diseases of the poor in any part of England, and more particularly in the metropolis, must have observed the very large proportion afflicted with the different forms of scrophula. To what can this be attributed but to the want of the common comforts and necessaries of life? to deficient food, clothing, and fire. In regard to diet some of the labouring classes are better off than others, and we find those so circumstanced, the least disposed to scrophulous diseases. The late Dr. Beddoes collected some interesting facts on this subject. Butchers, who are of course well supplied with animal food, seem of all classes the least liable to consumption. Dr. Withering, in a letter to Dr. Beddoes, says, “ The only classes of men I have yet observed exempt from this disease are butchers and cat-gut makers. They both pass much of their time amidst the stench of dead animal matter. The former live chiefly on animal food, and are much exposed to the inclemencies of the season, whilst the latter live as other manufacturers, and work under cover in close and rather warm buildings.” A Gentleman was employed to examine the butchers of Bristol, with regard to the
healthfulness of their calling. The following specimens of the answers obtained to this person's interrogations may serve to give an idea of the whole: a butcher thirty years in business does not recollect any man dying in his service. He has had three or four apprentices at a time ; they live well, have hot meat for breakfast, with broth and onions; knew a boy die next door, in the slaughter-house, but in consequence
usage. He never had any thing the matter with himself. Another, fourteen years in the trade, had never
heard of a man dying of a consumption who was a butcher. Dr. R. Pearson made similar inquiries at Birmingham, and states, that he finds the complaints to which butchers are most subject, to be obesity, hepatic obstructions, and apoplexy; those to which they are the least liable are consumption and typhus.'
After giving other examples of a similar kind, the Author continues,
• The same observation seems to have been made in other coun. tries. The author of a dissertation on the propriety of placing phthisical patients in slaughter-houses, tells us he was led to the idea by observing the healthiness of the butchers, their wives, and families, at Montpellier. The Scotch fishwives, who live chiefly on animal food, are found to be little subject to phthisis, or any form of scrophula. Among the Cornish fishermen, who live chiefly on animal food, Davy found a similar immunity from consumption. Stable-boys, grooms, and dragoons, are enumerated among the favoured classes. They are likely to be well fed, and pass a good deal of their time on horseback; and the equal temperature of the stable may make them less liable to catarrhs.
• Let us now consider (our Author goes on to say) those circumstances which seem peculiarly unfavourable to the consumptive, and examine among
the lower ranks of society how those individuals are situated who suffer most from this disease. From Sir John Sinclair's statistical reports, the general conclusion may be drawn, that consumption and scrophula occur most frequently in those places where the inhabitants are the poorest, i. e. where they are the worst fed and clothed. In many parts of Scotland, where consumption is now prevalent, the old people affirm, that it was unknown before the warm Scottish plaiding was exchanged for the fine, thin, cold, English cloth, and woollen for cotton. So in the vale of Keswick it has been remarked, that consumption has increased with the increased use of cotton, among the women, instead of worsted, flannel, and stuffs.'
pp. 56 to 62.
To the impartial feelings of Reviewers, who are not anxious to defend or enforce any system, there may, perhaps, still remain some obscurity on the question of exemption, by particular callings, and in particular regions, from consumptive complaints. Still, however, enough is made out to establish tha fact, that where good clothing, regular exercise in the open air,
and plenty of animal food, are obtained, scrophula and consumption are diminished almost in the same ratio. The constant inhalation of animal effluvia, may have some influence, as in cases of butchers and cat-gut manufacturers; but, in this case, neither the principle nor the fact is so demonstrable as that clothing and food are preventives. Sources of mechanical irritants, if we may use the term, or those which immediately apply themselves to the lungs, are much dwelt upon by some, especially by foreign authors; but it may be questioned whether most of these are not, to say the least, materially assisted by confineinent and an unwholesome position of the body, as in the examples of weavers, tailors, spinners, carpet-manufacturers, flax-dressers, and others.
There is, however, one instance, of mischief springing from this source, which is so remarkable and melancholy, as to deserve special notice. It is that process of the needle manufactory, called dry grinding. It is said that those who engage in this branch of business, do it with the almost certain expectation of its proving eventually fatal, and that the lure of high wages is necessary to procure hands. The persons who are employed ' in this labour, by which the needles are pointed, are universally, and in a short time affected by symptoms of approach
ing pulmonary consumption. They go on coughing till they • either spit blood, or a thick substance having the appearance of * matter. They decline in flesh and strength, and seldom sur
vive the fortieth year. Pin makers are said to suffer in the 6 same way.'
It does not require to be stated, that it is the fine particles of matter arising from the materials used in the various manufactories above mentioned, and taken into the lungs, that immediately affect the organs in this deplorable inanner. One feels astonished, that, in the last mentioned examples, something is not contrived as a covering for the face, which, without interrupting the breathing, might, in a very great measure, prevent the inhalation of the offending matter.
In going over the alleged sources of the complaint, the tion of its contagious or non-contagious nature came in order to be discussed. Our Author adopts the opinion generally held in this country by medical men, that it is not catching. We are, however, much inclined to the opposite side ; and suppose that although the infectious nature of consumption is by no means equal to what some continental physicians have conceived it to be, still a long-continued and reiterated application of effluvia, from the lungs of a consumptive individual, may at length operate upon another in the way of infectious matter.
Dr. Heberden, a man above all praise' for fidelity of observation, and freedom from prejudice, strongly inclines to the
opinion of the infectious nature of phthisis. Quid in hac re verum sit,' he says, viderint alii; equidem nondum usu 'magistro eo progressus sum, ut aliquid certi de ea mecum 'statuere potuerim: fateor autem me vidisse nonnullos tabe periuntes, quorum morbus non aliud probabilius habuit initium, quam quod assidue una fuissent, aut etiam dormissent cum tabidis!
The sentiments of Hoffman are nearly similar, and in a balance of authorities, we think that the positive opinions of such men as Heberden and Hoffman, may very fairly weigh against the negative ones; that is to say, the total silence on this controverted subject, of Hippocrates and Celsus.
British physicians we conceive to have been misled in reference to this inquiry, by the confessedly slighter, more tardy, and more insidious operation of consumptive miasma, than of any other infectious matter, with which we are acquainted. In instances of the disease being communicated from one to another, it should seem that there must have been a slight predisposition at least in the recipient; for although, in this qualified way, we conceive consumption to be communicable, yet we have no notion that such is the case with scrophula.
We are now advanced to the last chapter of the work under review; that, in which the treatment of the disease is considered. The first suggestion which presents itself, in reference to the preventive treatment of consumption, is this:-cold being confessedly a commonly exciting cause of the complaint, and yet the affection being comparatively rare in several countries where the cold is more intense than in Britain, are not the inhabitants of such countries in possession of means to counteract its noxious tendency, of which we are either ignorant or neglectful? This is, in truth, the case. It is a known fact, that even a hardy Russian is more sensible to cold, and more inconvenienced by it in this country, than he is in his own; and on the same principle, an Englishman suffers less from a winter in Petersburgh, than from a winter in London.
The proverbial variableness of our climate most unquestionably goes some way towards the solution of this apparent enigma; but, we believe, that the habits and modes of living in the respective countries, furnish as with still more assistance towards the explanation of the fact in question. Englishmen act upon erroneous notions on the subject of heat and cold. So much importance seems to us attached to the maintenance sud development of this position, that we shall here endeavour to enlarge a little respecting the grounds on which it is advanced; and in doing so, we shall first extract from our Author the relation he gives, from Dr. Guthrie, of the habits of the lower classes in Russia. We shall then shortly investigate the laws of temperature in