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that there was a form of consumption of an asthmatic kind.

Desault had very clear views of the true connection between tubercle and phthisis, and believed that generally hæmoptysis occurs subsequently to the tubercle, and in this latter opinion he was supported by Mudge and Gilchrist. The ulceration of the lungs was known to be an effect and not a cause of the disease. He drew attention to the frequency with which disorders of the liver attend consumption, and held to the doctrine that the latter is a contagious disease. In his opinion the beneficial effect of exercise was by breaking down the tubercle.

Tralles expressly believed that tubercle was the immediate cause of consumption.

Stark described tubercle and vomica with much minuteness, and stated that he had found them in the cellular membrane. His views were an advance upon those previously held.

Portal divided phthisis into several varieties, and believed that there were three kinds of tubercles.

Pearson published in the "Philosophical Transactions" a series of minute inquiries into the character and composition of different kinds of expectoration.

VIEWS RESPECTING TUBERCLE.

The views of tubercle as found in the lungs are very various, and deserving of attention.

Sylvius regarded them as glands in the lungs which suppurate and form vomicæ. Tralles considered them to be bronchial glands and vesicles distended by humours.

Clayton injected the veins of a dog with mercury, and found minute suppurations in the lungs, having each a globule of mercury at its centre. This was believed to indicate the mode of formation of tubercle, Willis was of opinion that the expectoration in phthisis proceeded from the minute vessels of the trachea, and was derived from the serous parts of the blood. When retained it putrified and formed ulcers. Boerhaave considered consumption to be a conversion of all the blood and chyle into pus. Thomas Reid believed that tubercle consists of obstruction of the exhalent vessels, caused by the viscidity of their contents. Sydenham divided consumption into four kinds, and in reference to the first-which includes cases of true phthisis-he states that the lungs, being incapable of assimilating the proper aliment, are overwhelmed with a crude phlegm, and that a part of the humours which ought to be thrown off by perspiration is retained by the lungs. Rush believed tubercle to be a collection of inorganic mucous substance. On considering these various opinions of the nature of tubercle, we cannot avoid seeing the similarity between some of them and those recently promulgated, and then withdrawn by Rokitansky, based upon the chemical learning of our day, which affirmed that the albuminous matters of the blood were expended in the formation of tubercle. The connection between scrofula and phthisis which was held to exist by those above-mentioned, who regarded. tubercle as a gland, was generally maintained, and particularly by Brillouet in 1789, and Radcliffe, (the latter at least believing it to be so in cold climates,) and also

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by the Edinburgh school in general.

On the other hand Simmons, in 1780, denied the connection both of phthisis and scrofula, and of tubercles and scrofulous glands.

AGE.

The age at which this disease prevails was the same two thousand years ago as now, for Hippocrates informs us that in his day it was from eighteen to thirtyfive years.

CAUSES.

In reference to the assigned causes of the disease which were held up to this period, we may first cite catarrh, to which reference has been already made, and acrid humours, either generated in the lungs, or descending from the head, and produced no doubt by the catarrh, as held by Sennertus, and Hofmann, and by Huxham, in 1758, when tubercles had been previously formed. Borelli believed that the smoke from the wicks of candles, and fat and oil when poured into a confined space and inhaled, was a cause of phthisis. Spigelius affirmed that in England it was commonly caused by tight dresses; whilst Van Swieten was of opinion that it was produced by the excess of animal food in which Englishmen indulged, Stahl agreed with the latter in believing that it was often due to inactivity and full living. Sims thought it to be frequently caused by the retention in the body of morbid matters produced by syphilis and gonorrhoea. Avicenna remarked upon the greater prevalence of phthisis in cold countries, and Blane affirmed it to be less frequent in hot

climates. Rush associated the disease with civilisation, for he remarked that it was unknown to the North American Indians before they associated with white men, and was not found among colonists in the earliest stage of civilisation. Walker, speaking of the atrophy of nurses, attributed that disease to the use of tea in the place of food. Musgrave saw a connection between gout and consumption. Withering remarked that ostlers and grooms living in the alkaline air of the stable were rarely consumptive; and De Haen noticed the arrest of phthisis during pregnancy.

CONNECTION WITH HECTIC AND HÆMOPTYSIS.

The connection of consumption with hectic fever has been already referred to. Amongst the Greeks the two conditions were held to be distinct, except so far that consumption appeared in the course of hectic fever; but in later times the hectic came to be regarded as a cause of consumption. Bontius recognised a true consumption with hectic. Macbride regarded phthisis and tabes as the principal species of hectic fever, but yet he admitted that the symptoms of phthisis precede the hectic. Cullen defined consumption as an expectoration of purulent matter with a hectic fever, more or less exquisitely formed, and commonly with ulceration.

In reference to the connection of phthisis and hæmoptysis, it has been shown that the early fathers regarded the latter as a cause of the former, and this view has been shared by many moderns. Cullen states that "the consequence of hæmoptysis is phthisis," and

Hofmann asserts that half the cases arise from hæmoptysis; but Desault, Mudge (who believed it to be the consequence of obstruction in the lung), and Gilchrist affirmed it to result from, or at least to follow, the deposition of tubercle. We have noticed the observation of Galen as to the occurrence of faucial hæmorrhage, and Van Swieten believed that hæmorrhage from the palate might be mistaken for tubercular hæmorrhage.

CONTAGION.

The contagious nature of the disease was perhaps universally believed by the ancients, and the belief has been conveyed through later ages to our own times. Sylvius, Hofmann, Desault, Van Swieten, and Darwin adopted it, and so much impressed were Morgagni and Valsalva with this quality of propagation that they declined to open the bodies of consumptive patients, and thus excused themselves for their inability to determine the immediate seat of tubercular deposition. Portal denied the contagious nature of the disease.

NATURE.

In reference to the nature of the disease in the sense of phthisis, as now understood, we have seen that it was regarded by the ancients as an ulceration of the lung; then there was a connection perceived between tubercle and phthisis; and then, as at the æra of Stark or Desault, tubercle was regarded as having an essential connection with phthisis, but Rush maintained that phthisis was not essentially a disease of the lung, but an affection of the general system, and

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