triment and the free administration of pure air, moderated in its temperature according to the season. Gentle exercise in a carriage, a boat, or on horseback, is still desirable, provided it is not at any time carried to fatigue, nor employed so as to expose the patient to the powerful rays of the sun or the chilling effects of cold winds.

One of the great objects in the treatment of confirmed phthisis is to guard against sudden accessions of inflammatory action and to discover them as soon as they arise; but the prevention is in this case much more important, for unfortunately the patient is seldom in a state to bear anything like active depletion. Still, however, should the indications of an attack of pneumonia or pleuritis show themselves, we may often with safety and with advantage take away from six to ten ounces of blood, according to the strength of the patient, or we may apply a cuppingglass to the chest and take a few ounces locally, at the same time reducing the diet, determining to the skin, and acting gently on the bowels; nor must we be too hasty in returning to the more generous or tonic mode of living, as we shall easily bring back the inflammatory condition. Where the tendency to repeated relapses is very marked, we shall do well to keep up some effectual counterirritation by means of the ointment of the tartrate of antimony, or by issues, setons, or perpetual blisters in the neighbourhood of the part.

Various symptoms are apt to arise in the course of phthisis, and to become of themselves very important, requiring to be checked; of these perspiration and diarrhaa are the most frequent, the disease seldom running its whole course without the occurrence of one or the other to a degree which renders it the object of treatment. The cough, likewise, and the hæmorrhage from

the lungs, are symptoms which often require the aid of palliative resources when all hope of doing essential good may be passed. Of each of these, therefore, we will say a few words, and first of the diarrhea. This frequently depends upon irregularities or imprudence in diet, and then a gentle laxative, as a scruple of magnesia and ten grains of rhubarb, or a few drachms of castor oil, will often remove it at once; but it is not right to persist in this mode of treatment; and if the laxative does not produce the desired effect, the various astringents should be employed; the chalk mixture, in doses of half an ounce or an ounce, with ten or fifteen grains of aromatic confection; and if this does not succeed, the kino, the catechu, or the hæmatoxylon. Should the tendency to diarrhoea continue, a slight mercurial, as two grains of the hydrarg. c cretâ, may be tried, in combination with a few grains of the compound ipecacuanha powder; and it will sometimes be necessary to repeat this every night for several doses before the tendency to relaxation gives way, while at the same time occasional doses of astringents and mild opiates must be administered. Profuse perspiration is another of the most distressing and weakening symptoms in the more advanced stages of phthisis, generally coming on as soon as the patient falls asleep in the day or at a very early hour in the morning when he wakes from his first sound sleep. The best remedies are, to avoid heavy and warm clothing, to be careful not to take fluids, particularly warm fluids, about bed-time, and when the state of the bowels will permit to take the mineral acids, particularly the dilute sulphuric acid, in doses of five to ten minims in the infusion of roses, which may be rendered more aromatic by the addition of an infusion of mint. The compound kino powder, likewise, in doses of five

grains or more at night or three times a day, will often relieve both the perspiration and the diarrhoea. With regard to the cough, it is so essentially a part of the disease developed in the lungs that nothing can entirely overcome it; we may, however, attempt to diminish its violence by various forms of remedy in which the different preparations of the poppy, the lettuce, the ipecacuanha, and the squill are combined with mucilage and syrup.

When hæmorrhage takes place to any extent from the lungs it is necessary to enjoin the most perfect tranquillity of mind and body, to keep the patient cool, to prohibit all warm drinks and all stimulating food, to administer the compound infusion of roses with an additional quantity of the sulphuric acid, with or without a drachm or two of the sulphate of magnesia, every six hours, according to the state of the bowels; and if this does not quickly succeed, to give the acetate of lead in doses of one or two grains every second, third, or fourth hour. If the pulse is frequent and strong, the digitalis in grain doses, or the infusion of digitalis in doses of a drachm or two, or the tincture to the extent of eight or ten minims may be used: when the hæmorrhage continues long, a drachm of the spirit of turpentine every six hours has occasionally succeeded when almost everything has failed.

It has been proposed in the treatment of phthisis to attempt to make application locally to the affected lung by inhalation, and for this purpose various substances have been employed with some apparent success, iodine, or chlorine inhaled from a vessel containing warm water, the vapour of tar-water, myrrh, and other balsamic substances suspended in the air; nor is it to be denied that good has occasionally resulted from the practice.

Besides the distinctive changes which take place in the progress of phthisis, the lungs are liable to several other chronic diseases, of which it is right that the student should be aware, although in general their diagnosis is not very distinct, and the treatment of which they admit is very limited and unsatisfactory. The lungs are subject to all the different forms of malignant disease; scirrhous, fungoid, and melanotic growths not unfrequently occupy large portions of these organs; they may be suspected, from the gradually increasing dyspnoea and dry cough by which they are attended, by the deformity they often occasion in the chest, by the dulness on percussion, and the absence of the respiratory murmur in the parts which they occupy, while at the same time many of the symptoms are wanting by which other diseases are marked; but their exact character can only be recognised by the occurrence of similar diseases in other parts and organs of the body, and by the corresponding action excited in the lymphatic glands. There is a peculiar disease, occurring particularly in the lungs of those who work in the coal-mines, in which a kind of spurious melanosis is produced, the whole substance of the lung being pervaded by a black colouring matter, frequently accompanied with black expectoration, and the patient dying with many of the symptoms of phthisis. The lungs are likewise though rarely the seat of hydatids, and occasionally become involved in the effects of hydatids generated in other organs, as the liver, from which viscus the hydatids sometimes make their way through the substance of the lung, and are coughed up mingled with bile and pus and mucus, the result of which is always doubtful, but occasionally such cases terminate well.

ACUTE PERICARDITIS.

Acute pericarditis is often an extremely obscure disease; like pleurisy it consists in inflammation of a serous membrane, and as in pleurisy the symptoms are very much modified by the character and quantity of the effusion. When it attacks persons of a good and hale constitution, in whom the effusion is usually moderate and contains a considerable proportion of organizable albumen, the most obvious if not the most common symptoms are, an acute or burning pain in the region of the heart, sometimes shooting towards the left shoulder or axilla, and occasionally increased by pressing the fourth, fifth, or sixth intercostal spaces, or by forcing the fingers beneath the margins of the ribs to the left of the scrobiculus cordis ; augmented impulse and accelerated action of the heart; a sharp or hard pulse; slight cough; sense of anxiety; sometimes delirium or a certain degree of incoherency of manner; and a difficulty in lying on the left side. These symptoms are perhaps sooner or later succeeded by a diminution of the heart's impulse; a less rapid, softer, easily compressible, but still somewhat jerking pulse; increased anxiety and dyspnea; till at length, unless the disease subside or be subdued by art, the heart appears to be nearly overpowered by the inflammation and its products; it beats feebly, irregularly, and with great rapidity; the anxiety and sense of suffocation become extreme; the patient cannot lie down; he leans forward; he labours for breath; cold clammy sweats break out; and he dies. This description, however, must be regarded as applicable only to the most exquisite and severe form of acute pericarditis attacking persons of good constitu