monic ftone, in perfons who appear little difpofed to a confumption, is, perhaps, concomitant of this diforder, though it may not have been preceded by fpitting of blood. The introduction of a foreign matter, duft for example, mixing with a glutinous humour, forms concretions, obftructs the airpipes, and difturbs the refpiration.

The ninth fection treats of the fcorbutic confumption. After having detailed some observations which appear to him of particular note, relative to the fuccessful treatment of this difeafe, the author proceeds to fome very important remarks upon this kind of confumption. The fcorbutic affection announces itself in different parts of the body, by the fwelling of the gums, of the tongue, of the upper part of the palate. These symptoms are often fucceeded or accompanied by fwellings at the extremities, and the face, by extreme laffitude, and at length by leannefs and atrophy; the cough is lefs ardent than in other cafes, and not continual; the matter expectorated is marked with bloody ftreaks; the pulfe is weak and a little inflamed. The diforder is tedious, and does not propagate in families. In the breasts of perfons who die fcorbutic, an overflowing of water is often found; the breaft is fwelled, flabby, and impregnated with a bloody and ferous humour. The mufcular fyftem has in these cafes a weak texture, the heart is foftened, the fubftance of the brain is filled with ferous matter, the bones often of the roof of the mouth, and of the inferior jaw-bone, are affected with rickets, and the teeth are black, rough, and apparenty increafed in bulk.

Change of air is good against the fcurvy; the bitter extracts of plants, of elicampane, of fumitory, of creffes, of trefoil, hydromel, oxymel, and acids in general, are indicated.

The tenth fection comprehends the venereal confumption. The lungs are very fufceptible of alteration from the action of the venereal virus, because of the great number of lymphatic veffels in that organ. The venereal contagion not only originates, but often accelerates the pulmonary confumption. The fuppreffion of gonorrhea, by ftyptic injections in the urethra, has often given rife to this diforder. The expectoration is then vifcous, and often purulent; and if this matter proceeds from the lungs, the complaint is then dangerous. The author relates, that having been confulted refpecting a child, the prefumptive heir of a kingdom, which was infected with the venereal poifon by his nurfe, he advised, in concert with other celebrated phyficians, to adminifter to him mer cury, having previoufly approved its effects upon the nurse. The antivenereal treatment, adminiftered in too ftrong dofes, occafions a ptialisme, followed with cough, difficulty of

breath

breathing, and, in fhort, all the fymptoms of a true confumption. M. Portal has opened feveral bodies affected with the venereal virus. The lungs adhered to the pleura, and were full of concretions, of a viscous humour, thick and whitish. The veffels of this vifcus were loaded with blood, the bronchia, the windpipe, and the glands of the larynx, were inflated with a reddish matter.

The pulmonary confumption which fucceeds fevers, conftitutes the fubject of the eleventh fection. Continual fevers, as well as intermittent and malignant, degenerate fometimes into a confumption; a depofit or congestion in the lungs produces this dreadful affliction, of which M. Portal defcribes the fymptoms, and relates fome important obfervations. The lungs are commonly hard and enlarged; their, furface is unequal and emboffed, and their internal fubftance full of concretions, and in such a state of fuppuration that the viscus falls away in actual rottennefs. The obftruction of the breast terminates itfelf by fuppuration, if art does not operate to wards its refolution. Jefuits bark ought not to be given in this cafe; but relaxants and aperients.

The twelfth fection concerns the nervous, the hypochondriacal, and hysterical confumption. The extreme fenfibility of the nervous fyftem, our author fays, produces a tenfion in many vifcera. The animal functions are deranged, and local ruptures are the common confequences of this disorder in the animal economy. The hysteria is also often the prelude to a confumption; the lungs in this cafe are contracted and confined, and there is a congestion in the veffels of the cheft, whence an inflammatory difpofition and fuppuration of the thorax. The melancholy attendant on this complaint often produces a fhort refpiration, painful, interrupted, and a stagnant humour in the lungs. Circulation becomes more difficult and lefs active, from the fpafms of the diaphragm. The texture of the vifcera is then enlarged, indurated, and becomes compact, and the morbific affection fpreads itself upon the lungs. Refreshing fluids, aperients, bitters, fecond, ed by a careful regimen and exerçife, are the most efficacious means the author has employed.

The thirteenth fection has for its object the confumption in confequence of parturition. Pregnancy has often retarded the progrefs of a confumption; but commonly, after lyingin, the fymptoms return with violence and produce death in a fhort time.

The fourteenth fection contains fome obfervations upon thofe confumptions which fucceed contufions and wounds of the breaft. This fection terminates the first part of the work, and in it the author has made a judicious applica

tion of the principles which he has developed in the preceding.

The fecond part is divided into five fections. The first treats of the fymptoms of confumptions in general, and of thofe appearances which ferve to determine the fpecies. He has noted three degrees in the pulmonary consumption. It is effential to know the fymptoms well, in order to establish a diagnofis which cannot be equivocal. The firft ftate is indicated by fpitting of blood, dry cough, frequent yawning, glutinous fpitting, the body becoming emaciated, flow fever, heat, and drynefs of the fkin. The face is commonly pale, except in the time of paroxyfms, when we perceive upon each cheek a diftinct fpot of clear vermilion. In this stage, the urine is clear and abundant. The fleep is interrupted, the voice is rough, fometimes almoft extinct, and there is a heat in the breath. In the fecond stage thefe fymptoms augment. The expectorations are more vifcous, copious, and bloody, The cough is more obftinate. The difficulty of breathing greater. The urine lefs abundant and of a deeper colour. The patient is fubject to frequent naufea and afterwards vomiting. În the third stage of the diforder, the fever is ftronger, the leannefs and delicacy augment; prefpiration becomes painful; the nocturnal fweats are vifcous and foetid: these are fucceeded by diarrhoea the urine is fcarce and very red. The feet, the hands, the face, &c. are affected with oedematous swellings The hair falls, and the nails affume a hooked form, and a bluish colour. The expectorated matter refembles polypufes; it is tough and membraneous: death often comes fuddenly upon the patient in this state.

The author indicates afterwards the variety of modes in which the confumption may fatally terminate. It may exist without ulceration of the lungs ; the abfcefs, without expectoration of pus may occafion death; and there have been patients who only fpit at this fatal moment. The phyfician ought to eftablish his diagnoftic, his prognoftic, and his treatment, from obferving the general fymptoms, the complex of which furnishes indications more certain of the complaint than the existence of any one alone; fo variable and uncertain is this disease.

The author alfo indicates the difference and the effects of hemorrhages in confumptions: fometimes, fays he, the openings of the fmaller veffels occafion a frightful hemorrhage; at other times the greater veilels have been destroyed as well as a great part of the lungs, without almost any hemorrhage; which fufficiently proves that the prognosis of thefe fort of ailments cannot be the fame in all cafes.

Our author afterwards fpeaks of the consumption which is

con

connected with diforders of the liver; and as this is very frequent, he bestows particular attention on it. The fwelling of the right lobe, gives occafion to an extenfion of the right wing of the diaphragm and the compreffion of the lungs. An effufion in the right cavity of the thorax produces equally this effect. The liver protrudes confiderably above the falfe ribs in thefe confumptions; when the right lobe is every day enlarged, fays the author, we are apt to fufpect from the feel, obftructions in the hypochondria of thofe who have an enlargement in the liver, which induces phyficians to neglect the real diforder, while they attempt to treat another which does not exist. The works of Baittew, Bonnet, Morgagni, and Lieutaud, have fufficiently expofed thefe errors.

In the fecond fection, the ufual duration of the pulmonary confumption is difcuffed. There is confiderable difference in the progrefs of confumptions according to its species; to the age, to the conftitution, to the fex of the patients, and of courfe according to the different accidents which may happen. The fcorbutic, fcrophulous, catarrhous, rheumatic, and gouty confumptions, are in general the longest in duration. The exanthematous are more rapid. That which comes after fuppreffions of blood, are the fooneft mortal. The rapidity of this diforder is much greater when the fubjects are young.

In the third fection, our author communicates the refearches that he has made upon the blood of confumptive patients. The mafs of blood diminifhes very foon in all these cafes. The author fays that he has found a very fmall quantity in the bodies of thofe who have died confumptive. He has neglected nothing to throw light on this object. He has alfo made fome experiments, by mixing the blood with the pus, in a vafe, and he has been able in a little time to diffolve it, and to annihilate all the red globules. Bile produces the fame effect. Lime-water diminishes the denfity. The tartar of potash produces the fame phenomena, but with lefs efficacy.

The fourth fection is the refult of repeated diffections, and we are able to pronounce of this part, that it is anatomy ufefully applied to medicine. This, however, does not adinit of analyfis.

In the fifth fection, M. P. makes fome obfervations upon the treatment of the pulmonary confumption in the last stage. Divers caufes may produce this complaint, confequently it is neceffary to vary the treatment, and to combine the following circumftances, the age, the fex, and the conftitution. When the organic rupture is fuch that it leads to the laft degree of confumption, there is no other than the palliative method left to follow. The ufe of attenuant drinks, barley-water, chicken and beef broth, light emuifions and juleps are recom mended,

mended, with waters diftilled from lettuces, purilain, and other fimilar plants mixed with fyrup of orgeat, of goofeberries, &c. by extinguishing the heat and leffening the fyftaltick force in the vellels, the fuppuration he conceives is diminished. Heating and ftimulant remedies he confiders as fatal at this epoch of the diforder: though with fome inconfiftency he excepts the preparations of opium, which when there is not an habitual difpofition to fweat, he has found to fucceed very commonly.

In fpeaking of fumigations, the author has not been feduced by the eulogium that fome phyficians have paffed upon them. Travelling, on the contrary, and the refpiration of the pure air upon the mountains and in the woods, he confiders as very falutary. With all kinds of confumptions, however, the fame air cannot agree. The fea air fucceeds with hereditary and fcrophulous confumptions. It is injurious to the fcorbutic confumption, which commonly finds relief in the fouthern climates.

Stimulant remedies, which are found fo ufeful in the beginning of the illucfs, would be very injurious in the last period. Sudorifics in particular ought no more to be employed. The author oppofes frenuoufly a phlogistic regimen in this state. The lighteft nourishment, ripe fruits, and light acid drinks, are the only modes of affording relief in this fatal ftate.

Such is the beft analysis which our limits permit us to prefent of this interefting publication, which on the whole is well deferving the attention of the young practitioner. The work is certainly highly ufeful, confidered as a history of the difeafe; and the anatomical refearches evince equally the attention and ability of our author-But when we have faid this, we have faid all we can in commendation. From what has been exhibited in this fketch, the reader will perceive that our author is a theorist, and his theory, we will venture to fay, is the worst that ever degraded and perverted medicine; the humoral pathology, we repeat, has done more injury to mankind, and afforded more fcope to quackery, than all the other dreams. of phyficians and nofologifts. It is long and justly exploded in the British fchools, and we are furprised to find the phyfiologifts of the continent ftill labouring in the trammels of this abfurd fyftem. The fimple vegetable remedies which our author prescribes are trifiing, and must be ineffectual; and though he recommends ftimulants in fome of the early flages of the difeafe, they are evidently fuch as can produce no falutary effect, but must rather increase that debility, which it is the great object of the phyfician to combat and to overcome.

We have our doubts whether even his treatment in the lat ter ftages, is at all judicious.-From our own experience we

can