1819: Laennec describes causes of consumption

In 1819, when he wrote his book, "Mediate Auscultation," Dr. Rene Laennec, of France, had no idea that consumption, or what he referred to as phthisis pulmonalis and what we refer to as tuberculosis, was caused by a bacteria.  So, as with other physicians of his era, he was force to speculate based on his studies and own observations.

Some things he suspected as causing tuberculosis were:

1.  Cold:  It was more common in northern Europe and America where the temperature has a tendency to become cold.  It is less common in southern Europe and between the tropics.  In places where it is cold year long, such as high up in the Alps, people tend to prepare for cold weather better with warm clothing and houses. (1, page 341)

2.  Too light clothing:  This may give the impression of cold, particularly in young women whose disease typically begins with pulmonary catarrh, pneumony, or pleurisy.  (1, page 342-343)

3.  Locality: It is more common in large cities than in small ones, and more frequent in small cities than in the country. It was less common on the seashore than inland.  Sailing, or a long voyage at sea, tends to offer as a cure.  (1, page 343-344)

4.  Haemoptysis:  Many physicians suspected this cause inflammation that resulted in congestion of the vessels, leading to blood in the lungs.  However, Laennec wasn't convinced, suspecting the blood was a result of the tubercles in the lungs.  (1, pages 345-347)

5.  Depressing passions: Strong and long lasting passions, such as grief, tend to not only cause consumption, but cancers and other accidental productions as well.  He said people in the city are likely to come into contact with more people, "and is in itself a cause of more frequent and deeper vexation." Plus, in the city, people are more prone to be witness "the greater prevalence of immortality... a constant source of disappointment and misery." (1, page 347)

6.  Fevers:  Severe continue or intermittent fevers are a common cause of phthisis.

7.  Infected people:  A question Laennec postulated was: is consumption contagious?  He said it had long been suspected to be contagious, although he had seen many cases of people living together with a consumptive who did not themselves succumb to the disease.  Still, he said, the common people still suspect it is a contagious disease

While the exact cause may have eluded him, he was aware that, while Hippocrates suspected phthisis attacked people between the ages of 18-35, and Bayle suspected it attacked people between the ages of 40-40, Laennec believed that "no age was exempt from it." (1, page 352)

He did, however, believe women were more subject to it than men.  (1, page 353)

References

1. Laennec, Rene Theophile Hyacinthe, "A treaties on the diseases of the chest, and on mediate auscultation," tranlated by John Forbes, 1838, New York, Philadelphia, Samuel S. and William Wood, Thomas Cowperthwaite and Company

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