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PREFACE.

I OFFER NO APOLOGY for adding to the already numerous list of works on Consumption. The subject is still incomplete, and must remain so till a higher knowledge than any which we yet possess shall have utilised, and rendered available for practice, the immense collection of facts which the literature of Phthisis now presents to the student.

The observations recorded in the following pages are the result of a minute study of cases at the Hospital for Consumption, extending over ten years. They have been carefully and impartially made, and are, I conceive, due to the Profession. It is hoped that, as simple records of facts, they will be accepted as a contribution to the pathology of the disease.

It will be seen that I have from these facts attempted a classification of Phthisis, and have sought to indicate its varieties and their ultimate progress by such natural characters as shall assist us to their recognition in the daily work of practice.

The illustration of all which tends to induce chronicity in tubercular disease, of the forms in which it becomes most prolonged, and of the influences which assist its arrest or retardation, has received especial attention, and will, it is hoped, prove of interest.

An attempt has been made for the first time to assign a relative duration to the different varieties of Consumption. In the diagrams given, the result of many observations has been represented to the eye; but, although constructed with mathematical accuracy from the materials available, they only express the averages of a few thousand cases, and the deductions will be regarded as merely approximations to truth.

For the considerations on general pathology, and for all purely theoretical statements advanced, I should apologise to the class of readers for whom this work is intended, whose early studies and later experience may lead them to regard these as superfluous.

The tendency of the present day to break up pathology into fragments; the undue importance assigned to auscultation ; and the temptation to allow the convenience of a subdivision of practice in large cities into many departments, to represent a similar separation in the great laboratory of nature, must be my

excuse.

By repeated reference to the impossibility of considering any morbid phenomenon as single; to the constant unity in all actions of the system ; and to the general import of all local disease, I have endeavoured to unite the branch of pathology considered in these pages to the general science from which it has occasionally been sought to sever it.

52 UPPER BROOK STREET, GROSVENOR SQUARE:

September 1865.

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THE ELEMENTS

OF

PROGNOSIS IN CONSUMPTION.

CHAPTER I.

PRELIMINARY.

CHAP.

I.

An accurate knowledge of the questions concerned in estimating the prognosis, or probable course and termination, of any given case of phthisis, can only be arrived at by possessing a practical acquaintance with the disease itself; with its origin, history, and most usual course and terminations; with its average duration, its modification by treatment, by inherited or individual tendencies, and by its complication with other diseases ; and, finally, with the actual physical

} condition of the patient on whom we are called to pronounce an opinion.

Without such general knowledge, the most accurate physical examination and the most refined tact in estimating symptoms must fail in establishing more than a diagnosis,-perfect, it may be, as regards the present, but fallacious as representing the future of our case. From a want of perception of this fact arise the mistake so commonly made, of trusting exclusively to auscultation, and the ill repute which the most refined methods of exploration of the chest have occasionally

B

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