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The great mortality from this disease in the United States, and the general inutility of remedial efforts, ought to excite public attention, and awaken inquiry as to methods of prevention. From an examination of the bills of mortality within my reach, and information derived from medical correspondents in various sections of the Union, I am obliged to conclude that there are at least fifty thousand deaths by consumption, every year, in this country.
Allowing the same mortality from this disease to the entire population of the United States that there has been from it for several years past in the cities of Portsmouth, Boston, New York, Philadelphia, Baltimore, Washington, Charleston, and Natchez, and the number of deaths for the whole country would considerably exceed fifty thousand.
Yet notwithstanding this immense mortality, the disease attracts but little attention. If a case of yellow fever or malignant cholera occurs in any part of the country, the whole community become alarmed, and have recourse to measures of prevention. Few persons, however, think of resorting to any means to prevent the extension of consumption; a disease far more destructive of human life in this country than any other, and in which preventive measures are of great efficacy.
In this communication, I purpose to exhibit, by the statement of a few facts, the alarming prevalence of this disease in the United States, with the hope of awakening attention to some measures calculated to diminish it.
The following table exhibits for a series of years the number of deaths by consumption, and also the whole number of deaths from all diseases, in some of the largest cities in the country:
1824 4311 736 1824 4399 576 18:24 1297 242 1824 1469 188
From this table it appears that the proportion of deaths by consumption, to the whole of the deaths by all diseases is, at
Portsmouth, N. H., as 1 in 5,39 Philadelphia, as 1 in 7,17 Boston, 1 " 5,79 Baltimore,
1 " 6,18 New York,
1 " 5,89 Washington, 1 8,51
Charleston, S. C., as I in 7,08. It also appears that the mortality from consumption is the greatest in the most northern cities. Thus it is greater at Portsmouth than at Boston, (and it is greater at Portland than at Portsmouth. The whole number of deaths from all diseases during the last year at Portland was 305, of which number, eighty-four were by consumption, being in proportion to all the deaths as one in 3,53.) The disease is more frequent in Boston than in New-York, and more so in New-York than in the cities farther south. It will be noticed, however, that the deaths by this disease are less in Philadelphia than in Charleston and Baltimore. This may be owing partly to the inland situation of Philadelphia ; as it is well established, that this disease is more prevalent in the cities on the Atlantic, than in those of the interior; and partly to the fact, that many individuals from the north, affected with disease of the lungs, visit the cities of the south, particularly Charleston, for the sake of a warm climate, but die there of consumption. This prevents our ascertaining from bills of mortality all the deaths that occur from consumption among the inhabitants of the northern cities, and improperly swells the list of reported deaths in some of the southern cities.
But though there is less of this disease in southern and warm climates than in northern and cold ones, yet it prevails to a great extent even in warm countries — in Italy, in the West Indies, and in the southern states of this country. As I have said, it prevails more in towns on the Atlantic than in those of the interior, though the difference is not, I apprehend, so great as many suppose. According to the statements of some writers, there is but little of this disease in the Valley of the Mississippi, and in the western parts of this country. Mr. Flint, in his · History and Geography of the Mississippi Valley,' remarks that . Pulmonary consumption is a very uncommon disease, not often witnessed in the northern region of the western country. Fifty persons fall victims to this terrible destroyer in the Atlantic country to one that dies of it here. We can hardly believe this to be correct. It is difficult, however, to obtain much accurate information on this subject, as but few of the towns in the western country have published bills of mortality; but from information derived from various sources deemed authentic, it appears that although this disease is less frequent at the west than in the east, yet it prevails even in the former to a great extent.
The whole number of deaths at Natchez for thirteen years — from 1822 to 1835 — was 1904, and the deaths by consumption during the same time 100. This at first appears to be but a slight mortality from consumption. But it should be recollected that the total mortality is very great — equal to that of the most sickly cities of Europe; and that 100 deaths by consumption in thirteen years, for the population of Natchez, is nearly equal to the mortality from this disease in Philadelphia though it is in proportion to the whole number of deaths but as one in nineteen, while in Philadelphia the proportion is as one in seven.
It is however true, that many predisposed to consumption, and while
in the Atlantic country, are affected with lung complaints, regain their health on removing to the west. Several such instances have fallen within my own observation. But this may as properly be attributed to the remedial effect of a long journey and mental excitement, as to the climate of the western country. Long journeys, with pleasurable mental excitement, are among the most useful remedies in the early stages of this disease.
It is generally believed that consumption is much more frequent and fatal in cities, than in the country. This is probably true in Europe, where the inhabitants of the large cities are far less healthy than those in the country
But from all the facts I can obtain on this subject in the United States, it appears there is not great, though there is some difference. It is difficult to ascertain the exact amount of mortality in most of the small towns of this country, as but few of them have any bills of mortality. In the town of Woodbury, in the western part of Connecticut, containing 2050 inhabitants, the whole number of deaths during the last eleven years is 347, of which number fifty-five, or about one sixth of the whole, were by consumption. I have accurate accounts from above twenty small towns in the interior of Connecticut and the western part of Massachusetts, some but for one and others for three and four years, which show that from one-sixth to one-eighth of all the deaths are by this disease. By the bill of mortality for Rutland, (East Parish) Vermont, containing about thirteen hundred inhabitants, it appears that from 1797 to 1816 the whole number of deaths was four hundred and ten, of which number forty-nine, or one-eighth of the whole were by consumption. In the country there is, I apprehend, less predisposition to this disease than in cities, though exciting causes are in the former more numerous and powerful.
Has this disease increased in the United States within the last half century ? From my own observation, and from statements furnished me by aged medical men, I think it has considerably increased in country towns.
In some of the cities it appears to have increased no faster than the population, while in others the increase of the disease has been much the greatest. This is particularly true of the city of NewYork, where in 1830 the deaths by consumption were 974, and in 1835 amounted to 1437.
Formerly, as we are informed by Dr. Colden, there was but little of the disease in New York. Speaking of the city about ninety years since, he observes: The air of the country being always clear, we have but few consumptions, or diseases of the lungs. Persons inclined to be consumptive in England, are often perfectly cured here by our fine air.'* Similar observations respecting the rarity of consumptive diseases in this country, and the beneficial effects of our climate upon those who came here from Europe with impaired health, are found in the letters and writings of the first settlers of New-England. Probably some recoveries were attributed to the influence of the climate that should have been credited to other causes. That the disease, however, was less common half a century since than at the present time, is evident from the observations of aged medical men. Dr. Holyoke of Salem, in a letter to Professor Wigglesworth, in 1790, observes: This disease has of late become much more frequent, and makes up now, I believe, a tenth or perhaps a sixth of our whole bill of mortality.'t Consumption has,
* Amer. Med. and Phil. Reg. Vol. 1. Mem. Amer. Acad. of Arts and Sciences.
however, always prevailed here. It was the most fatal disease among the Indians, previous to the settlement of this country by the Europeans, and since then is said to have become still more destructive. The celebrated Indian chief, Red Jacket, has lost nine of his family by consumption
Is pulmonary consumption curable ? Medical men, who have devoted many years to the study of this disease, have been divided in opinion upon this question. It is however generally conceded, that some genuine cases of consumption have recovered, even after ulceration had occurred. But such cases are so extremely rare, that the disease may be considered a fatal one. I shall not therefore detain the reader with an account of the remedies which have been used, and are now recommended in this disease, but content myself with remarking, that even incurable cases may be greatly alleviated and protracted by judicious means, and pass to the consideration of the causes of consumption, and measures of prevention.
The causes of consumption may with propriety be divided into the predisposing and the exciting. Among the first, and probably the most frequent, is the inheritance from one or both parents of a morbid constitution, or tendency to this disease. Scrofulous affections also predispose to this complaint, and these are often inherited, though they are as frequently caused by improper diet, impure air, deficient clothing, or by whatever weakens the system, or prevents its full and healthy develop ment.
By exciting causes are meant those that awaken into diseased action this predisposition to the disease, such as colds, inflammation, and other affections of the lungs, which in those not at all predisposed to consumption seldom produce it, though they sometimes do, when neglected or improperly treated. But such instances are not common, and it is certain if the predisposition did not exist, there would be but little of the disease. It is therefore by preventing the transmission from one generation to another of this predisposition, or morbid constitution, that we must look for much diminution of the disease in this country.
But how can this be effected ? In answer to this inquiry, I submit the following observations:
First. Those strongly predisposed to consumption, should conscientiously abstain from matrimony. Duty to themselves and their country requires this. It is criminal in those in whom this disease is lurking, to connect themselves by marriage, and inflict upon themselves and those with whom they are connected unspeakable misery. On this subject more correct views should be entertained, and religiously acted upon. If young people, in the indiscretion peculiar to their age, incline to form such alliances, parents and friends should guard them against
Hitherto they have been reprehensibly neglectful in this respect. For young persons, there is much excuse. Females in whom this disease exists in a latent form, are in early life the most interesting of
Their minds are usually precocious and brilliant — their countenances fair and animated and, to a careless observer, appear blooming with health. But in truth, this precocity and brilliancy are symptoms of impending danger. This has been stated by most writers on consumption, and must have been observed by all who have given much attention to the incipient forms of this disease. Even after the
disease is established, it often for a while appears to increase the beauty of its victim. Percival has poetically and correctly alluded to this:
'O! there is a sweetness in beauty's close,
And is ready to wing her flight away.' But though those predisposed to consumption are often as beautiful as the flowers of spring, they are as delicate and fragile. They usually have slender forms and narrow chests; their lungs are easily irritated'; they take cold from slight exposure, and have frequent cough, which for a while is scarcely noticed, or readily yields to remedial measures. Such persons, I repeat, should avoid matrimony, especially in early life. If no exciting
cause awakens into diseased action the apprehended predisposition before the age of twenty-five, and they are in good health, there will then be less danger, as reasonable hopes may be indulged that the disease will never be developed.
Secondly. Neither should those marry who are sickly, or whose constitutions are much impaired by disease, even if not consumptive. A late writer on consumption, Dr. Clark, who speaks from great experience, considers dyspepsia in the parent the most fertile source of that vitiated state of the system in children which leads to this disease. An impaired state of health, however produced in the parent, is often manifested in the children by a tendency to scrofulous and consumptive diseases. Thus we often find the younger children more disposed to disease than the elder, and on inquiry, find it may be attributed to a change in the health of one or both parents. Parents should remember that inattention to their own health, or living irregular, dissipated lives, not only impairs their own health, and causes themselves much suffering, but that the evils they experience from this source will be transmitted to their offspring. Like the fabled Laocoon, the long-envenomed chain' that binds the father, also encircles and destroys the children.
Thirdly. Early marriages are likewise productive of consumption in this country. Causes that in Europe operate to prevent early marriages, do not exist here. Hence we observe very early marriages among all classes.
The stripling from college, and the girl from the boarding-school — the apprentice when he arrives at the age of twenty-one, and girls from the age of fifteen to twenty - enter into this state, and though in some instances no evils result, yet not unfrequently we notice the health of one or both of the parents decline, and if they do not die, their children are feeble, and often cut off before adult age. I speak from personal observation, when I say, that early marriages are in this country often productive of consumptive diseases. Unless remarkably healthy, none of either sex should marry before the age of twenty-four, or not until two