but upon his back only; when he cannot breathe with tolerable ease, except the trunk of his body be erect; when, even in this posture, the breathing is very difficult, and attended with a turgescence and flushing of the face, together with pårtial sweats about the head and neck, and an irre gular pulse; these circumstances mark the diffi culty of breathing in progressive degrees, and con sequently, in proportion, the danger of the disease. A frequent violent cough, aggravating the pain, is always the symptom of an obstinate disease.

As I apprehend that the disease is hardly ever resolved, without some expectoration, so a dry cough must be always an unfavourable symptom.

As the expectoration formerly described marks that the disease is proceeding to a resolution; so an expectoration which has not the conditions there mentioned, must denote at least a doubtful state of the disease; but the marks taken from the colour of the matter are for the most part fallacious.

An acute pain, very much interrupting inspira tion, is always the mark of a violent disease; though not of one more dangerous than an obtuse pain, attended with very difficult respiration.

When the pains, which at first had affected one side only, have afterwards spread into the other; or when, leaving the side first affected, they entirely pass into the other, these are always marks of an increasing, and therefore of a dangerous disease.

A delirium coming on during a pneumonic inflammation, is constantly a symptom denoting much danger.

353. When the termination of this disease proves fatal, it is on one or other of the days of the first week, from the third to the seventh. This is the most common case; but, in a few instances, death has happened at a later period of the disease.

When the disease is violent, but admitting of resolution, this also happens frequently in the course of the first week; but, in a more moderate state of the disease, the resolution is often delayed to the second week.

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The disease, on some of the days from the third to the seventh, generally suffers a remission; which, however, may be often fallacious, as the disease does sometimes return again with as much violence as before, and then with great danger.

Sometimes the disease disappears on the second or third day, while an erysipelas makes its appearance on some external part; and, if this continue fixed, the pneumonic inflammation does not recur.

354. Pneumonia, like other inflammations, of teh ends in suppuration or gangrene.

355. When a pneumonia, with symptoms neither very violent nor very slight, has continued.

for many days, it is to be feared it will end in a suppuration. This, however, is not to be determined precisely by the number of days: for, not only after the fourth, but even after the tenth day, there have been examples of a pneumonia ending by a resolution; and, if the disease has suffered some intermission, and again recurred, there may be instances of a resolution happening at a much later period from the beginning of the disease, than that just now mentioned.

356. But, if a moderate disease, in spite of proper remedies employed, be protracted to the fourteenth day without any considerable remission, a suppuration is pretty certainly to be expected; and it will be still more certain, if no signs of resolution have appeared, or if an expectoration which had appeared shall have again ceased, and the difficulty of breathing has continued or increased, while the other symptoms have rather abated.

357. That in a pneumonia, the effusion is made, which may lay the foundation of a suppuration, we conclude from the difficulty of breathing be.coming greater when the patient is in a horizontal posture, or when he can lie more easily upon the affected side.

358. That, in such cases, a suppuration has

actually begun, may be concluded from the patient's being frequently affected with slight cold shiverings, and with a sense of cold felt sometimes in one, and sometimes in another part of the body. We form the same conclusion also from the state of the pulse, which is commonly less frequent and softer, but sometimes quicker and fuller, than before.

359. That a suppuration is already formed, may be inferred from there being a considerable remission of the pain which had before subsisted, while, alongst with this, the cough, and especially the dyspnoea, continue, and are rather augmented. At the same time, the frequency of the pulse is rather increased; the feverish state suffers considerable exacerbations every evening, and by degrees a hectic, in all its circumstances, comes to be formed.

360. The termination of pneumonia by gangrene, is much more rare than has been imagined; and, when it does occur, it is usually joined with the termination by effusion (346); and the symptoms of the one are hardly to be distinguished from those of the other.

361. The cure of pneumonic inflammation must proceed upon the general plan (264); but the importance of the part affected, and the danger to

which it is exposed, require that the remedies be fully, as well as early, employed.

362. The remedy chiefly to be depended upon, is that of bleeding at the arm; which will be performed with most advantage in the arm of the side affected, but may be done in either arm, as may be most convenient for the patient or the surgeon. The quantity drawn must be suited to the violence of the disease, and to the vigour of the patient; and generally ought to be as large as this last circumstance will allow. The remission of pain, and the relief of respiration, during the flowing of the blood, may limit the quantity to be then drawn; but, if these symptoms of relief do not appear, the bleeding should be continued till the symptoms of a beginning syncope come on. It is seldom that one bleeding, however large, will prove a cure of this disease; and although the pain and difficulty of breathing may be much relieved by the first bleeding, these symptoms commonly, and after no long interval, recur; often with as much violence as before. In the event of such recurrence, the bleeding is to be repeated, even in the course of the same day, and perhaps to the same quantity as before.

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Sometimes the second bleeding may be larger than the first, There are persons, who by their constitution, are ready to faint even upon a small bleeding; and, in such persons, this may prevent