Tea-sorters, furriers, brass-founders, steel-grinders, leather-dressers and others, are very liable to bronchitis and pleuritis, with symptoms resembling those of phthisis-but these persons recover upon the removal of the external irritating condition. The disease in these cases being maintained by external influences; whereas in phthisis, it is so by inherent, morphological causes. The ordinary train of symptoms, indicative of tubercular phthisis, is well known. There is first languor, a worn expression in the countenance, with slight coughing, and the hair of the head readily falls off. The respirations are easily accelerated by slight exertion, and the pulse is usually small, feeble, and frequent. As the disease advances, there is loss of flesh; pains are felt in the chest, the cough increases, and expectoration begins. The appetite is variable; and in women the catamenial function is usually disturbed. Afterwards, the cough is harassing, the expectoration copious, and the nights disturbed or sleepless. Finally, the disease closes with extreme emaciation, profuse night sweats, constant cough, copious expectoration, thrush, or diarrhoea. The practical rule to be borne in mind is, that these symptoms, however light, are signs, not of the commencement, but of the continued advance and progress of the disease. It is impossible to attempt to pourtray by any general statement the variety of symptoms met with in different individuals. Each case stands upon its own merits, and the following ones have been selected from numerous others, not only on account of some point of interest which they severally illustrate, but because in all of them the fatal issue of the malady enabled us to prove the connexion between the symptoms and the morphological disease. To have related a series of complaints and ailments, as characteristic signs of consumption, where from the recovery of the patient this connexion could not be demonstrated, would have been a departure from the inductive method to which it has been our wish and intention in the present work to adhere. CASE I. Some years ago, I was consulted respecting the health of a young lady aged eighteen. The mother, who brought her to me, was tremblingly alive to the horrors of consumption, which had carried off some members of her family,—and as this was her only child, she was naturally very anxious. She stated, 66 My daughter has frequently a hem! it is not a cough, but only a hem-take that dreadful noise away, and she was never better in her life." The general appearance of the patient did not denote any illnessand she said she was very well. Pulse 70 only, soft, and regular, but remarkably thrilling. The respiratory sounds were normal; the tongue clean; no feverish heat; bowels, &c. regular. Percussion gave a clear L and uniform sound on each side of the chest. She rides on horseback to the extent of eight or ten miles every day without fatigue; her appetite and sleep are good, and there is no pain anywhere. Under these apparently favourable circumstances, it is not surprising that the mother was by several members of her family thought too anxious. But now comes— according to our researches the most important feature of the case. Six years ago, the young lady had measles, and for many months after them she was poorly, subject to relaxed throat and colds, and it was at that period 'a hem' was first noticed. Change of air, and other remedies removed these symptoms; but ever since she has been liable to a return of them-and now the hem 'is worse. Simple remedies were prescribed by me, and after two or three interviews the visits were discontinued, and I saw nothing more of the patient at that time. Three years after, I was requested to visit this young lady in consultation. She had now hooping-cough, with symptoms of pleuritis and other inflammatory complications, for which she had been bled, leeched, and blistered. The paroxysms of cough were distressing; she was emaciated; her hair came off, and the pulse was now frequent and irregular. A little blood had been two or three times observed in the expectoration. Percussion, and the stethoscope amply confirmed the inferences drawn from general symptoms; and it was clear that consumption was in active progress. The temperament, naturally docile and patient, was now much disturbed with a train of fretful and hysterical symptoms. She shrank from the lightest touch with a shudder; every thing she handled was obliged to be warmed; any article in the least degree cold, produced a painful thrill and shivering. Even feeling the pulse made her hysterical. The fingers of one hand were often cold and clammy, and at the same time those of the other, hot and dry. Sometimes two fingers were observed hot, and the next two of the same hand cold. Similar variations of temperature were observed in the cheeks, which were alternately pale and red, hot and cool. All lowering measures of treatment were now abandoned, and every thing done to calm the emotions, lessen the spasmodic paroxysms of the cough, and invigorate the constitutional power. But all efforts were unavailing; the case terminated fatally, and the post-mortem examination proved the existence of an extensive scrofulous degeneration of the pulmonary parenchyma, extending its inflammatory complications to the air-tubes and the pleura. In this case the presence of scrofulous diathesis was presumable-from the statement of the mother, that members of her family had previously died of consumption. This presumption was strengthened by the health of the patient remaining so long delicate, L 2 by the relaxed condition of the throat, the catarrhsand 'hem,' after measles. It is probable that granulations or small tubercles existed at this time in the lungs; but the circumstances of her parents enabled them to command the comforts and conveniences of life, and to take their child from place to place for change of air and situation. Under these favourable conditions, and from the small amount of symptoms, we may believe the vis medicatrix, and the vis scrofulosa equally balanced, and a longer period of immunity from new disturbing events might have led to recovery,-to the ascendancy of the fibrous morphology, with absorption of useless elements. But unfortunately, at a critical juncture she became exposed to the contagion of hoopingcough,―incautiously visiting her cousins, who shortly before had the malady. This new additional irritation decided the course of the disease. With respect to its duration, dating from the attack of measles, it was nine years in threatening and in progress. The practical lesson to be deduced, is the necessity in all cases of coming early to a right conclusion as to the anatomical condition of the lungs; and the importance of estimating even so light a symptom as a hem' not by the inconvenience it occasions, but by the declared diathesis. CASE 2.-An unmarried lady aged thirty-seven |