in truth, was the first to make some use of the ear to ascertain the state of the chest, for Hippocrates did the same, to a limited extent, and Avenbrugger to a much greater degree; but for all that has rendered knowledge upon this subject exact, and built up into a science, we are indebted to Laennec. The signs, and consequently the diagnosis of phthisis, and the knowledge of its progress, and therefore the prognosis, became more exact from his labours.

Louis followed in the same path, and gave a more accurate detail of the symptoms, etiology, and pathology of the disease than any who had preceded him.

M. Piorry has, at various times, expressed novel and independent views both as to the nature and the treatment of phthisis; and in a paper, recently read before the Académie de Medecine, he developed the following propositions:

"1. Pulmonary Phthisis is a combination of multifarious variable phenomena, and not a morbid unity; 2. Hence there does not and cannot exist a specific medicine against it; 3. Therefore, neither iodine nor its tincture, neither chlorine nor sea salt, nor tar, can be considered in the light of anti-phthisical remedies; 4. There are no specifics against phthisis, but there are systems of treatment to be followed in order to conquer the pathological states which constitute the disorders; 5. In order to cure consumptive patients, the peculiar affections under which they labour must be studied and appreciated, and counteracted by appropriate means; 6. The tubercle cannot be cured by the use of any remedy, but good hygienic precautions may prevent its

development; 7, The real way to relieve, cure, or prolong the life of consumptive patients, is, to treat their various pathological states, which ought to receive different names according to their nature; 8. Consumption thus treated has often been cured, and oftener still life has been considerably prolonged; 9. Phthisis should never be left to itself, but always treated as stated above; 10. The old methods, founded on the general idea of a single illness called phthisis, are neither scientific nor rational, &c.; 11. The exact and methodical diagnosis of the various pathological states which constitute the malady, will dictate the most useful treatment for it."

The most remarkable features in the treatment of the disease during the present century have been, the removal of the patient to a milder climate, and the administration of cod-liver oil. The former was advised in all stages of the disease, and seemed to be called for by the urgency of the cough, and perhaps by the frequent presence of inflammatory complications. Hence multitudes were sent away to die distant from their home and friends. This evil has been abated of late years, and care is now taken to avoid such a recommendation when the disease is far advanced and the life is in peril. The latter is of very recent introduction into general use-only since the commencement of the career of the distinguished Professor of the Institutes of Medicine in Edinburgh; but, as a remedy in other diseases, it had been recommended and adopted to a small degree at the end of the last century. During the last fifteen years its use has been

universal, in all stages of phthisis, and in many other diseases.

SUMMARY.

Having thus sketched the progress of opinion and knowledge upon this subject, let us, by way of summary, endeavour to show in what degree the knowledge of the present day differs from that of preceding ages:

1. The diseases formerly included in the term Phthisis or Consumption were found to be various, and one class has been selected out from the number, and the term rigorously restricted to it.

2. Tubercle in the lungs is regarded as the distinctive mark of this class.

3. The term tubercle formerly included numerous deposits, varying in nature and character; but now it is, as far as possible, restricted to one kind of deposit.

4. The increase of the means of investigation has opened new difficulties in determining the nature of deposits, because the new kind of knowledge is yet imperfect; and hence the nature of tubercle has not been settled on its histological characters.

5. The question of the essential identity of scrofula and phthisis is yet undecided.

6. The intimate nature of phthisis, as to whether its first origin lies in the lungs or in the general system, is still undecided.

7. The immediate source of the deposit found in the lungs is still undetermined.

8. The occurrence of the deposit is generally still

held to be the first evidence of the existence of the disease.

9. The existence of the deposit and its nature, the progress of the deposition in the lungs, and the site, degree, and progress of the destruction of those organs, is a knowledge perhaps peculiar to this century, and is now in a highly advanced state.

10. The state of the general system was as well known to the ancients as to ourselves, if we select those cases known to the former which are now alone admitted by the latter.

11. The fatal tendency of the disease has been in all ages alike admitted, and at this day nearly one-eighth of the whole mortality in England is due to this now carefully selected class of cases.

12. There is an impression that, within a few years, the effect of modern treatment has been to prolong life during the attack of the disease; and our distinguished colleague, Dr. Williams, has felt himself justified in saying how long it is increased. There are also grounds for believing that a cure is sometimes effected; but the mortality referred to, and the general feeling of professional and non-professional people alike, is that the disease is a fatal one.

15. The general principles of treatment and the methods employed are still the same as in former ages (due allowance being made for the separation of the particular class of cases which we are now able to effect), except that now bleeding is not resorted to, and the connection with catarrh is not necessarily admitted, although we fully admit the influence of a

cold in developing the disease. That there has been a change in the aspect of the disease at various æras is highly probable, according to the habits and prevailing constitution of the age, and hence the former practice and views might then have been as little incorrect as

ours are now.

16. There has been but little variation in the remedies employed in all ages, as we have seen that milk, cream, eggs, meat, vegetables, exercise, open air, sea voyaging, change of climate, and adaptation of temperature and dryness of the air, steel, bark, olive oil, mutton suet, &c., have been heretofore employed. There have been the selection and rejection of minor remedies as emetics, digitalis, hydrocyanic acid, &c., with every age, and the leading treatment of this day has been anticipated, although not in the precise form of cod liver oil.

17. Hence as a final expression we may state that, whilst we have a selected class of cases, with an improved diagnosis and pathology, and these improved views are so largely shared by all practitioners, that the treatment is now similar in all parts of the kingdom, we are not agreed as to the essential nature of the disease, have no unfailing mode of treatment, and the disease is still essentially and almost as universally a fatal one as it has been in all ages.