(Bleated) Monday Series: A Disease With No Remedy VI

The British physicians as well, discussed the nature of hereditary transmission of phthisis, loosely gathering into opposing camps of solidists and humoralists.[1] Although the Dutch Hermann Boerhaave had already classified disorders either as congenital or connate, medical men in Britain who were interested in hereditary transmission debated on the possible causal routes of diseases in order to establish clear criteria for recognizing hereditary diseases. As López-Beltrán mentions, these physicians debated on categorizing hereditary diseases—those identified as constitutional—with those “acquired” after conception (congenital and post-natal), forcing discussions of “original source, chronology of appearance and recurrences, and permanence (or chronicity).”[2] Recognizing the importance for categorizing hereditary distinctions appropriately, London surgeon Joseph Adams (1755-1818) wrote in 1815 that the peculiarity of constitution, as defined either as family or hereditary, was often mistakenly used synonymously. It was Adams that comprehensively adopted the French notions of hereditary diseases for the English audience.

Historian Elizabeth Lomax points out that Adams did not confine himself to a single cause for phthisis, but suggested that factors associated with poverty, such as poor diet and cold, were probably involved. He discovered no new empirical facts, Lomax claims, but his historical relevance is in his reclassification of diseases thought to be hereditary on the basis of their national history.[3] Familial constitution and hereditary constitution, Adams argues, are distinct, with the former referring to constitutional diseases confined to a single generation, and the latter traced from generation to generation. Adams also significantly contributed to British discussions on hereditary transmission by building upon Boerhaave’s distinctions, and clarifying the differences between dispositions and predispositions. He wrote:

constitutional dispositions are more commonly confined to brothers and sisters, than hereditary and that, whether family or hereditary, they always show themselves at an early period of life.[4]

In addition, Adams concluded that connate diseases were not hereditary, and hereditary predispositions can be brought up either climate, or other external causes, which can prevent the diseases’ emergence.[5] Other members of the British school, including William Stark (1742-71), Matthew Baillie (1761-1823) and Thomas Young also advocated ideas of individual susceptibility. Yet, after Adams, “barely a single a single discussion of hereditary malady written during the nineteenth century failed to elucidate the concept of predisposition.”[6]

Medical hereditarianism did not affect British social attitudes on degeneracy in the later Georgian period as it did on the French. Hereditary disease was mainly concerned in regards to familial traits, for distinguishing pedigree data and protecting future progeny against hereditary taint.  The fear of marrying into hereditary tainted families was well-established by the late eighteenth century, as parents and relatives examined potential suitors for evidence of chronic disease.[7] “Is tuberculosis a ‘family’ disease?” J.B. Huber asked in 1906; “In many instances it is so—so often that the fact is unquestionable.”[8] But unlike the French, the British were slow in adopting ideological basis for hereditary transmission, with the British adoption of hérédité occurring between 1860 and 1870; in part, one can argue this was due to the slow reception of general ideas of inheritance—particularly Lamarckian and Buffonian influences—but one can also argue that British physicians generally accepted ideas of hereditary illness, without the same agitation between the profession as the French medical men did, though it is not to say these ideas were passively accepted. Physicians such as Adams, James Pritchard, and William Cullen fiercely contributed to the study of hereditary transmission of diseases, though they did not shake the social atmosphere as violently as the French.


Conclusions

Through their disputes over hereditary maladies, eighteenth century French physicians clarified the casual structure of hereditary transmission that gave early generations of nineteenth century physicians in Britain and France a comprehensive account to build their theories of heredity. This series examined the ideological basis of medical hereditarianism upon social and moral attitudes, by arguing that on one hand, the notion of hereditary transmission, while presenting itself as incurable, gave physicians creative room to develop new theories of heredity and disease transmission, including “predisposition;” and on the other hand, these ideas were generally accepted due to their attractive framework for explaining social ills. Thus, the concept of hereditary disease maintained a paradigmatic status in due part to its ability to play a more diffused social role.

 

NOTES


[1] C. López-Beltrán, “Human Heredity: The Construction of a Scientific Domain,” PhD Thesis (King’s College London, 1992); Ch.3 “Of Taints and Crystals. British late-18th century views of Hereditary Disease,” section 3.1 “Erasmus Darwin, a prelude.”

[2] López-Beltrán, “Human Heredity,” section 1.3, “1600-1800, Medical Men and the Hereditary. An Overview.”

[3] E. Lomax, “Hereditary or Acquired Disease? Early Nineteenth Century Debates on the Cause of Infantile Scrofula and Tuberculosis.” Journal of the History of Medicine and Allied Sciences 32 no.4 (Oct. 1977), 363. In addition, Lomas points out that Adams implied that supposedly hereditary diseases could be avoided once the precipitating causes had been discovered; further, he did not deny the possibility of hereditary transmission of disease, but “reiterated that the concept had been abused by Portal” (363).

[4] J. Adams, A Treatise on the Supposed Hereditary Properties of Diseases (London: Printed for J. Callow, 1814), 21.

[5] Under the solidist theory that was prevalent at Adam’s time, congential influences were the only truly kind of hereditary characters. López-Beltrán  points out that by the late eighteenth century, “the notion of a general and unified explanation of hereditary transmission of both normal and pathological features was facilitated then by the strengthening of solidism” (“The Medical Origins of Heredity,” 121).

[6] J.C. Waller, “The Illusion of Explanation: The Concept of Hereditary Disease, 1770-1870.”Journal of the History of Medicine 57 (2002), p.420.

[7] Waller, “The Illusion of Explanation,” 411.

[8] J.B. Huber, Consumption: Its Relation to Man, and his Civilization, its Prevention and Cure (Philadelphia and London: J.B. Lippincott Company, 1906), 75.

 

Monday Series: A Disease with No Remedy V

Lithograph: portrait of P. Pinel, aged about 70; by Ducarm {?} after 'A. M.', published by Blaisot, n.d.

By the end of the eighteenth century, many medical men had written exhaustively on the hereditary predisposition to phthisis, implementing medical hereditarianism as a social recourse for advocating social distances between elements of society. Historian Sean Quinlan argues that between 1748 and 1790, heredity in France gave doctors an idiom for diagnosis in light of the social crisis resulting from the Revolution, in order to prescribe appropriate hygienic responses. Recognizing the high morbidity rates among the population, doctors strove to explain the so-called wasting diseases that appeared to “indicate the prevalence of hereditary degeneration among the population.”[1] Quinlan carefully notes that concerns over hereditary transmissions of disease were not conscious epistemological conceptual shifts, in which physicians gathered and applied new information from studies of phthisis; rather, attitudes towards domesticity, gender roles, and reproductive politics played a stronger rhetorical role in encouraging—if not forcing—physicians to shift conceptual thoughts of hereditary diseases to social concerns. He also adds that “moral degeneracy undermined the future vitality of European society,”[2] and forced physicians and state men alike to cure hereditary diseases through moral hygiene, by emphasizing family values. Reinforced by French essentialism, fears of hereditary taint downplayed any rationality, and strove to explain away widespread fears of degeneracy, nervous disorders, and demography decline. Essentialism was such a powerful explanation for heredity and moral degeneracy that hereditarians invoked sorrowful passions and unhealthy sexually activity such as masturbation and “venereal excesses” as causes for degenerating diseases like phthisis.[3]

Hereditary disease, as an explanatory tool for physical and moral degeneracy and as a diagnostic tool for explaining social ills, epitomized socio-political concerns in eighteenth century France. Some, such as Jean Baptiste Timothée Baumas, a physician at Montpellier medical school, claimed hereditary diseases challenged the natural order of things. As Quinlan explains, Baumas made a connection between heredity, consumption, and moral degeneracy and downplayed the positive aesthetic gloss often associated with consumption, believing that consumptive children who inherited morbid predispositions soon suffered from nervous disorders. Like some of his medical counterparts, Baumas believed that advocating moral hygiene was a far better approach in combating the hereditary disease and patients could generally overcome their hereditary limitations and self-consciously regenerate themselves. Other French physicians, such as Pierre Jean George Cabanis (1757-1808), Philippe Pinel (1745-1826), and Félix Vicq D’Azyr (1746-1794), attempted to reform the medical profession to become more socially relevant by emphasizing that hereditary transmissions of disease should be regarded as a public health problem.[4]

NOTES 


[1] Sean M. Quinlan, “Inheriting Vice, Acquiring Virtue: Hereditary Disease and Moral Hygiene in Eighteenth Century France.” Bulletin of the History of Medicine 80 (2006), p.667.

[2] Quinlan, “Inheriting Vice, Acquiring Virtue,” 665.

[3] David Barnes, The Making of a Social Disease: Tuberculosis in Nineteenth-Century France (Berkeley: University of California Press, 1995), p.29.

[4] Carlos López-Beltrán,. “The Medical Origins of Heredity.” In Heredity Produced: At the Crossroads of Biology,

Politics and Culture, 1500-1800. Eds. Stoffan Müller-Wille and Hans-Jürg Rheinberger (Cambridge, Massachusetts: The MIT Press, 2007), p.111.

Monday Series: A Disease with No Remedy IV

Dear Reader,

My apologies for the lack of posts and the lateness of this one. Apparently I’ve been so tired I failed to notice I didn’t schedule the Monday Series post properly.

As always, thank you for reading.

-Jai

A fascinating perspective for the popularity of the hereditary theory of phthisis is given by historian Carlos López-Beltrán, who persuasively argued in a series of papers that heredity has a richer and more complex history, than normally granted by historians of biology and medicine. Heredity is a historically constructed concept which was first conceived in mid-nineteenth century France out of a reification of the adjective les maladies héréditaries.[1] López-Beltrán claims it is important not to mistake the concept of hereditary transmission with the concept of heredity: the latter is a noun referring to a structured set of meanings that outlined and constructed our modern biological concept, and emerged during the mid-nineteenth century in France, with the British adoption of hérédité occurring during the 1860s and 1870s;[2] and the former an ancient borrowing from the legal and social, loosely constructed with the metaphorical mirroring between the resemblance between parents and children, and the passing of properties and titles through generations.[3] This metaphorical image remained a stronghold in medical theories, as the Hippocratic-Galenic solid-humoral physiology provided a long-standing tradition of a pathological basis of hereditary framed on the theory of temperaments or constitutions. López-Beltrán explains that

in their conceptual quest to make sense of the idea of a hereditary disease, Hippocratic-Galenic physicians were forced, long before other naturalists, to focus on the genealogical patterns of character transmission.[4]

Obvious empirical facts such as the resemblances between parents and offspring, and familial patterns of disease or deformities, are collectively gathered under the metaphor. In doing so, the hereditary became a powerful explanation tool for naturalists, physiologists, and social reformers alike.[5] Furthermore, López-Beltrán argues that medical men’s preoccupation with the hereditary transmission of diseases and its physiological roots helped to develop a much more subtle and profound definition of hereditary cause.

 

NOTES


[1] López-Beltrán, “Human Heredity: The Construction of a Scientific Domain,” PhD Thesis (King’s College London, 1992); “Forging Heredity: From Metaphor to Cause, a Reification Story,” Studies in the History and Philosophy of Science,25  (1994): 211-235; “‘Les maladies héréditaries’: Eighteenth-Century Disputes in France,” Revue d’historie des sciences 48 (1995): 307-50; “In the Cradle of Heredity: French Physicians and L’Héréditié Naturelle in Early 19th Century,” Journal of the History of Biology 37 (2004): 39-72; “The Medical Origins of Heredity,” in Heredity Produced: At the Crossroads of Biology, Politics, and Culture, 1500-1800. Eds. Stoffan Müller-wille and Hans-Jürg Rheinberger (Cambridge, Massachusetts: The MIT Press, 2007), 105-132.

[2] López-Beltrán, “Human Heredity,” Ch.1, “The Hereditary: From metaphor to cause. A reification story,” section 1.1, “From adjective to noun.”

[3] López-Beltrán, “Human Heredity,” section 1.1, “From adjective to noun.”

[4] López-Beltrán, “Human Heredity,” section 1.3, “1600-1800, Medical Men and the Hereditary. An Overview.”

[5] López-Beltrán, “Human Heredity,” “Introduction.”


Monday Series: A Disease with no Remedy III

In his A Treatise on the Consumption of the Lungs (1722), Edward Barry describes the influence of environmental stimuli upon an inherited malady such as consumption: “This constitution to some is natural and hereditary; but in many others be acquired, by the intemperate use of a hot, aromatic, saline, or animal Diet, or by previous Disorders, which relax the vessels, and deprive the Blood of the oily and balsamic parts, and render its salts too active and volatile.”[1] Like many other physicians of his time, Barry acknowledged “that phthisis, which is hereditary, and proceeds from a Constitution inclined to that Distemper, is most commonly fatal.”[2] Georgian medicine advocated a patient history that began before birth, centering on an individual whose physical and moral health was dependent upon hereditary qualities.[3] The relationship between the parent’s constitution and their offspring was an obvious empirical fact, though any constitutional defects—including hereditary dispositions to disease (diathesis)—were believed to be inherited along with phenotypical characters. “Still a period when both learned physicians and the common man saw disease as the sum of one’s transactions with the environment,”[4] physicians favoured explanations supporting hereditary disposition, particularly for chronic diseases with complex etiology as phthisis, scrofula, or gout. While the etiology of other diseases could also be attributed to heredity, historian Elizabeth Lomax points out that hereditary disposition played a larger part in the etiology of consumption, while a disease like scrofula seemed “to be precipitated by conditions associated with poverty,…tuberculosis attacked the rich and poor alike, leaving heredity as a prime suspect in causality.”[5] So familiar was the hereditary transmission of maladies that not until the 1840s were the first systematic attempts made to evaluate the hereditarian thesis in Britain.[6]

However, in the opinion of most Georgian physicians, most maladies identified as heritable were without remedy. Recognizing the importance of reassuring the patient, Benjamin Marten wrote, “no greater Harm can be well done to Consumptive Persons, than for People to tell them they are incurable.”[7] It is plausible that the concept of hereditary predisposition was constructed as an approach against the hopelessness of incurability. Historian J.C. Waller states that “instead of building a theory of hereditary disease on the basis of raw statistical data, doctors had constructed a concept—predisposition—for which there as scant evidence, and then used it to make it appear that the failure of children to inherit their parent’s maladies was exactly what a rational theory of heredity would predict.”[8] Emphasizing on this point, Waller asserts that the concept of hereditary disease arose as a by-product of a link between the notion of incurable disease and the ancient concept of unchanging individual constitution.[9] He further explicates that “this conceptual structure was formed because of a desire on the part of the medical profession to rationalize, and to some extent to excuse, its inability to treat a range of persistent maladies.”[10] In other words, the inherited malady is a spin-off of construction of the category of constitutional malady familiar in the Hippocratic-Galenic theory of medicine. For Waller, despite the fact that from the late eighteenth century, “the concept of hereditary disease diathesis was virtually ubiquitous in discussions of the origins of chronic illness,”[11] this does not explain why “the concept of heredity was so routinely applied to the sorts of medical conditions that most of the profession utterly despaired of curing.”[12] Physicians generally recognized a conceptual association between heredity and incurability and if Waller is correct in his objection, why did these physicians readily accept hereditary illness and devise cures though they faced evidential and theoretical difficulties with the concept?

Part of the answer is obvious. As historian Charles Rosenberg explains, “for the physician to have thrown up his hands, to have confessed ignorance and impotence would have been a real failure of commitment.”[13] Nevertheless, for the rational physician who could not single out the determinant factor for an inherited phthisis, would it not have been beneficial to simple remove the hereditary taint out of his diagnosis? Why was a hereditary explanation so necessary? I believe in part, the hereditary theory of phthisis was a theory of convenience. Not only could the hereditary theory explain away any ignorance the physician had about disease patterns as Waller argues, but it could also account for patterns of moral and social fallings in society, particularly as the concept of hereditary predisposition encouraged patients to overcome their diathestic limitations by implementing personal responsibility through individual lifestyle. In short, hereditary predisposition served its purpose as an ideology, for it “served effectively in helping dramatize the need for temperance for moderation in diet and sexual relations.”[14]

A hereditary predisposition of phthisis made sense of an otherwise inexplicable distribution of disease. It explained why a husband and wife slept together on the same bed and only one succumbed to the wasting malady. It also provided an acceptable rationale for treatment management in a time when infection was highly regarded as untreatable.[15] As a socially constructed disease, consumption was also a fundamentally destructive social force, with factors such as professional interests, ideologies, and socio-political pressures all playing a role. Rosenberg has argued that while the formal context of scientific knowledge of heredity remained largely unchanged between 1800 and 1900, the social applications of heredity has shifted markedly in scope and emphasis.[16] “It is an intellectual evolution,” Rosenberg writes, “which illustrates with remarkable clarity the way in which ideas putatively scientific can be shaped by the need of society to rationalize, to understand, to find plausible sanctions for social action.”[17] Social attitudes become relevant when they are sanctioned by the scientific doctrines advocating them.

NOTES


[1] Barry, A Treatise on the Consumption of the Lungs, 222, author’s emphasis.

[2] Barry, A Treatise on the Consumption of the Lungs, 245. A constitution is generally defined as a “view of the body as an organized structure, acting as a whole, its constituent traits being inherited en bloc” (R.C. Olby, “Constitutional and Hereditary Disorders.” In Companion Encyclopedia of the History of Medicine volume 1. Eds. W.F. Bynum and Roy Porter (London & New York: Routledge, 1993), 413.

[3] Sean Quinlan also points out that this perception may have been at odds with the Enlightenment ideal of tabula rasa, where an individual was born a sensible being and conditioned by his experiences with the environment. The fixed hereditary state of an individual was part of a conceptual shift within French medicine, where physicians began to develop new approaches and meanings to reproduction, sexual generation, and thus, inheritance. See Quinlan’s paper, “Inheriting Vice, Acquiring Virtue: Hereditary Disease and Moral Hygiene in Eighteenth-Century France.” Bulletin of the History of Medicine 80 (2006).

[4] Rosenberg, “The Bitter Fruit,” 157.

[5] Lomax, “Hereditary or Acquired Disease?” 373.

[6] J.C. Waller, “The Illusion of Explanation: The Concept of Hereditary Disease, 1770-1870.”Journal of the History of Medicine 57 (2002), 415

[7] Marten, A New Theory of Consumption, 3.

[8] Waller, “The Illusion of Explanation,” 421.

[9] Waller, “The Illusion of Explanation,” 413.

[10] Waller, “The Illusion of Explanation,” 414.

[11] Waller, “The Illusion of Explanation,” 410.

[12] Waller, “The Illusion of Explanation,” 426.

[13] Rosenberg, “The Bitter Fruit,” 161.

[14] Rosenberg, “The Bitter Fruit,” 161.

[15] F.B. Smith, The Retreat of Tuberculosis, 1850-1950 (London: Croom-Helm, Ltd., 1988), 40.

[16] Rosenberg, “The Bitter Fruit,” 154-5.

[17] Rosenberg, “The Bitter Fruit,” 155.

 

Monday Series: A Disease with no Remedy II

 

 

Jan Steen (1626-1679). The Doctor's Visit (1658-1662). Oil on panel. 49 × 42

 

The word “tuberculosis” was not introduced as a classification term until 1834 by the German physician Johann Lukas Schönlein (1793-1864),[1] though it was first used by the British physician Richard Morton (1637-1698) in 1689. Commonly named by the medical community as “phthisis,” or “consumption,” signifying the wasting characteristics of the chronic disease, this “white plague” was the single largest killer of all adults in the eighteenth and nineteenth centuries and served as a representation of the heightened sensibility idiosyncratic of an enlightened culture of “high-living.”[2] Often at odds with reality, phthisis was a chronic, symptomatic disease without a distinctive cause, and as a result, “its nonepidemic nature also increased its appeal for the enlightened, since the patient was able to die individually, not amidst the countless dead.”[3] However, as David Barnes points out, the illness was not merely a metaphor, “not just a sign through which social relations or anxieties expressed themselves.”[4] It was a real disease that killed real people and despite descriptions of romantic imagery and snobbish aspirations towards sensibility, it was a disease that doctors struggled to cure.

In 1720, English physician Benjamin Marten (1704-1782) wrote, “of all the Distempers that afflict Mankind, there’s not one, for the Cure of which more Remedies have been appropriated and invented than a Phthisis, or Consumption of the Lungs.”[5] In the search of remedies, William Lambe (1765-1847) agrees “the treasures of nature have been exhausted by the experiments of benevolence, or the audacity of empiricism.”[6] Thomas Beddoes (1760-1808) echoed similar words in 1803: “For the treatment of consumption…a great deal more remains to be done than to add to the mass of unexceptionable evidence, lately produced. No uniform method, and no single medicine is capable of effecting a cure in all the cases, referred to any denomination of disease.”[7] The long incubation period and occasionally asymptomatic nature of phthisis, along with its flexible and complex etiological model, led physicians to concentrate on developing cures for visible symptoms.

A mixture of medicine and dietetics were advised for consumptive patients, with an emphasis on proper diet, since “the patient in general should…eat food of easy Digestion”[8] to limit any obstructions in the bodily fluids. Edward Barry (1696-1776) advocated a popular milk diet, which he believed to be the “most fit to repair the great Decays of Consumptive Persons.”[9] Although Marten agreed with the theoretical benefits of a milk diet, he noted that he not “been able to discern such good Effects from it, in a true Phthisis, as to merit its being rely’d on for Course.”[10] Other physicians were more particular about outlining a dietary regime for consumptives. Philip Stern, for example, outlines a diet that allows a consumptive to “eat as often as he has an appetite, but never much at a time.”[11] No eggs or other animal foods were allowed, although a small quantity of veal or chicken broth was acceptable if the patient was weak. In addition, “potatoes, turnips, carrots, parsneps, beans, spinach, broccoli, fallets, bread and rice” was to constitute the general bill of fare, along with almond milk, barley water, or milk and water.[12]

Combined with diet, medicines were recommended to promise relief for the consumptive, “as they defend the Blood from the purulent Matter mixed with it and are mild and penetrating, as not to obstruct or irritate the Lungs in passing through them.”[13] Samuel Foart Simmons (1750-1813) advised the use of the elixir of vitriol, Peruvian bark, balsams, and periodic bleeding, and notes that “the use of blisters and issues, opiates, a milk and vegetable diet, exercise, and change of air, are pretty generally recommended by all.”[14] Other symptomatic cures, such as emertics, catharites, sorbefacients, epispastics, sudorifics, expectorants, demurcents, narcotics, suppuratories, astringents, tonics, angostura, lichen, were also advised. Beddoes in particular was fond of the foxglove. There were also other unique treatment methods. Many physicians advised Thomas Sydenham’s recommendation of country air and horseback riding. Lambe was fond of distilled water,[15] and Simmons wrote about “earth bath,” an old and common remedy in Genada and some parts of Andalusia.[16]

NOTES 


[1] E. Lomax, “Hereditary or Acquired Disease? Early Nineteenth Century Debates on the Cause of Infantile Scrofula and Tuberculosis.” Journal of the History of Medicine and Allied Sciences 32 no.4 (Oct. 1977), 357. Prior to the closing decades of the nineteenth century, phthisis was commonly believed only to afflict in pulmonary forms; the presence of the tubercule bacillus in other parts of the body proved that tuberculosis was prevalent as other diseases, particularly in scrofula, or King’s Evil.

[2] Historian Margaret DeLacy explicates that though there was a large numerical increase in deaths from consumption, this does not mean that more deaths were statistically attributed to consumption due to any fundamental change in the concept of the disease; one does not suggest the other, though it may raise questions for historical analysis. M.DeLacy, “Nosology, Mortality, and Disease Theory in the Eighteenth Century.” Journal of the History of Medicine and Allied Sciences 54 (April 1999), 266.

[3] C. Lawlor and A. Suzuki, “The Disease of the Self: Representing Consumption, 1700-1830,” Bulletin of the History of Medicine 74 (2000). 465. Roy Porter also provides an excellent description of the effect of Enlightenment ideology in the social perception of consumption, in particular, the ways in which the culture of sensibility affected diets and social habits. See his paper,. “Consumption: Disease of the Consumer Society?” in Consumption and the World of Goods. Eds. John Brewer and Roy Porter (London & New York: Routledge, 1993), 58-81.

[4] D. Barnes, The Making of a Social Disease: Tuberculosis in Nineteenth-Century France (Berkeley: University of California Press, 1995), 19.

[5] B. Marten, A New Theory of Consumption: More especially of a phthisis, or consumption of the lungs…(2nd Ed.) (London: Printed for R. Knaplock, 1722), 75.

[6] W. Lambe, A Medical and Experimental Inquiry into the Origins, Symptoms, and Cure of Constitutional Diseases; Particularly Scrophula, Consumption, Cancer, and Gout (Illustrated by Cases) (London; J. Mawman, 1805), 8.

[7] T. Beddoes, Observations on the Medical and Domestic management of the Consumptive: On the Powers of Digitalis Purpurea and on the Cure of Schrophula (New York: Penniman and Co., 1803), 4-5.

[8] Marten, A New Theory of Consumption, 142.

[9] E. Barry, A Treatise on the Consumption of the Lungs with a Previous Account of Nutrition, and the Structure and Use of the Lungs (London: Printed for William & John Innys, 1727), 260.

[10] Marten, A New Theory of Consumption, 145.

[11] P. Stern, Medical Advice to the Consumptive and Asthmatic People of England (16th ed) (London: J. Almon, 1776), 29.

[12] Stern, Medical Advice to the Consumptive and Asthmatic, 30.

[13] Barry, A Treatise on the Consumption of the Lungs, 262.

[14] S.F. Simmons, Practical Observations on the Treatment of Consumptions (London: J. Murrary, 1780), 31.

[15] Lambe, A Medical and Experimental Inquiry, 21.

[16] Simmons, Practical Observations on the Treatment of Consumptions, 78.