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as a primary disease; but, in the mean time, the means necessary for preventing its producing a phthisis shall be mentioned immediately, as they are the same with those I shall point out as necessary for preventing a phthisis from tubercles.

904. The preventing of a phthisis from asthma must be, by curing, if possible, the asthma, or at least by moderating it as much as may be done : and as it is probable that asthma occasions phthisis, by producing tubercles, the measures necessary for preventing phthisis from asthma, will be the same with those necessary in the case of tubercles, which I am now about to mention,

· 905. I consider tubercles as by much the most frequent cause of phthisis ; and even in many cases where this seems to depend upon hæmoptysis, catarrh, or asthma, it does however truly arise from tubercles. It is upon this subject, therefore, that I shall have occasion to treat of the measures mose commonly requisite for curing phthisis.


906. When, in a person born of phthisical parents, of a phthisical habit, at the phthisical period of life, the symptoms (899), in the spring, or beginning of summer, shall appear in the slightest degree, we may presume that a tubercle, or tubercles, either have been formed or are forming in the lungs; and therefore, that every means we can devise for preventing their formation, or for procuring their resolution, should be employed im. mediately, even although the patient himself should overlook or neglect the symptoms, as imputing them to accidental cold.

- 907. This is certainly the general indication; but how it may be executed, I cannot readily say, I do not know that, at any time, physicians have proposed any remedy capable of preventing the formation of tubercles, or of resolving them when formed. The analogy of scrofula gives no assist. ance in this matter. In scrofula the remedies that are seemingly of most power, are, sea-water, or certain mineral waters; but these have generally proved hurtful in the case of tubercles of the lungs. I have known several instances of mercury very fully employed for certain diseases in persons who were supposed, at the same time, to have tubercles formed, or forming, in their lungs; but though the mercury proved a cure for those other diseases, it was of no service in preventing phthisis, and in some cases seemed to hurry it on.

908. Such appears to me to be the present state of our art, with respect to the cure of tubercles; but I do not despair of a remedy for the purpose being found hereafter. In the meantime, all that at present seems to be within the reach of our art, is to take the measures proper for avoiding the in,

flammation of tubercles. It is probable that tubercles may subsist long without producing any disorder; and I am disposed to think, that nature sometimes resolves and discusses tubercles which have been formed ; but that nature does this only when the tubercles remain in an uninflamed state ; and therefore, that the measures necessary to be taken, are chiefly those for avoiding the inflammation of the tubercles,

909. The inflammation of a tubercle of the lungs is to be avoided upon the general plan of avoiding inflammation, by blood-letting, and by an antiphlogistic regimen ; the chief part of which, in this case, is the use of a low diet. This supposes a total abstinence from animal food, and the using of vegetable food, almost alone : but it has been found, that it is not necessary for the patient to be confined to vegetables of the weakest nourishment, it being sufficient, that the farinacea be employed, and together with these, milk.

910. Milk has been generally considered as the chief remedy in phthisis, and in the case of every tendency to it; but whether from its peculiar qualities, or from its being of a lower quality, with respect to nourishment, than any food entirely ani. mal, is not certainly determined. The choice and administration of milk will be properly directed, by considering the nature of the milk of the seve

ral animals from which it may be taken, and the particular state of the patient with respect to the period and circumstances.of the disease, and to the habits of his stomach with respect to milk.

911. A second means of preventing the inflam. mation of the tubercles of the lungs, is, by avoid. ing any particular irritation of the affected part which may arise from any violent exercise of respiration ; from any considerable degree of bodily exercise ; from any position of the body, which straitens the capacity of the thorax; and, lastly, from cold applied to the surface of the body, which determines the blood in greater quantity to the in, ternal parts, and particularly to the lungs,

912. From the last-mentioned consideration, the application of cold in general, and therefore the winter-season, in cold climates, as diminishing the cutaneous perspiration, is to be avoided ; but more particularly, that application of cold is to be shunned that may suppress perspiration, to the degree of occasioning a catarrh, which consists in an inflammatory determination to the lungs, and may therefore most certainly produce an inflammation of the tubercles there.

By considering, that the avoiding heat is a part of the antiphlogistic regimen above recommended, and by comparing this with what has been just now said respecting the avoiding cold, the proper

choice of climates and seasons for phthisical patients will be readily understood.

913. A third means of avoiding the inflammation of the tubercles of the lungs, consists in diminishing the determination of the blood to the lungs, by supporting and increasing the determination to the surface of the body; which is to be chiefly and most safely done by warm clothing, and the frequent use of the exercises of gestation.

914. Every mode of gestation has been found of use in phthisical cases ; but riding on horseback, as being accompanied with a great deal of bodily exercise, is less safe in persons liable to an hæmoptysis. Travelling in a carriage, unless upon very smooth roads, may also be of doubtful effect; and all the modes of gestation that are employed on land, may fall short of the effects expected from them, because they cannot be rendered sufficiently constant; and therefore it is, that sailing, of all other modes of gestation, is the most effectual in pneunionic cases, as being both the smoothest and most constant.

It has been imagined, that some benefit is derived from the state of the atmosphere upon the sea ; but I cannot find, that any impregnation of this which can be supposed to take place, can be of service to phthisical persons. It is however probable, that frequently some benefit may be derived from the

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