skill of the physician, we have more reason to be astonished that any can be alleviated or cured by his art.

The pen of the satirist, no doubt, may be fairly aimed against the presumption and ignorance of many individuals of this, as of every other profession; but cannot with justice be directed against the art itself: since, in spite of the obscurity which still involves some parts of the animal economy, many disorders are relieved, and some of the severest and most disagreeable to which the human body is liable, are cured with certainty by the art of medicine.

Unfortunately for mankind, and in a particular manner for the inhabitants of Great Britain, the pulmonary consumption is not of the number.

This disease may originate from various causes.— 1st, An external bruise or wound.

2d, The disease called pleurisy, including in that term an inflammation of the lungs themselves, as well as the membrane which covers them.

3d, The bursting of some of the blood-vessels of the lungs, independent of external injury, and owing to a faulty conformation of the chest, and the slenderness of the vessels.

4th, Certain small tumours, called tubercles, in the lungs.

The first cause I have mentioned is an external bruise or wound.

An accident of that kind happening to the lungs, is more dangerous and difficult to cure, than when the same takes place in most other parts of the body; because the lungs are vital organs, essentially necessary to life, and when their motion is impaired, other animal functions are thereby injured; because they are of an uncommonly delicate texture, in which a rupture having once taken place, will be apt to increase; because they are in constant motion and exposed to the access of external air, both of which circumstances are unfavourable to the healing of wounds, and because the mass of blood distributed

to the whole body passes previously through the lungs, and consequently the blood-vessels of this organ are more numerous than those of any other part of the body.

When we consider these peculiarities, it is natural to conclude, that every wound of the lungs must necessarily prove mortal; but experience has taught the contrary. Many wounds of the lungs heal of themselves, by what is called the first intention. The physician may prevent a fever, by ordering the patient to lose blood in proper quantities, and he may regulate the diet; but the cure must be left to nature, which she will perform with greater certainty, if she is not disturbed by any of those balsams which the wounded are sometimes directed to swallow on such occasions. But when the wound, either from injudicious treatment, or from its size, or from the bad habit of the patient, degenerates into an ulcer attended with hectic symptoms, the disease must be treated as if it had arisen from any of the other causes.

The pleurisy, or inflammation of the lungs, is a disease more frequent in cold countries than in mild; in the spring than in the other seasons; and more apt to seize people of a sanguine constitution than others.

Plentiful and repeated bleedings, fomentations, blisters near the affected part, and a cooling, diluting regimen, generally remove it, without its leaving any bad consequence. Sometimes, by the omission of bleeding in due quantity at the beginning, and sometimes in spite of all possible care, it terminates in an abscess, which, on bursting, may suffocate the patient; or, if the matter is cough. ed up, becomes an open ulcer, and produces the disease in question.

The third cause of the pulmonary consumption above mentioned, is, a spitting of blood, from the bursting of vessels of the lungs, independent of external wound or bruise. People of a fair complexion, delicate skin, slender make, long neck, and narrow chest, are more subject to this than others. Those who have a predisposition to this complaint, by their form, are most apt to be attacked

after their full growth: women from fifteen to three-andthirty; men two or three years later. In Great Britain, a spitting of blood generally occurs to those predisposed to it, in the spring, or beginning of summer, when the weather suddenly changes from cold to excessive hot; and when the heat is supposed to rarify the blood, before the solids are proportionably relaxed from the contracted state they acquire during the cold of winter. When a spitting of blood happens to a person who has actually lost brothers or sisters, or other near relations, by the pulmonary consumption, as that circumstance gives reason to suspect a family taint or predisposition, the case will, on that account, be more dangerous.

Violent exercise may occasion the rupture of blood-vessels in the lungs, even in those who have no hereditary disposition to such an accident; it ought therefore to be carefully avoided by all who have. Violent exercise, in the spring, is more dangerous than in other seasons; and, when taken at the top of high mountains, by those who do not usually reside there, it has been considered as more dangerous than in valleys. The sudden diminution of the weight of the atmosphere, co-operating with the exercise, renders the vessels more apt to break. Of all things the most pernicious to people predisposed to a spitting of blood, is, playing upon wind-instruments. Previous to the spitting of blood, some perceive an uneasiness in the chest, an oppression on the breath, and a saltish taste in the spittle; but these symptoms are not con

stant.

Nothing can be more insidious than the approaches of this disease sometimes are. The substance of the lungs, which is so full of blood-vessels, is not supplied so liberally with nerves; the lungs, therefore, may be materially affected, before danger is indicated by acute pain. And it sometimes happens, that people of the make above described are, in the bloom of life, and generally in the spring of the year, seized with a slight cough, which gradually increases, without pain, soreness in the breast, dif

ficulty of respiration, or spitting of blood. A slow fever supervenes every night, which remits every morning, with sweats. These symptoms augment daily; and, in spite of early attention, and what is thought the best advice, the unsuspecting victims gradually sink into their

graves.

Those who by their make, or by the disease having in former instances appeared in their family, are predisposed to this complaint, ought to be peculiarly attentive in the article of diet. A spare and cooling regimen is the best. They should avoid violent exercise, and every other exciting cause; and use the precaution of loosing blood in the spring. If their circumstances permit, they ought to pass the cold months in a mild climate; but, if they are obliged to remain during the winter in Great Britain, let them wear flannel next the skin, and use every other precaution against catching colds.

The fourth cause above enumerated is, tubercles in the lungs.

The moist, foggy, and changeable weather, which prevails in Great Britain, renders its inhabitants more liable, than those of milder and more uniform climates, to catarrhs, rheumatisms, pleurisies, and other diseases proceeding from obstructed perspiration. The same cause subjects the inhabitants of Great Britain to obstructions of the glands, scrofulous complaints, and tubercles in the substance of the lungs. The scrofulous disease is more frequent than is generally imagined. For one person in whom it appears by swellings in the glands below the chin, and other external marks, may have the internal glands affected by it. This is well known to those who are accustomed to open dead bodies. On examining the bodies of such as have died of the pulmonary consumption, besides the open ulcers in the lungs, many little hard tumours or tubercles are generally found; some, with matter; others, on being cut open, discover a little blueish spot, of the size of a small lead shot. Here the suppuration, or formation of matter, is just going to begin;

and in some the tubercle is perfectly hard, and the colour whittish, throughout its whole substance. Tubercles may remain for a considerable time in the lungs, in this indolent state, without much inconveniency: but, when excited to inflammation by frequent catarrhs, or other irritating causes, matter is formed, they break, and produce an ulcer. Care and attention may prevent tubercles from inflammation, or may prevent that from terminating in the formation of matter; but when matter is actually formed, and the tubercle has become an abscess, no remedy can stop its progress. It must go on till it bursts. If this happens near any of the large air-vessels, immediate suffocation may ensue; but for the most part, the matter is coughed up.

From the circumstances above enumerated of the delicate texture, constant motion, and numerous blood-vessels of the lungs, it is natural to imagine, that a breach of this nature in their substance will be still more difficult to heal than a wound from an external cause. So unquestionably it is; yet there are many instances of even this kind of breach being repaired; the matter expectorated diminishing in quantity every day, and the ulcer gradually healing; not, surely, by the power of medicine, but by the constant disposition and tendency which exists in nature, by inscrutable means of her own, to restore health to the human body.

It may be proper to observe, that those persons whose formation of body renders them most liable to a spitting of blood, have also a greater predisposition than others to tubercles in the lungs. The disease, called the spasmodic asthma, has been reckoned among the causes of the pulmonary consumption. It would require a much greater degree of confidence in a man's own judgment, than I have in mine, to assert, that this complaint has no tendency to produce tubercles in the lungs : but I may say, with truth, that I have often known the spasmodic asthma, in the most violent degree, attended with the most alarming symptoms, continue to harass the patients for a long