The continuing impact of the humoral understanding of medicine is still very much apparent in the work of Sir Richard Blackmore, the author of Worth’s most up-to-date text on tuberculosis:‘The Mass of Blood is a Composition of various and repugnant Ingredients, in which a Balance and Temperament, held by a due Symmetry of the Parts, and a regular Subordination of the passive, or less active, to the more active Principles, is preserved in its due Integrity, and a healthful Constitution, and this is effected by a constant Separation, and Exclusion of hurtful or superfluous Humours, that otherwise might annoy its peaceful Disposition, and interrupt its regular Circulation.’
A treatise of consumptions and other distempers, (London, 1724), p. 12.
Richard Blackmore, A treatise of consumptions and other
distempers belonging to the breast and lungs (London, 1724), title page.
Blackmore went on to suggest that the cause of some cases of tuberculosis was linked to heredity and that these type of cases invariably proved the most fatal, giving as evidence a case study of his own acquaintance:‘And here I crave leave to recite a remarkable Story on this Subject. About seven or eight and Twenty Years ago being in promiscuous Company, where the Conversation turned upon this Subject, and observing one of the Company look fat and florid, I addressed my self to him to this Effect. You, Sir, are so Happy in a hail Constitution, fresh Looks, and muscular Limbs, that you are safe enough from the Disease we are discoursing of. Sir, he replied, by all that appears you may justly be induced to bespeak me in the Manner you have done, but notwithstanding that, I am well assured, that I have not a Year longer to live, for it is not known, that for several Generations, any one of my Family has exceeded Forty, but generally they die about eight and Thirty; and, I now being turned of Thirty seven, I conclude I shall live but a little longer. He spoke this with such a sedate and undisturbed Mind, that I could not impute it to Melancholy, or a splenetick Whimsy; and I was confirmed in my Opinion, when in less than six Months after he sent for me to give him my Advice, I found him striving with a sharp and obstinate Cough, attended with a feverish Disorder, and a faded Aspect, and in despight of Medicine, in less than three Months, to my great Surprize, his Distemper entirely unravelled him, and he melted away.’
Blackmore’s understanding of the cause of tuberculosis therefore lay in an imbalance of the four humours, one which could be exacerbated by hereditary factors. Other ‘accidental’ forms of tuberculosis in Blackmore’s view were the result of a culmination of a series of various diseases, either acute or chronic. These, unlike the fatal ‘hereditary’ consumption, might indeed be cured by the sagacious physician and he suggested a number of treatments by which this might be achieved. It is clear that Blackmore’s explanation of the causes of tuberculosis precluded an understanding of tuberculosis as an infectious disease and though we know today how infectious tuberculosis can be, for the physicians of Worth’s generation few considered tuberculosis, or phthisis as they commonly called it, as an infectious disease which might be combated in the same way as other infectious diseases. Blackmore was, however, aware, that his explanation left much to be desired. As he admitted:‘The essential Difference, that distinguishes the Seeds of a Consumption from those of other Diseases, and which consists in their peculiar Dimension and Figure, that makes them stop in their way, and hang in the winding Meanders, and minute Recesses of the Lungs, by which means they obstruct and oppress them, eludes all Philosophick Enquiries, and remains, like almost all essential Principles, and inexplicable Secret; nor have the most acute and sagacious Physicians hitherto been able, by their most diligent Applications, curious Researches, and various Trials, to find out any Medicine of a peculiar and specifick Virtue, that can subdue, and extinguish this Herculean Disease, in the Manner that Opiates conquer Pain, the Peruvian Bark intermitting Fevers, and mercurial Remedies Venereal Sufferings; the Physician therefore is, very often, compelled to apply his Medicines to the most powerful and threatning Symptoms.’
Treatment, then, was not to effect a cure of the disease but to combat the various symptoms that this confusing disease presented to the physician. Blackmore was certainly not alone in this view. As Worth’s text by Richard Morton’s Phthisiologia seu Exercitationes de phthisi tribus libris comprehensae (London, 1689) makes clear, he too very much viewed tuberculosis of the lungs as inherently caused by an imbalance of the humours, ‘a vitiated disposition of the Mass of Blood, and of the Spirits in the Nerves, contracted gradually from several Procatartick or predisposing causes’. His eleven ‘Procatartick’ or underlying causes ranged across a wide spectrum which in his view ‘polluted and distemper’d’ the blood: 1) ‘the stopping of some usual and necessary Evacuations’; 2)’troublesome passions of the Mind’; 3) ‘a too plentiful, and unseasonable gorging of Meat and Drink’; 4) ‘the neglect of due Exercise’; 5) ‘Night-studies, and long Watchings’; 6) ‘a foggy and thick Air’; 7) ‘An Hereditary Disposition; 8) ‘an ill formation of the Breast’; 9 ‘Infection’; 10) ‘Chalky Stones’; 11) ‘also some particular Diseases, which corrupt and overthrow the Nature of the Blood and Spirits do occasion this Distemper’. As is clear from this list, Morton did understand the infectious nature of the disease, observing that the disease ‘like a Contagious Fever does infect those that lye with the Sick Person with a certain taint’ but unfortunately he leaves the matter there. His Procatarctick causes are merely the background causes, not the immediate cause of the disease which‘for the most part the taking of Cold, from whence it comes to pass, that in the Body disposed in such a manner by a load of Humours, or Water continually deriv’d from the distemper’d Habit of the Body into the Lungs, a Cough is caused, that is not easily shaken off, as that is wont to be, which happens from a meer accidental Cold, where the Matter is concocted within a few days into a putrid Flegm, and upon that is all perfectly thrown out by a Cough ( as I shall shew more largely in the Chapter of a Catarrh.) Moreover from a stock of very sharp and Malignant Humours, which were gathered before in the Habit of the Body, (as there is a continual supply of new Matter from the Circulation of the Blood) there is a continual and troublesome Cough produced, and sticks upon the Patient to his dying day: The Serum, or Water of the Blood being separated, as it were in a perpetual stream by the Glandulous parts of the Lungs, and not admitting of any Concoction until the Lungs, especially the Glandulous parts of them, swell from their being stufft, and grow hard, and at length the Tone of the parts is quite destroyed, and they are ulcerated by the sharpness of the Humour, that is separated by these tender and soft ways: Which indeed is the immediate Cause of a Consumption of the Lungs.’