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The former state of the tongue is a day by day, in despondency and in more frequent accompaniment of despair ; nor can there be a more that form of disease which originates trying death to the most religious of chiefly in hereditary predisposition; God's creatures. the latter, of that which is princi Under the general term, Conpally or entirely acquired, and in sumption, then, are comprehended which an irritated state of the sto- three different forms or stages of mach attends the disorder from the disease : 1st, General disorder of beginning, and often precedes it. the health-20, Tubercular cachexy In a third class of cases, of much -3d, Consumption, properly so rarer occurrence, the tongue is called. These different stages may, clean and natural in its appearance, in general, be distinctly recognised; and the digestive organs pretty re- but it is only in proportion to the gularly perform their functions. This physician's powers and habits of happens chiefly, Dr. Clark thinks, minute and careful observation that in females in whom the disease has the symptoms of the first stage will been mainly owing to hereditary be remarked, or in other words, that predisposition. Such patients bear, he will be able to detect the apand even require, a fuller and proach of the first tubercular disstronger diet ; with the others it is ease. But this is the time, by prothe reverse.
per applications, to prevent conThirdly, In consumptions the cir- sumption. If it be allowed to pass by, culation is subject to great variety ; as it is in many million cases, then in bereditary cases, the powers of “ The trot becomes a gallop soon, the heart, Dr. Clark thinks, are In spite of curb or rein." commonly under the ordinary stand Having thus spoken of the sympard, while the frequency of the pulse toms, let us now speak of the causes, is generally above it, and palpitation of consumption-and, first, let us is not an unfrequent symptom. In- attend, with Dr. Clark, to the heredeed, he thinks that a small feeble ditary nature of the disease. heart is a strong predisposing cause By hereditary predisposition, a of consumption.
term in the application of which Fourthly, The nervous system there has been some confusion, Dr. partakes of the general derange- Clark understands a peculiar condiment. Sleep is unsound, being tion of the system, depending upon either disturbed, or unnaturally its original conformation and organheavy and unrefreshing. The mind, ization, and derived from the parents, sympathizing with the body, loses which renders the individual more its energy; and the temper is often susceptible, or more liable to lapse remarkably changed. In the purer into certain diseases, than other perand less complicated cases of here- sons endowed originally with a ditary consumption, there is gene- more healthy organization. Now, rally great serenity of mind ; the it does not follow, as spirits are often of surprising buoy- sary consequence, that a child born ancy, and hope brings its cheering with a predisposition to a disease, influence with the last sufferings of must be attacked by that disease; the patient. That beauty is the but it will be more easily induced, worst of all to be borne by the lov- unless the condition of the system ing spectator of the dying one. But which constitutes the hereditary such a state of mind is far seldomer predisposition be corrected by proan attendant on consumption than is per management in early life. In generally believed, especially in some families, the hereditary predisthose cases in which the disorder of position seems so strong, that, withthe digestive organs leads to the out any cognisable cause, the regumorbid condition of the system. Iar actions of the economy become Then the poor patient is seen dying deranged, and the system lapses into
ne morbid state, which terminates entire substitution of artificial food Pataaily in consumption. Indeed, for the natural and only proper nour
some rare instances, the infant at ishment of infants; and in the sebirth has been found to be laboring cond, by improper, and often overinuer tubercular disease. On the stimulating, food ; and a hundred other hand, so weak is the hereditary other causes connected with early predisposition in many individuals, education. The education of girls thu a complication of powerful is too often such—especially in causes long applied is necessary to boarding-schools—it is needless to induce the disease. Between these describe it here—as to comprehend two extremes there exists every va- all the causes of consumption ; or, riety of shade in the disposition to if any be wanting, they are soon supconsumption. A disposition to plied by a fashionable life. On this eunsumption and to scrofula is often part of the subject, Dr. Clark dwells transmitted from parents to children, with much feeling ; but we have not by the deteriorating influence of room to follow him, and must now other diseases in the parents on the go on to consider a change to a physical condition of their offspring. milder climate as a remedy for that Thus, the children of dyspeptic, of deranged state of the health from gouty, and of cachectic parents, are which consumption springs. very liable to scrofula and consump Before such a change is resorted tion ; and this, though a more re- to, the disordered functions of the mote, Dr Clark thinks is probably body-particularly the digestive orthe original source of scrofulous and gans-must be corrected; and that tuberculous diseases.
must be done, not by any violent But the predisposition to con- means, but by slow, gradual, and sumption is very often acquired cautious treatment of local congeswithout any hereditary taint ; no tion and irritation, often combined person, however healthful may have with general debility, a pathological been his original organization, can state which it requires great judgbe considered totally exempt from ment and sagacity to manage. This the liability to consumption. It is being done, then the sooner the pamet with in early infancy, and occa- tient removes to a milder climate the sionally proves fatal to the octoge- better ; for the great utility of such narian. All causes predispose to it a climate consists in no “hidden which lower the tone of bodily magic," but in enabling the patient health — sedentary occupations — to pursue the restorative system abuse of strong spirituous or fer- through the whole year. mented liquors-unwholesome diet. The misfortune is, that the period In humid and cold situations, all of the functional disease is too often diseases which induce what is called permitted to pass, before any danger “ a bad habit of body.” Mental is feared ; and that relations are not depression accelerates the evil, and alarmed till symptoms of irritation, in constitutions laboring under tu or impeded function in the lungs, bercular disease, its destructive in- appear, of tubercular disease estafluence is most conspicuous. blished there, and fast leading to
But the origin of the constitution- the third and last stage of consumpal disorder which Dr. Clark de- tion. Even then, removal to a mild scribes as tending ultimately to con- climate, especially if effected by sumption, is very often to be traced, means of a sea-voyage, under very he says, to the mismanagement of favorable circumstances, may still children. The seeds of disease, be useful—but merely as a means which are to ripen at a later period of improving the general health, and of life, are frequently sown during of preventing inflammatory affect infancy and childhood-in the first tions of the lungs and bronchia. case by imperfect suckling, or the But when consumption is fully esta
blished—that is, when the character rested by nature, but in which a of the cough and expectoration, the long period must elapse before the hectic fever and emaciation, give work of reparation is completed, a every reason to believe the ex- mild climate has often been of great istence of tuberculous cavities in avail. In nicely balanced cases, the lungs, and still more, when the life may be preserved for many presence of these is ascertained by years by constant residence in a auscultation-he thinks that no be- warm climate-nor would there nefit is to be expected from change probably be any consumption at all, of climate. Under such circum- if, with the cuckoo, we could make stances, the patient should try the most favorable residences of his own
“ Our annual voyage round the globe,
Companion of the spring.” country, or even wait the result-it is needless to say what it will be Supposing a removal to a mild amid the comforts of home and climate to be decided on, which is watchful care of friends. It is in- the best climate ? No one climate deed natural for the relations of or situation is the best in all cases. such a patient to cling to that which In the first part of his book, Dr. seems to afford even a ray of hope. Clark gives the character of the But did they but know, says Dr. climate of all the different places Clark, the discomfort, the fatigue, resorted to by invalids, and has enthe exposure, and the irritation, deavored to draw a comparative necessarily attendant on a long view of their respective merits. It journey in the advanced period of was our declared intention to enrich consumption, they would shrink our pages with much of that most from such a measure ! Nor will valuable information ; but this artithe experienced medical adviser, cle has already grown to such a when he reflects upon all the acci- length, that we must omit it. Howdents to which the poor patient ever, it may be remarked of the must be liable, condemn him to the climates of the south of France and additional evil of expatriation. Alas! Italy, that, for consumptive invalids such unfortunate patients often sink in whom there exists much sensibia prey to their disease long before lity to frost and keen winds, and they reach the place of destination. more especially, if the immediate Almost all—nay all the rest- vicinity of the sea is known to disathrough pain and suffering, find, in gree with them, Rome and Pisa are a distant country, an untimely grave. the best situations for a winter resi
But there are chronic cases of dence. When, on the contrary, consumption, in which the disease the patient labors under a languid of the lungs, even though arrived or oppressed circulation, with a reat its last stage, may derive benefit laxed habit, and a disposition to by a removal to a mild climate— congestion or to hemorrhage, rather those in which the disease has been than to inflammation, and more esinduced in persons little disposed pecially when the season is known to it constitutionally, and in whom by experience to agree with the init usually occurs later in life than dividual, Nice deserves the preferwhen hereditary. The tuberculous ence. But in cases complicated afiection in such persons is occa- with gastric irritation, Nice is an sionally confined to a small portion improper residence. Indeed, Dr. of the lungs, and the system sym- Clark is of opinion, that where this pathises with the local disease. state of the stomach exists, no cliResidence in a mild climate, by mate which disagrees with it can strengthening the system, may save do the patient good, whatever be the patient. `In those fortunate, but his other ailments, and however farare cases, where the progress of vorable to them the climate may be. disease in the lungs has been ar
The climate which of all others
he thinks the best suited to con- exercise which it produces, sumptive patients, generally, is that principal agents in the cure, while of Madeira—for reasons assigned it seems also to act in a particular by him-and next to it, that of Te- manner on the nervous system. neriffe.
Many striking instances of the beThe profession are divided on the neficial effects of sea voyages in question, whether the preference is consumption, are authenticated. to be given to a seaside or an inland They are also much preferable to situation. Dr. Clark, from all he land journeys, in all consumptive has been enabled to learn and ob- cases which are complicated with serve, thinks that consumption, cete- palpitation, or increased action of ris paribus, is more frequent on the the heart, whether functional or desea-coast than in the interior ; but pending upon organic disease. But still, that the greater mildness of there may exist complications, on many maritime places, as of those the other hand, which would render on the south and south-west coasts a sea voyage unadvisable — as, of England, may more than com- when there is much nervous sensipensate for this difference, especially bility, a strong disposition to headwhen they are resorted to only for a ach, and an irritable state of the part of the year.
But of two cli- stomach ; a sea voyage, it is plain, mates, the physical character of must either do much good or much which being alike favorable, the one evil to an invalid, for it works on the sea-shore and the other in- strongly, for life or for death. Dr. land, he would certainly prefer the Clark recommends a cruise—and latter as a residence for a consump- not in the Mediterranean, but in the tive patient.
There was once a Atlantic. foolish idea prevalent even in the In place of sending consumptive profession, that the air of a marshy patients to pass the winter in a country was beneficial in consump- milder climate, it has been proposed tion ; but scrofula and consumption to keep them in rooms artificially are more frequent in many aguish heated, and maintained at a regular countries, than in others of a diffe- temperature. What says Dr. Clark rent character, and an attack of to this proposal ? He says what ague is surely more likely to prove seems to be the most rational, that the occasion of consumption than to with the advocates of such a meaprevent it. Thus, in the province sure, the state of the lungs appears of Frise, in the Netherlands, agues to be the only consideration ; whereabound, and it appears by a statis- as, it need not be told, that without tical table sent to our author by improving the general health, which Dr. Lombard, that consumption is cannot be done without exercise in more frequent there than in Edin- the open air, all measures, directed burgh. A humid atmosphere in a to the local disease, will be fruitcold climate is indeed one of the less. By such means, undoubtedly, most powerful causes of consump- the inflammatory action in these ortion.
gans may be kept down ; but they Is a sea voyage to be recommend- all favor the very condition of the ed or not, in cases of consumption ? system which led to the disease, Dr. Clark is decidedly of opinion and the removal of which condition that a sea voyage is beneficial in its can alone afford the patient a hope early stages, and most of all, when of recovery. Therefore, in the inthe disease is accompanied with cipient stages of consumption, he hæmoptysis (spitting of blood). He holds justly such a measure to be agrees with Dr. Gregory, who ex- generally most improper ; but in presses this opinion in his celebrat- the advanced stages, when all hopes ed Conspectus, that the unceasing of recovery have vanished, and motion of a ship, and the constant when removal to a distant climate is
totally useless, life may be prolong- may, and indeed will, recur, should ed, in many cases, by keeping the he expose himself to the influence invalids in apartments, the tempera- of any of its chief causes. And in ture of which is regulated in such a recovering from a very bad case, he manner as to maintain the air in the ought to remain long—perhaps for purest possible state. Females, years—in the climate which wrought from their habits, bear such a sys- the cure. Perhaps he may never tem of confinement better than again be able to live in any othermales—and both sexes, at the more never again be the man he once advanced periods of life.
was—and infatuated will he be, if of inilammation of the lungs, also, he lives as a strong man might, and which have occurred during the ever forgets that both his feet were winter, such a measure is good; once on the edge of the grave. but the patient ought certainly, if In conclusion, Dr. Clark submits possible, to pass the following win- the following corollaries as a sumter in a climate where confinement mary of his views regarding the nawill not be necessary, that his gene- ture and causes of consumption, ral health may be improved by ex- and its treatment, more especially ercise in the open air. Comparing, as connected with the effects of then, the benefits likely to result climate. to consumptive patients from a mild 1st, That tubercles in the lungs climate, and confinement to rooms constitute the essential character regulated to an agreeable tempera- and immediate cause of consumpture, there can be no question of tion. the decided superiority of the for 2d, That tubercles originate in mer. But when circumstances pre- a morbid condition of the general clude the possibility of changing system. the climate, then confinement to 3d, That such a state of system apartments of a proper and equable frequently has for its cause hereditemperature, is the best measure tary predisposition ; in other inthat can be adopted to avoid the in- stances being induced by various jurious effects of our cold, damp, functional disorders; while in a and variable climate during the third class of cases, perhaps the winter season.
most numerous, it arises from the Can any general rule be given conjoint effects of both these with respect to the length of time causes. which a consumptive invalid may 4th, That consumption is to be be required to pass in a mild cli- prevented only by adopting such mate, in order to overcome the dis- means as shall counteract the hereposition to the disease? No. When ditary predisposition, where it exit is had recourse to for the removal ists, and maintain a healthy condiof the disordered health which pre- tion of the various functions from cedes tubercular cachexy, a single infancy to the full development of winter may be all that may be ne- the body. cessary-when tubercular cachexy 5th, That in the general disorder is established, and still more, when of the health which leads to tuberthere is reason to suspect the pre- cular cachexy, or in tubercular casence of tubercles in the lungs, se- chexy itself, and even when tuberveral years may be requisite. In cles are formed in the lungs, unatconsumption, properly so called, tended with much constitutional Dr. Clark, throughout the whole disturbance, a residence in a mild work, expresses his belief that cli- climate will prove beneficial ; and mate, with rarest exceptions, will be also in cases of chronic consumpof little or no service.
tion, at any stage, where the lungs When the disease is cured, the are not extensively implicated in patient should never forget that it tubercular disease, and where the
11 ATHENEUM, vol. 5, 3d series.