as in the giving way of any other part of the body, the local disease may in the course of time aggravate and keep up the febrile state. The affected gland is in this instance at first almost microscopically minute; but as the disease advances, it swells and becomes of a reddish grey colour, or it may at once take on a suppurative action-it may become an abscess varying from the size of a pea or less to that of a walnut or more; or it may go on enlarging to any extent without suppuration or becoming an abscess at all,-the function of the affected lung in this case being, nevertheless, as completely disturbed as if it did take on the suppurative state; but in most cases of consumptive disease both kinds of disorganisation go on at the same time, one gland or cluster of glands suppurating, and sooner or later bursting and discharging their contents into the air-passages, rendering the lungs at the same time more or less cavernous and hollow;-another gland or cluster of glands swelling and coalescing so as to fill up and solidify the air-cells of the part they occupy. These at least are among the principal changes to be found in the lungs of persons who die of consumption; and they are all, as I have already said, more or less gradually produced in the course of repeated paroxysms of general remittent disorder. The matter expectorated by the patient consists of the contents of the tuberculous abscess, and more or less mucus, sometimes mixed with blood; while the cough may be either produced by a lodgment of matter in the air-passages, or be a spasmodic effect of the cold air coming in contact with the ulcerated surface of the diseased lungs;-almost every patient, however, has it periodically more or less severe. To understand this subject in all its bearings, you have only to observe the more palpable changes which take place in the glands of the Neck of certain patients. These glands, in the healthy living subject, can neither be seen nor felt; but apply any general influence that shall excite Fever in an individual predisposed to glandular disorder,—such as starvation, exposure to cold, or the abuse of mercury, and what do you find? Why, these very glands gradually enlarge and form tumours; which

tumours, as in the case of tubercles of the lungs, are sometimes of a solid kind, and when examined after death have the same reddish grey appearance, but more frequently like them terminate in abscesses, the contents of which, so far as mere likeness is concerned, are the identical contents of pulmonary tubercles, or Vomicæ," as these tubercles are sometimes called. In the one case, the patient is said to have the "Evil" or Scrofula, in the other Phthisis or Consumption ;—the difference of place, and the degree of importance of this in the animal economy, making the only difference between them. In still farther proof of the correctness of this explanation, I may mention, that Louis and others have detected tuberculous matter in various other Glandular parts of the bodies of patients who have died consumptive. If it be objected that they have also detected it in the Bones, I answer, the bones, like every other part, have a glandular apparatus; and this more particularly in the neighbourhood of their cartilaginous or secretive surfaces-the joints. In the joints, accordingly, we often find tuberculous matter developed. The shafts of bones, having fewer glands, are seldom affected with tuberculous disease.

We now come to the question of Cure; and from what we have already said, you must be. aware, that however curable Pulmonary Consumption may be in the commencement,-in the later stages—that is, where a very considerable portion of the lungs is destroyed-it cannot possibly be cured, though even in this case, the disease, by proper management, may sometimes be arrested. But here, instead of confusing you with fine-spun differences and distinctions, the delight of the schoolmen, I shall try to explain my meaning to you by similitudes; for similitudes, in the words of Fuller, are indeed "the windows that give the best light."-Some of you doubtless have had a certain portion of a tooth slowly consumed by disease, which disease, [tooth-consumption?] by some change in your manner of living, or otherwise, has all of a sudden stopped, and the remaining sound portion of that identical tooth has continued to be useful to you for years! Such arrest of the consumption of

a tooth, I have often myself obtained by Quinine internally administered; and Dr. Irving of Cheltenham, some time ago, detailed to me two cases in which he succeeded with that remedy. Well, then, with medicines of this class, and sometimes even without any medicine at all, the same thing may take place in the lungs; and I have known persons reach a good old age, who had portions of their lungs destroyed, but who, by proper medicine, and attention to the temperature of their chambers, preserved the sound parts from going into further decay. Such persons, at greater or less intervals of time, may even be free from the graver symptoms of consumption, and only commence to expectorate during some change of weather, when they have slight febrile attacks; but these will leave them again on the return of warm weather.

But Consumption, in many instances, is curable-curable in stages even considerably advanced. The reparative power inherent in a living body is so great, that if you break the bone of your leg or arm, nature, without any physic at all, will reunite the broken partsprovided the system be kept free from fever. Cure the consumptive fever, and nature will repair the broken lung as surely as it will cure the broken leg. Oh! but, say the men who . decide this question in the negative-how can that be, seeing the lungs are always in motion? -that of itself would prevent such a desirable end. That of itself, Gentlemen, would do no such thing. Many and many persons have had a small sword or a pistol-ball passed through their breast, so that it has come out again at the back, and have yet perfectly recovered. Perhaps the lung in such cases was not wounded? So I have heard people say; but my answer was ready. The patient spit blood immediately on the receipt of his wound! That, I fancy, you will call pretty conclusive evidence of the lungs being wounded. Well, then, people so wounded have recovered, though all the time their lungs were in motion. Cure the consumptive fever, I repeat, and the lungs will cure themselves as certainly as any other injured parts of the body. Those who deny the curability of consumption are generally ignorant, con

ceited creatures, who know nothing but what they have picked up in books or in the dissecting-room-they argue of the beginning from what they have seen of the end-of the living from their dissections of the dead.

The same power that may set a ship on the right course, improperly applied will set it on the wrong. This is exactly the case with medicine; the same power that has cured a disease in one person, may cause or aggravate it, according to circumstances, in another. How frightful, then, that such powers should be daily wielded by men who have not the smallest idea of the principle upon which their remedies act! No wonder we have such contrary estimates of the value of remedies in pulmonary consumption. A case of this disease, which was cured, I will now read; it is from the pen of the patient, himself a physician,--the late Dr. Currie, of Liverpool, who wrote the Life of Burns,—and it is given by Dr. Darwin in his Zoonomia. "J. C. aged 27, with black hair, and a ruddy complexion, was subject to cough from the age of puberty, and occasionally to spitting of blood; his maternal grandfather died of consumption under thirty years of age, and his mother fell a victim to this disease, with which she had been long threatened, in her 43d year, and immediately after she had ceased to have children. In the severe winter of 1773-4, he was much afflicted with cough, and being exposed to intense cold in the month of February, he was seized with Peripneumony, [inflammation of the lungs, now called Pneumonia]. The disease was violent and dangerous, and after repeated bleedings, as well as blisterings, which he supported with difficulty, in about six weeks he was able to leave his bed. At this time the cough was severe, and the expectoration difficult; a fixed pain remained in the left side, where an issue was inserted. Regular hectic [habitual or wasting fever] came on every day, about an hour after noon, and every night heat and restlessness took place, succeeded towards morning by general perspiration. The patient, having formerly been subject to AGUE, was struck with the resemblance of the febrile paroxysms, to what he had experienced under that disease, and

was willing to flatter himself, it might be of the same nature; therefore he took Bark in the interval of the fever, but with an increase of his cough." This patient eventually recovered by change of air and horse-exercise,the last, a remedy held in high repute by Sydenham. What first induced Sydenham to prescribe horse-exercise for pulmonary consumption? Was it any knowledge he had obtained in the dissecting-room? No such thing; it was the same kind of experience that first taught the Peruvian peasant the value of Bark as a remedy for ague-the observation of its good effects upon the living. You might dissect dead bodies all your life, without ever once guessing that either the one agency or the other could beneficially influence any kind of disorder. See, then, the difference betwixt watching the action of external influences on living bodies and dissecting and hair-splitting the broken-down organs of dead ones! "Whatever philosopher or projector," says Dean Swift in his Tale of a Tub,

I can find out an art to solder and patch up the flaws and imperfections of nature, will deserve much better of mankind, and teach us a more useful science than that so much in present esteem, of widening and exposing them,—like him who held Anatomy to be the ultimate end of physic." Persons of this

stamp, we have seen, are not yet extinct.

The relationship existing between Consumption and Ague is not only established by the remissions and exacerbations of the above case, but also by the remedies that proved successful in its treatment,-horse-exercise and change of air having cured agues, which had resisted every kind of internal treatment, Bark among the number;-so that Bark is no more a specific for ague, than for any other disease. Were you to judge solely from the experience of the case I have just read, in which the Bark not only failed, but actually aggravated the symptoms, you might be led to conclude, that it ought never to be exhibited in consumption; but you will please to remember that the same is every day the effect of its employment in ague,-in which latter disease we therefore dismiss it for arsenic, opium, iron, or some other chrono-thermal agent, which

may better answer the peculiar habit of the patient, and which we cannot know till we try. Never, like weak-minded persons, take your estimation of any medicine or system of medicine from its success or failure in one or two cases.

In the 13th volume of the Medical Gazette, you will find the detailed case of a man labouring under Consumption; for whom Mr. Maclure, the gentleman who narrates it, prescribed generous diet and quinine. Dr. Marshall Hall examined the patient with the stethoscope, and pronounced an unfavourable prognostic. Even after commencing the quinine, and when a considerable improvement had taken place in the appearance of the patient, Dr. Hall still held that the case would be fatal ;-"again the stethoscope was consulted-again it uttered the same sepulchral responses; and according to it, the poor patient ought by this to have been moribund, his pulse, good looks, muscular firmness, appetite, and his high spirits notwithstanding. I need hardly add," says the narrator of this case, "that our judicious friend the doctor was much surprised, as well as gratified, to witness his appearance" witness his appearance" - alluding to the change after the cure had taken place. Justice to Dr. Marshall Hall compels us to say, that he was anything but gratified with this result; for in another number of the same journal, not only does he speak daggers at Mr. Maclure for publishing the case; but he goes into a very learned discussion as to whether the cessation of symptoms were not a SUSPENSION rather than a CURE. For our present purpose, it is quite enough that he admits suspension; and if this suspension continued for a series of years, it is scarcely worth while inquiring whether the patient was cured. or not. In fact, the matter would resolve itself into a mere dispute about words.

By Emetics frequently repeated, and alternated with chrono-thermal medicines, I am satisfied I have cured or arrested many cases of consumption, some of them, too, in apparently very advanced stages. The stethoscopists will, of course, question this, and ask how I could know, without using their instrument. I shall, therefore, give you a case of

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this kind in which it was employed, not by myself, but by men who have the reputation at least of being wonderfully quick in the use of it :-A pianoforte maker, aged 36, came to me much emaciated: he complained of shiverings, chills, and heats, night sweats, cough, and expectoration of matter, tinged with blood occasionally; he informed me that he had been a patient at a provincial dispensary, from which, after having for some months taken much medicine, and been repeatedly blistered, he was discharged as incurable. The stethoscope, he informed me, had been consulted in his case by Drs. M. and A. both of whom told his wife he was in the last stage of Consumption, and there was no hope. I prescribed hydrocyanic acid three times a-day, and ordered him to take a pill, containing a combination of opium and quinine, at that period of the day when he should find himself most free from the symptoms of his disease. From that day he began to recover his flesh and spirits; his pulse, which was 120, gradually fell to 80; his appetite improved daily; his expectoration diminished in proportion; and in about three months he returned to his work, without any complaint whatever. I must not omit to add, that I ordered him to apply a galbanum plaster to his spine, in which he had suffered from chills, and these it effectually stopped. A year afterwards I saw him again; when, in the presence of Dr. Selwyn, of Ledbury, he told me he was quite well, and was still at his work, and he expressed to me his gratitude for my successful efforts in his favour. Now, some will say this case was Consumption, and some not,-for when the patient dies, nobody disputes it; but when he gets well, every body does ;-some again may say that the disease might break out again at some future period, say five or six years after, -which I am ready to grant; and what is more, to admit, may happen after a cure in any disease whatever and so may a fractured bone that has united and been cured in the best possible manner, become in the course of years and constitutional change, disunited again as you may find, if you will read the account of the diseases of the sailors who accompanied Lord Anson in his voyages.

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A maid-servant, 25 years of age, the subject of Consumption, had been an out-patient at the same dispensary for several months, during which she had been bled, leeched, and blistered, but as she found herself daily getting worse, she came to me; she was then spitting blood and muco-purulent matter; her pulse was quick and small; she had chills and heats, and night sweats, with severe cough. I prescribed hydrocyanic acid, as in the above case, with opium and quinine during the remission; with this treatment she recovered completely, and though several years have now elapsed, she has had no return of her disease.

When I first entered into private practice in this country, I was much abused for giving prussic acid, and that too by individuals who afterwards ordered it in their own prescriptions! "We old practitioners," I have been told by some of these very enlightened persons, "don't like your iodine,―your prussic acid,-your creosote, and your new medicines. We have known injury to follow their use."-And what remedy in the world in the hands of blockheads may not do the same? Iodine, prussic acid, and the new medicines, are only valuable in the hands of those who know the principle of their application ;—like fire or hot water, they are not to be left at the mercy of fools or children; inasmuch as, like either of these agents, they may warm you in one degree, and destroy you in another. Moreover, they will not agree with all patients in any dose; but who they are to agree with,

you cannot of course know till you try; and, therefore, you will suit your patient's constitution as best you can-for, in the words of Lord Bacon, a wise physician doth not continue still the same medicine to a patient, but he will vary if the first medicine doth not apparently succeed-for of those remedies that are good for the jaundice, stone, agues, &c. that will do good in one body which will not do good in another-according to the correspondence the medicine hath to the individual body.” Is not this matter of every day's experience? How can we tell before we try, whether opium will set a person to sleep, or keep him awake all night? or that prussic acid will aggravate consumption in one case and cure or