Debility from the want of accustomed stimuli, is mentioned by Dr. Hosack as another cause of consumption, and he instances those confined in the State Prison. The want of accustomed air and exercise, the deprivation of the use of spirituous liquors and good diet, to which the prisoners had been accustomed before their confinement, was observed by him to have produced this disease.
Depressing passions of the mind, and a consequent too free use of spirituous liquors have also been noticed by authors among the predisposing causes of Consumption.
The last of these causes which I shall notice, is the disposition of the system to form calculous deposits in the lungs, generally in consequence of a plethoric habit. Phthisis from this cause however is rare; of nine hundred patients examined by Bayle, only four were of this description.
These various causes having either separately or conjointly predisposed the body to Phthisis, are most frequently excited into action by a common catarrh; which becomes the more active by frequent repetition. The danger arising from catarrh is not a little increased by the popular mode of treating it: stimulating spirituous drinks, and a vast variety of remedies of the same class are the usual prescriptions. Almost every body has an infallible remedy for a cold; some of them innocent, but many injurious. The common prejudice in favour of “feeding a cold” increases the mischief, and unfortunately, the disease not generally affecting the system sufficiently to destroy the appetite, as in many other maladies, nature does not prevent the practice. Abstinence, cooling acidulous drinks, with perhaps a gentle saline cathartic, are the safest and most effectual remedies in curing a common catarrh, when of its usual slight form. At the same time, inhaling warm air, by means of Mudge’s apparatus, is a valuable and grateful auxiliary to this treatment. Catarrh is so common and generally so easily cured without any consequent ill effects, that it is too apt to be neglected. Many a patient, labouring under incipient Phthisis, has been supposed to be affected by merely a “trifling cold,” and the only opportunity for curing the disease has been lost. “The evil becomes irremediable before it calls either the attention of the parents, the friends, or even the physician, who has not been familiarly conversant with the fatal consequences of this disease.”[5]
Pneumonia is not unfrequently an exciting cause of Phthisis. Like catarrh, its frequent repetition is more dangerous than a single attack. Pneumonia may indeed act merely as a predisposing cause of Consumption, by leaving the lungs in a debilitated and irritable condition, favourable to the production of that disease; but it is an exciting cause, when in consequence of inflammation of the lungs, suppuration follows, and vomica or empyema is the consequence. This shews the close analogy between Phthisis Pulmonalis and ordinary Pneumonia. In the first, the inflammation being seated in the cellular and comparatively insensible portion of the lungs, is slow and gradual, and the consequent suppuration forms in the same manner; while in Pneumonia, the membranous as well as cellular portion of the lungs being involved in the disease, the inflammation is rapid and violent, and must soon terminate in either resolution or suppuration. Hence Phthisis Pulmonalis was appropriately called by Dr. Rush a “Pneumonicula.” No word could more accurately describe the nature of the disease. That acute observer has drawn an excellent parallel between the two diseases, and concludes with observing, “In short the pneumony and Consumption are alike in so many particulars, that they appear to resemble shadows of the same substance. They differ only as the protracted shadow of the evening does from that of the noon-day sun.” It is remarked, however, that all cases of Pneumonia terminating in suppuration are not necessarily fatal. If a predisposition to Phthisis do not exist, or the constitution be not too much debilitated, a vomica may burst and be discharged, and the patient recover.
A third exciting cause of Phthisis, is the suppression of accustomed evacuations. These evacuations are the menses, the lochiae, the discharges in Leucorrhæa, and from ulcers, fistulæ and issues. Retention of the menses producing Chlorosis, being a consequence of debility, does not excite primary Phthisis Pulmonalis, but the secondary form of the disease. Suppression of the menses, however, not unfrequently excites a Consumption, bearing all the characters and requiring the treatment of primary Phthisis. The plethora, consequent on the cessation of the menses, has often the same effect.
Asthma, by the constant irritation to which it subjects the lungs, becomes an exciting cause of Consumption.
Several eruptive diseases, as Scarlatina, Small-Pox and measles, often produce the same disease.
Morton also enumerates stone in the kidneys and bladder, gout and rheumatism, as causes of Consumption.
By the same author, contagion is supposed to communicate this disease. Morgagni, Van Swieten, Home and Heberden all hold this opinion. And Morgagni relates that Valsalva, who was predisposed to Consumption, was so satisfied of its contagious nature, that he constantly avoided being present at the dissection of the lungs of persons who had died of that disorder.