We have already referred to this complaint in the preceding Section, and have noticed its probable con nexion with Scrofula ; but, whatever be our opinion on this point as a pathological question, it is a disease which amply deserves to be made the subject of dis tinct consideration. It is characterized by pain in the side or the chest, attended with cough, dyspncca, 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 cliarrhcea 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 po'verful 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 disposi sition, it is often very difficult to assign any immediate 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 civiliza tion 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 ren der the body liable to suffer from the state of the at mosphere, Phthisis may be regarded as the great scourge of the island. It has been calculated that not less than 55,000 persons are annually destroyed by it, which, if we estimate the total population of England at 12,000,000, will not he very far short of part, of the whole popu lation. 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 gra dual manner, and supervenes upon the affections of the chest, it is sometimes difficult to decide upon its pre sence. 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, various been employed for this purpose. Upon the,-rtole, however, we con ceive that an attention to the general condition of the patient, to his previous constitution and hereditary dis position, are more important than any one symptom, and will generally enable its to form a correct judgment. Although the state of the lungs in Phthisis has been carefully examined, and the appearances which they ex• hibit very minutely detailed, there still remains much uncertainty respecting the nature of the proximate cause, or of the manner in which the exciting causes produce the change of structure which the parts expe rience. When we examine the lungs after death, we find them to be filled with hard tumours, called tuber cles, 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 Scro fula 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 affec tions 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 little to offer, except a melancholy narrative of the failure of all the plans that have been presented to the public. Indeed, to those who have witnessed the condition to which the lungs are reduced, after they have ex perienced the ravages of this complaint, it can excite no surprise that all attempts at cure should be entirely unavailing, and must impress the mind with the full conviction that it can only be in the very earliest stages that any relief is to be obtained from the interposition of medicine. It is therefore to the prevention of Phthisis rather than to its cure that we are to direct our efforts, and this, if it can be accomplished, must depend upon avoiding the exciting causes, especially cold and mois ture, and still more, by using every means for fortify ing the body against their influence. Warm clothing and airy rooms, moderate exercise, regularity in diet and in all the habits of life, may do much in preventing the extreme susceptibility to catarrh, but for those whose situation will admit of it, and who are disposed to make so great a sacrifice, the removal to a warmer and more settled climate, is the only effectual preven tative. How far this is to be advised when the disease has actually established itself, or what stage of Phthisis admits of a chance of cure by this means, is a question on which it is extremely difficult to decide ; and there is no point concerning which a practitioner feels a more painful duty imposed upon him, than to pronounce the doom of his patient to be irrevocable, by discouraging his removal, or to subject him to a more painful fate, by separating hint from the comforts of his home and the attentions of his friends, without a prospect of relief.
In the earlier stages of Phthisis, or where the disease is impending, without the lungs being actually disor ganized, our great object is to prevent or counteract inflammation, and yet this must be done in such a way as to diminish the strength in as small a degree as pos sible. General blood-letting is sometimes admissible, hut it must be always had recourse to with caution ; we may with less hazard employ topical bleeding, if the pain of the chest and state of the pulse seem to in dicate it, and still more blisters, which are perhaps the most power fug remedies that we possess in this disease. We must endeavour to allay the cough by mucilagi nous mixtures, to which small quantities of opium may he added, and we may endeavour to allay the fever by diaphoretics; but we must proceed with great caution in the administration of any substance that is intended to act upon the capillaries of the skin, in consequence of the tendency to profuse perspiration, which always exists in the latter stages of Phthisis ; the same remark applies also to the bowels. How far any benefit is to be expected from sedatives is still a controverted ques tion ; for although we apprehend there can be no doubt of the advantage which is occasionally derived from digitalis, in certain inflammatory states of the chest, yet we are not disposed to expect much from it where the structure of the lungs is affected. As, however, we have no means of ascertaining when this crisis has actually occurred, a cautious employment of digitalis may be generally admissible ; but it should always be given in small doses, and we think it may be assumed as a general principle, that if no benefit be obtained from small doses of this medicine, we are not to hope for any advantage by increasing the quantity ; on the contrary, we should expect that its deleterious opera tion would he induced, with all its train of distressing consequences. When the hectic is fully established, nothing is to be attempted but the palliative treatment, and for this we must refer to the remarks that we have already offered on the subject. It only now remains for us to sooth the termination of life, by diminishing, as far as lies in our power, the various sources of un easiness that from time to time rise up to distress the patient. Every candid practitioner will confess, that beyond this, he can have no expectation of obtaining the least relief from the aid of medicine; and it is a duty which he owes to himself no less than to his pa tient, to refuse his consent to any of those experiments, which, with whatever pretensions they may be sup ported, must be regarded as the offspring either of de lusion or of empiricism.* Another disease, which, like Phthisis, is supposed to be nearly allied to Scrofula, if not to be a mere modi fication of it, is Rickets. It would seem to have first made its appearance in modern times, for it is too re markable in its symptoms to have been overlooked ; and there is probably some reason to believe that it is not now so frequent as it was half a century ago. It is essentially a disease of the bones, in which they in crease in bulk, and at the same time lose their firmness, so as not to hear the weight of the parts attached to them without being bent out of their natural form. It makes its first appearance at an early age, and conti nues until about ,the period of puberty. During this interval the patient suffers from the immediate effects of the distortion that is produced in various parts of the body, as well as from irregularity in the different or ganic functions, and especially in those of the digestive organs, so as to induce a great degree of emaciation and debility, which not unfrequently affect the mental as well as the corporeal faculties, and ultimately pro ceed to a fatal termination. When the disease assumes a less acute form, the powers of the constitution filially overcome the violence of the disease ; but the deformi ty of the bones still continues; and when it has affected the trunk of the body, it often materially deranges some of the functions, and leaves the parts in a state from Nvhich they can never afterwards recover themselves. The cause of Rickets is not yet ascertained; many of the circumstances which tend to induce Scrofula seem also to favour the appearance of Rickets ; but we are dispo sed to regard them as distinct complaints, because we do not perceive that the s)mptoms are necessarily con nected together ; but, on the contrary, that they com monly attack certain individuals separately, and are not convertible into each other. The affection is generally thought to be hereditary, yet the tendency is not so ob vious in this case as in Scrofula, or in Phthisis; and we perpetually observe examples, where a single member of a family is diseased without any other suffering from it. The proximate cause of Rickets appears to be a change in the physical and chemical constitution of the bones, the animal matter which enters into their com position being probably in a morbid state, and the earthy matter either deficient in quantity, or altogether want ing ; but in what way these changes are effected, or how they follow from the exciting cause, we are alto gether unable to explain.