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process and products; and, although ultimately destructive, it is the most gentle step towards the death of the tissues. Nay, various proofs will be adduced that fatty transformation is often a salutary process, assisting materially in the removal of phthinoplasms and other superfluous products of inflammation.

The preceding imperfect sketch will, I trust, make it apparent that the views now offered are not barren speculations; but, if they prove to be well founded, they are largely suggestive of practical measures. The great indication to sustain the vitality and sufficiency of the bioplasm, by all available means, medicinal, regiminal, and climatic, will be the first suggestion for the prevention and treatment of consumptive disease. A second, equally obvious, will be the avoidance of all influences which may injure the bioplasm; generally, by deleterious action on the whole body; or locally, by exciting low inflammations in the lungs or other organs. A third indication, more difficult than the others in its fulfilment, is to counteract the injurious effects of phthinoplasms already formed, and to promote their quiescence or removal.

It has been our endeavour in the chapters on the Treatment, and in those containing the illustrative Cases, to show how these indications are carried out; and, although in the worst and most rapid forms of disease, we have still to confess that medicine is almost powerless, yet, in those less overwhelming, and in those more chronic, which happily constitute the far greater number of cases, we have been able to adduce many proofs (and these might be largely multiplied) that much may be

done to mitigate, to prevent, to retard-aye, and even to arrest and cure, this most destructive of human maladies.

And here occurs an opportunity, which must not be lost, of saying a strong word on what renders the practice of our art much less successful than it might be if it had a fair chance :-I mean the fickleness or indocility of the patients or of their friends. Our recorded cases are dry enough to read, being neither smooth in diction nor sensational in narrative: but they teach this lesson, that those patients benefited most surely and most permanently, who early, and at reasonable intervals, sought for advice, and who implicitly and faithfully followed it to the best of their ability, during the several months or years required by the nature of their cases. On the other hand, only irregular and uncertain improvement ensued where the advice was imperfectly carried out; and relapses, serious and even fatal, resulted often from its neglect. This is an old grievance, and we must not cease to raise a warning voice against it. The cause lies very much in the ignorance and conceit of even the educated classes in medical matters, especially of the aristocracy, many of whom consider themselves better judges than medical men; and, if they seek advice, neglect to follow it, or capriciously decide to discontinue the treatmentto change the doctor-or, it may be, to, try homœopathy, or some equally absurd form of quackery-at the very time when the patient's life and recovery depend on the steady continuance of a plan of rational treatment. It is awful to reflect on the numbers of valuable lives that are sacrificed to such ignorance and caprice! and until the

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public intelligence becomes sufficiently enlightened to discern the wickedness and folly of this reckless tampering with health and life, our own profession at least should not cease to protest against it. We have difficulties enough to contend against in our endeavours to correct and control the decaying tendencies of the frail body, without having them fatally aggravated by the officious interference of ignorance and prejudice. The treatment of Pulmonary Consumption involves a long watchful struggle with a strong, subtle, and insidious enemy; and to secure any amount of success, the will, the faith, and the hopes of the patient must be persistently and patiently on our side.

It was mainly the unsatisfactory and inconclusive character of histories of short duration that induced me to select for statistical analysis those cases only, which had been under observation for a period of one year and upwards. A large proportion of the patients who seek the advice of a consulting physician come once, and may never be seen or heard of after. In those who repeat their visits within a few weeks or months, changes for the better cannot be relied on without the test of longer time to prove their permanency; and the cases of death occurring within these short periods belong to those acute and overwhelming forms of the disease which art is never likely to control: happily these early deaths are so rare that they only slightly affect the average duration of life in all cases.

The statistical parts of this work have been entirely executed by my son, Dr. C. Theodore Williams, who has bestowed much labour upon them. His assistance in this

department has been the more satisfactory to me, because I have neither taste nor talent for that kind of work, which is nevertheless indispensable where precision and accuracy are required. It is necessary to explain that his calculations contained in Chapters XV., XVI., and XXIV. are based on the 1,000 cases selected (as stated) from my note-books during a period of twenty-two years; and those only who are familiar with the numerical method of tabulating and calculating facts and results can form an idea of the amount of work required in this investigation. The results appear to be highly interesting, and, although much in accordance with the general impressions which I had previously derived from my experience, it is much more satisfactory to have determinate figures to rely on, than the hazy tokens of vague memory.

The abstracts of cases, occupying six chapters, are not limited to the 1,000 cases above mentioned, but are taken from my whole experience, private and hospital; and are selected chiefly to exemplify the matter in the text bearing on the nature, varieties, signs, symptoms, causes, duration, and treatment of Pulmonary Consumption. In the preparation of these cases for the press, and in their arrangement into groups, my son joined his labours to mine, and thus the work has been more rapidly accomplished. The task of selection has been difficult: it would have been easier to have increased them two or three-fold, as there was abundance of material; but it was judged better to give only representative cases, and not to swell the volume, and try the patience of the reader by numbers which would probably prove too monotonous and tedious to be read. The short fatal cases narrated

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are selected chiefly on account of the post-mortem appearances; and the chronic cases, many of which are still living, give a longer insight into the nature and course of Pulmonary Consumption than any that have yet been given to the Profession.

The short chapter on the Physical Signs of Consumption is introduced to explain the signs and interpret the terms given in the histories of the cases. It is more than thirty years since the appearance of my last work on the physical signs of diseases of the chest, and it has been for more than twenty years out of print; but I have found no need to change the language which I then used, except in the way of simplification and abbreviation, and to adapt it to describe the varieties in the history of phthinoplasms. I flatter myself that the views given of the pathology and tendencies of these will render their physical diagnosis more intelligible and easy than it has been generally considered hitherto.

The chapters on Family Predisposition and other causes of Pulmonary Consumption and on Hæmoptysis are contributed by my son, the statistics bearing on them being derived chiefly from the 1,000 cases which he had tabulated from my notes. Some important deductions respecting the origin of Consumption and the pathology of Hæmoptysis will be found in these chapters.

The Summary View of the treatment of Pulmonary Consumption is only slightly modified from that which appeared in the Lancet three years ago. In the subsequent chapters which consider the treatment in relation to the forms or varieties of the disease, I have found it convenient to divide it into the three heads, antiphlo

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