cure; the other, from supervening anatomical retrogradation; the former, as the general rule, will in future be liable, upon slight events, to asthenic forms of illness; the latter, peculiarly to scrofulous disease and consumption.

Here, then, are anatomical grounds for studying the history of a patient whom we are required to treat; with a view to determine,-whether the organisation be in all important parts sound and undamaged, and the constitution therefore robust; or-whether the structural changes of a former cure possibly render the constitution delicate; or lastly,-whether the defects of a cure, establish the scrofulous diathesis.

In the first class, many events or irritating causes will pass off harmless; and when disorders do occur, they are prompt and regular, easily recognized, and easily treated. In the second class, minor events or irritating causes will provoke disturbances which are tardy and irregular; nutrition in contact with the anatomical changes of cures, being disposed to general, rather than special types. In the third class, retrogradations spring up or supervene, without any noticeable event or adequate external cause, the constitution is scrofulous and consumption probable. And it may be laid down as a general rule of practice, that those active interferences as regards the abstraction of blood, purgation, &c., which may be proper and needed for inflammation in persons of the first class; will be improper and injudicious for those of the other two classes.

7

But it will be asked, how are we to discriminate in which class a patient is to be ranked? This important question touches upon a point that has already been discussed. There are no broad lines of demarcation in any department of nature, nor is there here between strength, delicacy, and scrofula,-they blend in different individuals into each other. There will in many cases be no difficulty, but others will indeed require patient inquiry and an acute judgment. We cannot smooth all difficulties; a reasonable basis of classification may be laid down, but it is the special duty of the physician, threading his way amidst acknowledged intricacies, to determine as respects the individual. It is not easy, for the most part, to obtain a reliable history of former conditions and illnesses, either from the patient or the parent; all that ought to be remembered is usually forgotten, or so imperfectly recollected as to be of little avail; and we have frequently to deal with obscure cases, and delicate constitutions, with nothing more of service in diagnosis than present feelings, whilst it is obvious that much more than present ailments in respect of the etiology of consumption, is essential to establish a valued opinion. Difficulties have sometimes been encountered in making a full inquiry into all the former circumstances of a patient, from the reluctance felt by the individual or his friends to state candidly all they know; or from a horror naturally evinced at being considered scrofulous. This obstacle may possibly be diminished, when it is more generally known

that scrofulous diseases are founded in universal laws, and that all persons are liable to them, if injurious agents be brought into operation, or adverse circumstances be present, during the growth of the body, that scrofula is only a conventional term expressing forms of nutrition below the natural standard; and that the prevention and cure of consumption demand, not only the careful treatment of disease in infancy and childhood, but a correct history of the structure afterwards, with reference to anatomical states and

cures.

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CHAPTER III.

THERAPEUTICS AND CURE.

"We denounce unto men that they would give over trifling; and not imagine that so great a work, as the stopping and turning back the powerful course of Nature can be brought to pass by some morning draught, or the taking of sonie precious drug; but they would be assured that it must needs be that this is a work of labour, and consisteth of many remedies and a fit connexion of them amongst themselves. For no man can be so stupid, as to imagine, that what was never yet done, can be done, but by such ways as were never yet attempted." -BACON.

DURING the progress of our researches upon the origin, and morbid anatomy of consumption, we have several times had the question put to us-But can you cure it? And the value of the labour bestowed upon the subject has, for the most part, been estimated by the answer given to this eminently practical interrogation. The same question must now be more or less vividly present to the mind of the reader; and we purpose, after a few preliminary observations, to bring our results to bear upon this important topic.

When persons speak of the cure of consumption,

they very probably speak of the cure of a malady, the preliminary anatomical state of which may have arisen from an accident at birth,—an infantile pneumonia, or a feverish dentition; which may have been increased subsequently, by measles, scarlet-fever, or hoopingcough; but which now, with slow progress, has become a chief malady, evolving signs-cough, expectoration, loss of flesh, and debility. To fly for medical aid, for the first time only, after the appearance of these signs, is to seek assistance at the eleventh hour, and to impose upon our art the difficult task of resisting a great natural law, with but few helps and weakened resources. What then is to be done? First, let us answer :-If we watch the progress, observe the times, and study constitutional changes after the reputed cure, of all severe internal maladies, from birth to puberty, and realize the fact that the preliminary state disposing to consumption may be founded in the cradle,--we may prevent it. But what can be done for those now suffering from consumption in its early stage? We must find out the present condition of the lung by percussion, and the stethoscope; by the general appearance of the patient, the pulse, cough, and expectoration. We must learn the characteristics of the constitution and temperament; habits or occupation; and the history of all former maladies and cures. Lastly, we must discover whether removable irritating conditions be still present and operating. And if upon the result of these inquiries, we found judicious measures, and meet