The predisposing causes are, heredita ry disposition ; mal-conformation of the chest ; sanguine temperament; scrofu lus diathesis ; which is indicated by a fine, clear, and smooth skin, large veins, deli cate complexion, high coloured lips, the upper one swollen, white and transparent teeth, light hair, and light blue eyes, with a dilated pupil : there is great sensibility, uncommon acuteness of the understand ing, and a pecufiar ge ntleness and softness in their manner; the immoderate use of venery ; certain diseases, as the !looping cough, syphilis, and various exanthemats, particularly the measles; various employ ments, as stone-cutters, needle-grinders, flax-dressers, and all sedentary occupa tions, particularly those which require a considerable degree of stooping; the re trocession of eruptions; indulgence in in toxicating liquors ; and according to Dr. Beddoes, hyper-oxygenation of the blood. The exciting causes are, homoptysis; em pyema; catarrh, particularly the influen za ; asthma, obstructions of the abdomi nal viscera, particularly an enlarged and indurated state of the liver; calculi form ed in the lungs ; contagion and tubercles. The proximate cause is supposed to be an ulcer in the lungs.
The pro/rime in this disease depends upon the causes whence it originates, and upon the violence of the symptoms ; Wit be in consequence of empyema or tuber cles, there is more danger than when it arises from hsemoptysis or wounds in the chest, but every cue of phthisis is always attended with danger. The progress of phthisis is often interrupted by preg nancy and mania ; the latter has produced a radical cure, but in the former it almost always returns after delivery with in creased violence.
to the treatment of this disease it will be particularly expedient to avoid, and, if in our power, to remove the occasional causes mentioned above, by the proper methods, which are mentioned in other parts of this treatise ; if several of the premonitory symptoms, as a dry, short, troublesome cough, occasional stitches in the side, slight dyspncea upon usingexer cise, and a pulse somewhat accelerated and hard, should attack a person of a phthisical habit, the most powerful reme dies must be employed without loss of time : blood-letting, in a moderate quan tity, will be necessary, and it should be repeated at proper intervals till those symptoms are relieved, taking care, how ever, not to reduce the strength of the patient too much, as debility is the most urgent symptom•in the course of the dis ease : the bowels should be kept regular by gentle cathartics, as the calomel and rhubarb. After these evacuations, the ipecacuanha, either alone, or with a small quantity of emetic tartar,should be given in the morning, fasting, in such doses as will excite vomiting once or twice at most; when the heat, fever, cough, and pain in the chest are considerable, small doses of the nitre, or the saline mixture, with nauseating doses of the emetic tar tar, should be- given three or four times in the course of the day : in this stage of the disease, small doses of colomel, admi nistered at bed-time, are of considerable service, except there is a tendency to diarrhea, as the bowels, by its use, are not only kept regular, but it, at the same time, acts as a powerful deobstruent, and, in our opinion, an alterative course of mercury is of advantage, in the incipi ent stage of phthisis, for the removal of indolent tubercles : should the cough prove violent, opiates may be given at bed-fime, and in the night, if necessary, the extractum papaveris albi, in closes of five grains or more, is particularly suita ble ; if there be a fixed pain in the breast or sides, increased upon coughing, local blood-letting, and small blisters applied in succession about the thorax, will afford considerable relief, or a seton may be made as near the part affected as possible. In the second stage of the disease, the employment of emetics, composed of the ipecacuanha, with a few grains of the sul phate of zinc, must be duly persisted in, in the morning, fasting: when the morn ing sweats are very profuse, the infusion of roses or vitriolic acid should be em ployed with freedom; other in the pro portion of two or three drachms to a pint of water, with some of the mucilage of quince-seeds, makes a grateful and slight ly tonic mixture, a glassful of which may be taken frequently, or the Bristol or Seltzer waters may be drank; they are very efficacious in moderating the thirst, burning heat of the palms of the hands and soles of the feet, and the partial night sweats: opiates must be given in such as will quiet the cough and procure sleep, taking care, however, to obviate costiveness, and if the patient feel a sickness in the morning after them, coffee will effectually remove it; muci laginous fluids, combined with small quantities of spermaceti, are also of ser vice in allaying the irritation in the fumes. When the inflammatory diathe sis is subdued, chalybeates, combined with myrrh and carbonate of potash, may be given with advantage ; lime-water is a suitable menstruum for dissolving the myrrh. The digitalis is strongly recom mended in these two stages in particular; it certainly is deserving of a fair and im partial trial, and appears to be a medicine well suited to this disease, more especial ly in the inflammatory stage, from its well known power of rendering the ac tion of the heart and arteries more slow than natural, a desideratum in phthisis, in which the pulse ranges from eighty to one hundred and twenty, ormore ; it also is very efficacious in exciting the action of the absorbents: the factitious airs may also prove an useful auxiliary, or air im pregnated with the oxide of zinc, or man ganese, in their most comminuted state, might be applied to the lungs by means of an apparatus, as recommended by Dr.
Darwin, in his Zoonomia, or by that of Mr. Watt, of Birmingham : the vapour of a saturated tincture of ether, impreg nated with hemlock, may be inhaled; It is made by macerating for a few days from one to two scruples of the dried leaves of the hemlock in an ounce of the ether. The hectic paroxysm may be prevented, or cut short, by the effusion of tepid water at the commencement of the hot stage, or its effects may always be moderated by moistening the palms of the hands and soles of the feet with vine gar or cold water ; it should always be resorted to, when the burning heat men tioned above is present ; it is not only per fectly safe, but highly refreshing. In the third stage, should the above plan not be adopted in time, and diarrhoea has made its appearance, the gentle emetics be fore mentioned are recommended to be administered, provided the strength of the patient is not too much exhausted ; mild astringents should at the same time be employed, as the decoction of harts horn, or logwood, angostura, colombo, kino, and mucilagi nous de mu Icent liquors, combined with opiates and absorbents. During the inflammatory period of phthi sis, a vegetable diet, with milk, is indis pensably requisite; souins, sago, barley, and rice, afford an agreeable variety ; the lichen islandicus is strongly recommend ed, and is deserving of a trial ; the ripe subacid fruits may be indulged in at pleasure ; attention must, however, be paid to the state of the bowels: oysters, muscles, craw-fish, lobsters, and the tea tacea in general, also flounders and whit ings, may be allowed occasionally, pro vided they do not disagree with the stomach, and do not aggravate the symp toms. In the advancedperiods, when the hectic is completely formed, a small portion of animal food may be taken for an early dinner, if it does not greatly in crease the heat, and when the appetite becomes voracious, which it sometimes does towards the fatal termination, small quantities should be taken frequently : the drink, in almost every period of the disease, should consist of toast and water, Malvern water, milk and water, butter milk, rice water, or the juice of ripe sub acid fruits mixed with water, and occa sionally lemonade. Wine, spirits, and fermented liquors of all kinds, must be strictly prohibited, and the practice of mixing rum and other spirits with milk cannot be too strongly reprobated ; where, however, there is but little in creased excitement, and the pain is in considerable, a more nourishing diet, and a moderate quantity of wine, may be al lowed, but the wine should be more or lees diluted with water, and in the puru lent stage, an invigorating diet always 'affords more or less relief. the whole course of the disease, every irre gularity and all crowded places must be studiously avoided. The patient should be advised to repair to Bristol in the early part of the disease, and should make use of such exercise, as his strength will bear, as swinging, gestation in a car riage,.or riding on horse-back in progres Sive journeys, or the alternation of this last exercises and gestation in a carriage, but a sea voyage is the most effectual of all kinds of gestation ; the patient must by all means avoid the piercing north east winds in this country ; it will there' fore be advisable for him to visit a tem pevate southern climate during the win ter and spring : the patient should be ad vised to lie on a hair mattress, with slight coverings over his body, and should be earnestly requested to go to bed early, and to get up soon in the morning, evert if obliged, through debility, to lie down in the course of the day: the feet should be kept dry and warm, and the patient should wear flannel or cotton next to his skin ; the formet, however, is far more sa lutary ; in the florid consumption, an elevated and inland air is often of the most essential service. Should we be so fortunate as to subdue this too fatal disease by the means recommended above, it will be indispensably requisite for the patient to persevere in the regimen recommended in the treat ment of this complaint, for a considerable length of time after every symptom of the disease has disappeared, and he must return to his former manner of living with the utmost caution; the diet should, however, be light and nourish ing, and in moderate quantity: the pa tient should breathe a pure dry air, and should take such exercise, particularly on horse-back, as he can bear without fatigue, and should use the warm bath ; and when the constitution can be brought to bear it, he may employ the cold bath or sea bathing.