Remarks on the antecedents and treatment of consumption / by Charles Drysdale, M.D.

  • Drysdale, Charles R. (Charles Robert), 1829-1907.
Date:
1865
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    REMARKS ON THE ANTECEDENTS AND TREATMENT OF CONSUMPTION. CHAELES DRYSDALE, M.D., M.R.C.P. Lond. ; F.R.C.S. Eng. ; PHTaiCIXN TO THE FAJtRINODON DI3PBNSABV. Read at the Harveian Society, February, 1865. LONDON: PRINTED BY M'QOWAN AND DANKS, GREAT WINDMILL STREET, HAYMARKET, W. MDCCCLXV.
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    REMARKS ON THE ANTECEDENTS AND TREATMENT OF CONSUMPTION. 0- liV order to speak of the treatment of consumption, it is abso- " lutely essential, in my opinion, that we be well acquainted with the antecedents of the disease. It has been well said by a great physician, that the greatest steps in modern medicine have consisted in discovering the laedentia and removing them ; as, for example, when it was discovered tliat the fearfiirscourge of scurvy wliich destroyed so many of our brave seamen but a few years ago, in the French wars, was owing to an error in diet. Dr. Law tells us that, in 1780, Admiral Geary's squadrons after a cruise of ten weeks, had 2,i00 men affected by scurvy.' There are, of course, cases where the discovery of the causes of a disease are but of slight consequence to its correct treatment. For example, a broken limb may be bandaged up without our caring much how it was broken, or a cataract extracted with the same idea. But, in the case of phthisis, tlie right treatment of the disease is, I am convinced, so completely involved in the knowledge of the accidents which have produced it, as to render It essential that these be well studied, before approachino- the practical question, How are we to treat a particular case of%on- sumption ? Hereditary Transmission.—Lu»o\ says half of the cases of phthisis are hereditary; Piorry, one-fourth ; Euysch, four- fifths. Dr. Walshe says that about one-fourth of his phthi- sical patients had a father or mother or both parents similarly affected. Dr. Edward Smith's cases gave about one-fourth also. One of the most frequent parental antecedents of phthisis is scrofula. This is vouched for by Lugol and Hardy. Children aged parents are liable to phthisis; and the off- spring of very young parents, according to some authors, are also liable. Excessive sexual zndulgciice, or mastiorbation, in tlie parents are stated to be frequent causes of consumption in the offs])ring ; in fact, generative debility, however caused. [ideni'pcrance.—AmowQ diseases attributed by medical autliuiities to the excessive use of alcoholic liquors, it is said that the children of drunkards, and even of gouty parents, aro liable to consumption.
    Excessive Tobacco-smoking.—Dr. Copland and others have laid great stress on the injurious effects of tobacco-smoking on the offspring, and with justice. Personal Antecedents.—The influence of employment on the production of phthisis is well marked, and it is chiefly to the writings of Villermd, Greenhow, Tardieu, and Edward Smith, that we must refer for information on this point. Dr. Greenhow stated in an address " On the Effects of Trade on Health," de- livered at the London meeting of the Social Science Association in 1862, that in England and Wales diseases of the chest of all kinds, inckiding consumption, caused on an average; 100,000 deaths annually from 1847 to 1855. If the mortality through England and Wales could be reduced to that of the most favoured districts, there would be an annual saving of more than 45,000 lives. The most important contribution, however, in my opi- nion, yet made to the knowledge of the causation of phthisis is thab made by Dr. Christison in 1863, at the Edinburgh meeting of the Association. " Taking," he says, " the population of Scot- land in 1855 at 3,000,000, and assuming that the deaths from consumption were nearly all specified, or, at least, nearly so, which is probable, the total mortality in 100,000 was 2,080, and that from consumption 237. Dividing the mainland into large towns of 10,000 and upwards, and the rural mainland, comprising all smaller towns, with the pure country, it appears that the mortality from consumption in 100,000 was in the rural mainland 186, and in the great towns 333, or not much short of double. But let us look into the facts more narrowly, and the real difference will be found still greater. In Glasgow, whose population in 1858 was 356,000, and where all the town- causes of mortality greatly abound, so that the annual deaths reach 2,890 in 100,000, or almost 1 in 38, those from consump- tion are as high as 385 in 100,000. In the case of Berwickshire, however, we have the most perfect example in Scotland of a population combining the richest agriculture with freedom from the deteriorating influence of mining, manufactures, and large towns. None of its towns exceed 3,500. There is, I think, only one large factory in it—a paper manufactory—and there are no mines. There, accordingly, the total annual deaths are 1 in 70; and the deaths from consumption amount to 104 in 100,000. The general mortality is nearly one-half that of Glasgow ; and the share contributed by consumption is nearly one-fourth of the proportion of that city." The same account holds good for England, although in a rather less marked degree than in the longer-lived country of Scotland. The annual mor- tality of Scotland is 1 in 48 ; of Sweden, 1 in 51; of Norway, 1 in 55. In Hertfordshire the mortality from consumption is 179 in 100,000 annually; it is 363 in 100,000 in Livei-pool;