from my own experience I can take notice of. This is the case of phthisis from a calcareous matter formed in the lungs, and coughed up, frequently with a little blood, sometimes with mucus only, and sometimes with pus. How this matter is generated, or in what precise part of the lungs it is seated, I acknowledge myself ignorant. In three cases of this kind which have occurred to me, there was at the same time no appearance of stony or earthy concretions in any other part of the body. In one of these cases, an exquisitely formed phthisis came on, and proved mortal: while in the other two, the symptoms of phthisis were never fully formed; and after some time, merely by a milk diet and avoiding irritation, the patients entirely recovered.

884. Another foundation for phthisis, analogous, as I judge, to that of tubercles, is that which occurs to certain artificers, whose employments keep them almost constantly exposed to dust; such as stone-cutters, millers, flax-dressers, and some others. I have not observed in this country many instances of phthisis which could be referred to this cause; but, from Ramazzini, Morgagni, and some other writers, we must conclude such cases to be more frequent in the southern parts of Europe.

885. Besides those now mentioned, there are

probably some other causes producing tubercles, which have not yet been ascertained by observation; and it is likely, that in the state of tubercles there is a variety not yet accounted for: but all this must be left to future observation and inquiry.

836. It has been frequently supposed by physicians, that the phthisis is á contagious disease; and I dare not assert that it never is such but in many hundred instances of the disease which I have seen, there has been hardly one which to me could appear to have arisen from contagion. It is possible, that in warmer climates the effects of contagion may be more discernible.

After having said, that a phthisis arises from tubercles more frequently than from any other cause, and after having attempted to assign the variety of these, I now proceed to mention the peculiar circumstances and symptoms which usually accompany the coming on of the disease from tubercles.

887. A tuberculous and purulent state of the lungs has been observed in very young children, and in some others at several different periods before the age of puberty and full growth; but instances of this kind are rare and the attack of phthisis, which we have reason to impute to tubercles, usually happens at the same period which I have assigned for the coming on of the hæmoptysis,

$88. The phthisis from tubercles does also generally affect the same habits as the hæmoptysis, that is, persons of a slender make, of long necks, Harrow chests, and prominent shoulders but very frequently the persons liable to tubercles have less of the florid countenance, and of the other marks of an exquisitely sanguine temperament, than the persons liable to hæmoptysis.

889. This disease arising from tubercles, usually commences with a slight and short cough, which becomes habitual, is often little remarked by those affected, and sometimes so little as to be absolutely denied by them. At the same time their breathing becomes easily hurried by any bodily motion, their body grows leaner, and they become languid and indolent. This state sometimes continues for a year, or even for two years, without the persons making any complaint of it, excepting only that they are affected by cold more readily than usual, which frequently increases their cough, and produces some catarrh. This, again, however, is sometimes relieved; is supposed to have arisen from cold alone; and therefore gives no alarm either to the patient or his friends, nor leads them to take any precautions.

890. Upon one or other of these occasions of catching cold, as we commonly speak, the cough becomes more considerble; is particularly trouble

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some upon the patient's lying down at night, and in this state continues longer than is usual in the case of a simple catarrh. This is more especially apt to, call for attention, if the increase and continuance of cough comes on during the summer

season.

891. The cough which comes on, as in 889, is very often for a long time without any expectoration; but when, from repeatedly catching cold, it becomes more constant, it is then at the same time attended with some expectoration, which is most considerable in the mornings. The matter of this expectoration becomes by degrees more copious, more viscid, and more opaque; at length of a yellow or greenish colour, and of a purulent appearance. The whole of the matter, however, is not always at once entirely changed in this manner but while one part of it retains the usual form of mucus, another suffers the changes now described.

892. When the cough increases, and continues very frequent through the night, and when the matter expectorated undergoes the changes I have mentioned, the breathing at the same time becomes more difficult, and the emaciation and weakness go on also increasing. In the female sex, as the disease advances, and sometimes early in its progress, the menses cease to flow; and this circum

stance is to be considered as commonly the effect, although the sex themselves are ready to believe it the sole cause, of the disease.

893. When the cough comes on, as in 889, the pulse is often natural, and for some time after continues to be so, but the symptoms have seldom subsisted long before the pulse becomes frequent, and sometimes to a considerable degree, without much of the other symptoms of fever. At length, however, evening exacerbations become remarkable; and by degrees the fever assumes the exquisite form of hectic, as described in 858, 860.

894. It is seldom that the cough, expectoration, and fever, go on increasing, in the manner now described, without some pain being felt in some part of the thorax. It is usually and most frequently felt at first under the sternum, and that especially, or almost only, upon occasion of coughing; but very often, and that, too, early in the course of the disease, a pain is felt in one side, sometimes very constantly, and so as to prevent the person from lying easily upon that side; but at other times, the pain is felt only upon a full inspiration, or upon coughing. Even when no pain is felt, it generally happens, that phthisical persons cannot lie easily on some one of their sides, without having their difficulty of breathing increased, and their cough excited.