pletely disappeared, and the general health was so far restored, that the patients seemed to have recovered. But it must be confessed that such examples are rare, and that the most successful treatment of the second stage of phthisis seldom proceeds beyond an arrest of the tubercular symptoms, and a partial and temporary restoration of health. I have seen this painfully illustrated on many occasions, where, after every urgent symptom had long been absent, and the most hopeful anticipations appeared to have been realized, the patient has suddenly relapsed, and all the phthisical symptoms have reappeared. Where, however, the tubercle is small in amount, the disease not hereditary, and the original strength of the patient capable of being permanently restored, there appears to be no reason why recovery should not occur as easily at this stage as at the preceding one. But it too generally happens that the softening process is delayed until the tubercular secretion is so extensive, and the health so much reduced, that, far from proving a salutary action, it aggravates the whole disease, and leads to a still further increase of the morbid deposit.

Laennec-the parent of auscultation-rested his main hope in the treatment of consumption upon the arrival of the disease at its third stage, and the contraction and ultimate healing of the pulmonary cavities. Many have followed in the track of this great authority, either from a spirit of obsequious

But

ness, or from misinterpreting certain pathological conditions which have fallen under their observation. The main argument advanced in support of Laennec's views, is based upon the peculiar contractions or puckerings of the lung, occasionally discovered, after death, in persons who had not died of phthisis, and who were never supposed to have been the subjects of consumption; these pathological appearances being looked upon as the cicatrices of former tuberculous cavities. evidence of this kind, unless it can be coupled with a knowledge of the whole previous history of the patient (which is seldom the case), is scarcely admissible, because it is certain that such a condition of the lung may result from other causes than phthisis. Pleurisy, pneumonia, sphacelus, or pulmonary abscess, may equally produce it, and after the lapse of a short time, leave nothing behind which would distinguish the effect of one from that of another. I might illustrate this by the following brief narration of the post-mortem examination of a gentleman, who lately died suddenly, whilst in the enjoyment of robust health. The walls of the chest, both above and beneath the right clavicle, were observed to be considerably sunken ; and the lung corresponding to these parts was found contracted and drawn downwards, nearly two inches below the level of its fellow, whilst internally it exhibited a number of grey cartilaginouslooking lines, running in different directions, one

of larger size than the rest occupying its centre ; the whole presenting the same appearance as many drawings I have seen of the supposed cicatrices of tuberculous cavities. Every other organ of the body was, apparently, healthy. I ascertained from the family of the deceased, that he had suffered, some years previously, so severely with pleuropneumonia of the right side, that his life was despaired of; and I cannot doubt that the peculiar alteration in the lung depended upon the destruction of some of its tissue, and the subsequent contraction of its pleural investment, caused by that attack.

Although I would not deny the possibility of a cure in the last stage of phthisis, by the escape of the softened tubercle and the healing of the cavity, I cannot help maintaining its extreme rarity, and confessing that I have never met with an unequivocal example of its occurrence. It is, happily, not very infrequent to find persons, even in the third stage of consumption, with their pulmonary disease so stationary, and their general health so greatly restored, as to be able, by the exercise of proper care, to pursue their former avocations, and to enjoy for a long time-perhaps for some years a fair amount of happiness. But such persons cannot be strictly said to be cured of their disease: upon close investigation, the most fortunate of them will be found to be more or less invalids, and, sooner or later, they will fall the

victims of phthisis ;- their pulmonary cavities, although perhaps considerably contracted and quiescent, have not healed, but are liable at any time to become the seat of renewed disease; whilst some neighbouring tubercle is almost certainly present, ready to develope, under any exciting cause, its fatal properties.

The phthisis of children, although in many cases severe and rapidly fatal, is, upon the whole, more frequently recovered from than that of the adult, and this from two causes:-first, from the greater power of resisting disease so conspicuous in early life; and, secondly, because in children the chief portion of the diseased matter is accumulated in the bronchial glands. In these structures it commonly does less injury than in the lungs, and should it not become absorbed, is more disposed either to undergo calcareous transformation, or to become hardened and innocuous; and even when softening actually occurs, the resulting scrofulous abscess may, in favourable cases, be completely discharged through an opening into one of the adjacent bronchial tubes. In one or other of these or other of these ways, the diseased glands sometimes become contracted, or even obliterated, and complete recovery ensues.

Such I believe to be an impartial view of the curability of consumption. It is a subject upon which the physician should speak with great caution, and no little diffidence. In the early stages, before tubercle has become softened, he is

oftentimes permitted to be the instrument for arresting the disease, and sometimes even for eradicating it. In a more advanced stage, his efforts may in some few instances be successful; or he may, at least, check the onward course of the malady, and not only administer relief to, but also prolong the existence of, his patient. At a still later stage, although he can scarcely hope to effect a cure, he may nevertheless, in the majority of cases, alleviate suffering, and in some, add years of life and even of comfort, to the afflicted. In far too many instances, however, his most skilful endeavours will be unavailing; he may lessen the severity of the disease, and mitigate some of its most painful consequences; but he will fail in his attempts to check its onward progress, or to prevent its fatal issue.

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