The term Phthisis, or Consumption, in its broadest sense, is applied to all those diseases, in which the system sinks under a gradual waste of the powers of life. These diseases may be divided into two great classes—1. That form of Consumption in which the lungs are unaffected.—2. Phthisis Pulmonalis, properly so called, where the lungs are the seat of the disease.
Under the first class are included,
1. Atrophia, or Consumption from want of nourishment, or excessive evacuations, but without hectic fever; excluding all those forms of disease produced by immoderate evacuations, in which the lungs become affected.
2. Tabes, accompanied with hectic fever, frequently attended with disease of the mesenteric glands, and produced most commonly by scrophula.
The second class, Phthisis Pulmonalis, to the consideration of which this essay will be more immediately confined, may be also subdivided into,
1. Primary, where the lungs are the original seat of the disease, and as a consequence, the general system becomes affected.
2. Secondary, where the system being first reduced by any debilitating cause, the lungs become secondarily affected, as a symptom of the general disease.
These two forms of Consumption, although somewhat similar in their symptoms, yet proceed from opposite causes, and require opposite treatment. The one is a disease of pure inflammation; the other of unmixed debility. In the one, an active antiphlogistic treatment is necessary; in the other, the system requires all the support, which tonics and good nourishment can afford.
Phthisis Pulmonalis is thus defined by Dr. Cullen, “Corporis emaciatio et debilitas, cum tussi, febre hectica, et expectoratione purulenta.” This definition is peculiarly incorrect, because it leads us to neglect, the first stage of the disease; if the symptoms of an Incipient Phthisis were stated to us, and we were asked, what was the disease, from this definition we would be perfectly at a loss for an answer. Except the cough, none of the symptoms there stated are to be found in the first stage of Consumption. And yet that is as truly a part of it, and of as much importance to the practitioner, as the last stage, which alone is included in Cullen’s definition.[3]
Agreeably to this definition, in his view of Phthisis Pulmonalis, Dr. Cullen makes ulceration of the lungs and hectic fever essential to its existence, and seems rather to consider the preceding symptoms a cause of this ulceration and fever, than as constituting an integrant part of the disease.