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cases, the patient will require but a single pillow in the last stage. The dyspnea sometimes becomes less after the suppuration has commenced. I have known two cases, in which the uneasy sensation in the throat was one of the most distressing symptoms, the patients being unabled to swallow any thing solid for some weeks before death. Portal records several cases in which the voice failed, and the organs of deglutition were affected; and, upon dissection, no change of structure could be discovered, except in the viscera of the thorax. The rapidity and degree in which the body wastes, vary in different individuals. In most instances, this is one of the first circumstances which excite alarm; but sometimes even this symptom is wanting, and fat has been found around some of the viscera of those who have died consumptive. The expectoration of
pus, which, if any one symptom could deserve the name, might be considered a diagnostic of the disease, is not always present. In some instances, abscesses, which have proved fatal, have been found in the substance of the lungs, not communicating with the air-cells. Concretions of different kinds are often expectorated by phthisical patients, sometimes fleshy, sometimes osseous, and occasionally resembling a portion of the bronchia. Tulpius asserts, that he has seen pulmonary concretions, in which vascular ramifications could be distinctly traced. The membraneous substances often expectorated, and mistaken for portions of lung, are probably of the same nature as those which are formed in the larynx, and upper part of the trachea in croup. In one case of a young man, whom I attended in strumous phthisis, there was no expectoration of any kind till within a few days before his death; but, during the progress of the disease, he used frequently to vomit, after a violent fit of coughing, and then discharge a considerable accumulation of mixed
and mucus. The exacerbations of fever are often well marked, but occasionally very irregular, and sometimes so slight as not to be noticed. I have seen one case in which no rigors were ever experienced, nor any profuse perspiration, till the last week. Aphthæ not unfrequently appear in the last stage. Morgagni, and more recently Portal, asserts, that some individuals have died of pulmonary consumption without ever having coughed. 'Est enim,' says the former, 'aliquando in
pulmonibus materia peccans nec pauca,' et qua expelli possit; sed nulla est tussis propter hebetem ac deficientem sensum in tunica intima bronchiorum.' The symptoms of strumous phthisis are therefore infinitely varied, and rarely occur in the exact order and connexion in which they are described by authors."
After describing the progress of the disease, the constitution in which it occurs, and the symptoms by which it is characterized, Dr. Southey proceeds to enquire into its external causes, beginning with a medical survey of the globe, in order to ascertain the degree in which consumption prevails in different regions; and those circumstances, such as climate, clothing, food and habits, to which its greater or lesser prevalence is to be attributed.
Dr. Southey sets out from the northern extremity of Europe. Honebow, Olafsen, and Povelsen, Sir George Mackenzie, and Mr. Hooker, all agree that consumption is one of the most prevalent diseases of Iceland; it is attributed to the severity of the climate, the hardships to which the inhabitants are exposed in fishing, and the little care they take to avoid wet and cold. Linnæus, in his Tour in Lapland, asserts, that among the Laplanders pleurisies are very common, but that consumption occurs, only now and then. Dr. Guthrie and Dr. De Mertan practised many years in Russia, and assert, that pulmonary consumption is not a frequent disease there; the same also appears to be the case in Denmark. We are in the habit of associating together cold and consumption; this immunity from the disease in climates where the cold is so much more intense than in our own, is attributed by Lord Molesworth to their warm stoves, and the plenty and pureness of their beech-wood fuel, while its prevalence in London is referred to the gross
and unwholesome fumes of our coal-fires. In the north of Germany, pulmonary consumption seems nearly as prevalent as in England; if you talk to a German, he is as familiar with lungensucht and auszehrung, as we are with consumption. In 1804 one-fifth of the deaths in the hospital at Berlin arose from consumption. The Dutch have a climate not warmer than ours, and their apartments are said to be large, airy, and what an Englishman would think chilly. Yet Dr. Cogan, who practised some years at Rotterdam, states, that they are comparatively exempt from this disease. Finke, in his Medical Geography, makes a different statement, (on a Dutch authority:-" Verhandelingen van de natuur en genees. kundige correspondentie opgericht in s'Hage.” S. 98.) That, at the Hague, out of 1457 deaths, three hundred and eleven are from consumption; that is, more than one in five; and at Bergen-op-Zoom, out of one hundred and fifty-seven deaths, thirty-nine from the same disease; that is, nearly the same proportion: if, however, we may place any reliance on the assertions of Hollanders in this country, there can be no doubt of its comparative unfrequency among them. At Vienna, some say one-sixth, and others one-tenth of the deaths arise from consumption. In France, the disease appears to be prevalent, and is attributed by Finke to the thin dresses of the natives. The women (says he think they must be ill to be interesting.
Hai aujourd'hui une santé indecente,” says a lady who feels herself thoroughly well; and in the spring, whatever may be the weather, they put on thin summer dresses, catch colds, and
go into consumptions. That consumption is frequent at Paris, the evidence of Portal is sufficient,--at this very time, one of the most eminent physicians in the French metropolis. The south of France is often considered as a favourable cli. mate for consumptive patients. Yet, at Lyons, the summer is very hot; the winter very cold, and diseases of the chest, particularly consumption, are frequent. Formerly, the consumptive in England were sent to Montpelier. Smollett long ago said, “ that this senseless custom yearly costs many lives.” “In Dauphiné, says Thierry, Erfahrungen, W.S.W.S. 44. the neighbouring Alps cause diseases of the chest; whoever has weak lungs, does not last long there; the dry tempestuous winds cause blood-spitting and consumption.
Consumption is well known throughout Italy; in the hospital of Santa Maria Nuova, at Florence, fitted up for 1200 patients, Domier found a number of consumptive. In Spain, it is well known, and is believed to be contagious; the bedding and clothes of those who die of it are burned; the same is the belief and practice of the Portuguese; they send their consumptive patients from Lisbon into Allentejo, particularly to Beja. The Maltese themselves are not subject to consumption, but consumptive patients from England are injured by the climate; the same is said to be the case with Sicily, where the disease is known and believed to be contagious. The inhabi. tants of the Archipelago seldom suffer from pulmonary affections. In Egypt, the disease seems to be unknown; most travellers are silent about it; and Savary states, that it does not occur there. Celsus considered the climate of Alexandria as well suited to the phthisical. At the Cape of Good Hope, we learn, that consumption was one of the diseases most fatal to the English settlers. In Bengal, it is not common; though, in a European regiment stationed at Bombay, about six cases occurred annually. Chardin says, that the Persians are not subject to pulmonary complaints.
Crossing the Atlantic, Dr. Southey takes a view of the new continent." The Greenlanders (says Crantz) are subject to consumption and blood-spitting; many drag along severad years with a weakness and defluxion on the breast, that suffocates them at last.” In Canada, pleurisies appear among the prevailing diseases; consumption is not mentioned. Among the northern Indians, according to Hearne, it carries off great numbers of both sexes and all ages. In New England, it is very common; before the arrival of the English, it was one of the two disorders most fatal to the American Indians; and this is attributed by General Lincoln to the disuse of furs, which they sold instead of wearing. At Boston, consumption and dysentery are said to be the diseases of the place, and are attributed to obstructed perspiration. In Portsmouth, in New Hampshire, it appears that one-fifth of the deaths are caused by pulmonary consumption, and that it destroys in the same proportion at New York, and nearly the same at Philadelphia. According to Volney, among the most prevalent diseases throughout the United States, are colds and coughs, frequently terminating in consumption. In the West-India Islands, consumption is by no means a common complaint. Io Jamaica, according to Hunter, it hardly ever occurs; and Lempriere says, that the climate was most favourable to the scrofulous, and those affected with pulmonary complaints. Du Tertre and Bryan Edwards corroborate the statement, that the disease is almost unkpown in the West Indies. It is better known in Barbadoes than in any other of the islands. Phthisis is common at Bermuda and the Azores. At Madeira, it appears, that it is one of the diseases to which the natives are most subject.
One of the first things which strike us in those nations, among whom consumption is most prevalent, is the deficiency of their clothing. The people, in the north of Europe, it is true, live in a climate of far greater inclemency, but how do they guard against the severity of the cold? (Phil. Trans. vol. 68.) “ The legs and feet (says Dr. Guthrie, describing the winter dress of the Russian boor) are guarded against the cold by many piles of coarse flannel, with a pair of boots over all; at the same time, that their bodies feel all the warınth of sheep-skin coats, and nothing is left open to the action of the air but the face and neck; his wooden hut is caulked with moss, snug and close; it is furnished with an oven, which answers the triple purpose of heating the house, dressing the victuals, and supporting on its flat top the greasy matrass on which he and his wife lie; in the same apartment sleep the children, and secondary personages of the family: they undergo, during the night, a most stewing process from the heat and closeness of their situation; insomuch, that they have the appearance of being dipped in water, and raise a steam and smell in the room not offensive to themselves, but scarcely supportable to the person whom curiosity may lead thither." How different this to our thin clothing, and half-warmed apartments. In certain parts of our own island, consumption is said to have been more prevalent, as the clothing has become scanty. In many parts of Scotland, (says Sir J. Sinclair,) where consumption is now prevalent, the old people affirm, that it was unknown before the warm Scotch plaiding was exchanged for the fine, thin, cold, English cloth, and woollen for cotton. So, in the vale of Keswick, it has been observed, that consumption has increased with the increased use of cotton among the women, instead of worsted, flaunels, and stuffs.
But, in our mode of living, thin clothing is not the only cir, cumstance which disposes to consumption; some classes of our countrymen appear to be almost wholly exempt from it, while others suffer peculiarity. Those who are most exempt,