The Lumleian Lectures on the Aetiology of Phthisis
Authors: J. Andrew
Journal: BMJ (1884)

THE aetiology of phthisis covers so wide a field, requires for its com- plete discussion so many different lines of inquiry, so many different methods of research, that it would be absurd to attempt to teach it in detail within the time at my disposal here.Nor was such my intention in adopting these words for the title of these lectures.It was convenient to have a short heading, and yet one which would allow me the fullest liberty to choose, from any quarter, whatever facts or arguments there may be available for my more limited purpose.Far from attempting an exhaustive treatment of so vast a subject, I shall regard it from one comparatively narrow point of view-viz., the com- municability of the disease immediately or mediately from the sick to the healthy.Is or is not phthisis contagious?And here it is my duty at once to confess myself to be an anti- contagionist, and to admit that, in spite of the sincerest wish and endeavour to state the case fairly and without prejudice, my argu- ment must have been, in form if not in matter, more or less biassed by its being framed rather to attack a given proposition than to establish any other in its place.This question of contagion, wherever it arises, whether in the case of phthisis or of other diseases, has rarely been discussed with judicial calmness.The practical issues are so important, and appeal so strongly to the imagination, whilst facts lend themselves so readily to contra- dictory theories and ex parte treatment, that the opposite sides too often deal out to each other but scant courtesy, or even justice.And thus the argument is carried on by arguments unsound and tainted from the very first-by ingeniously manipulated statistics, by facts incompletely given, and by utterly irrelevant appeals to feeling.It may be in part from this emotional element in the controversy that the very idea of contagion has often been rejected in cases which seem to us now scarcely to admit of even speculative doubt.Thus, Dr. John Armstrong hotly denied the contagiousness of typhus fever in his Lectures on the Aiorbid Anatomy, Nature, and Treatment qf Acute and Chronic Diseases (posthumous edition by JosephRose, 1834), anid this, too, in cases where glandular swellings and a petechial rash were present which it is impossible to believe to have been cases of typhoid fever.I am well aware that very different opinions were held of Dr.Armstrong's character and of the value of his opinions; but, by the testimony of friends and foes alike, he was the most popular teacher of his day, a careful observer, who had enjoyed special opportunities for studying fevers; and yet in so plain a case as the spotted fever of London and Edinburgh he renounced his belief in its contagious- ness.At the very outset of the inquiry, a difficulty confronts ulswhiclh has never hitherto been satisfactorily met, which I, at any rate, cannot hope to remove, but over which I must somehow contrive to stumble.It is thedefinition of phthisis.All that I can do is to state the sense which I myself attach to the term phthisis, and to beg that my argu- ment may be judged of by reference to that and not to any other description.Of course, it mnst be so framed as not to beg the qtues- tion under discussion, and must, therefore, be imperfect.Byy phthisis, then, I mean a specific disease, characterised, anatomically, bya new growth, which may wear very different aspects at different periods of its existence, and in different organs or tissues, especially, according as it is found in the interior of organs, or as it presents upon a free serous, mucous, or cutaneous surface.The new growth may occur in almost any organ or tissue, but does so most frequently in the lymph- atic tissues and in the lungs.Generally it proceeds from numerous different points, the growths from which may or may not coalesce, -thus leading, e.g., in the lungs to two different types of lesion, viz., miliary tuberculosis, and to more or less extensive areas of infiltra- tion and consolidation.