I have generally observed that dyspepsia, possessing this unfavourable tendency, has had a peculiar association of symptoms-not sufficient, perhaps, always to distinguish it, but, nevertheless, of some practical moment: capricious, and sometimes excessive appetite, great pain at the epigastrium, flatulency, obstinate sickness, gradual emaciation, and high and hopeful spirits, have been more or less conspicuous.

Certain diseases affecting the thorax have been often regarded as predisposing causes; but this is only correct to a limited extent, and under peculiar circumstances. From the many inquiries I have made of consumptive persons, as well as from the cases I have myself been able to watch, I am led to the conviction that neither inflammation of the lungs, bronchitis, nor pleurisy, of an acute form,— attacking persons of ordinary health and free from consumptive predisposition,-running an ordinary course, and judiciously treated,-have the slightest tendency, either immediately or prospectively, to induce phthisis. I am inclined to consider them even, in some measure, opposed to its developement; that is to say, the state of system in which they are apt to arise, is of a different character to that which generates tubercle; this, perhaps, is the most conspicuous with respect to pleurisy, but it is also true, generally, with the others.

Chronic pleurisy has been considered as productive of consumption, but I have never seen anything

which would justify such a conclusion, and I believe it to have been formed more upon supposition than from observation of the occurrence. The chronic forms of bronchitis and of pneumonia differ, however, in this respect; for, although either of these may exist for almost any length of time without producing the least indication of phthisis; yet they may, under peculiar circumstances, which will be alluded to in the next chapter, gradually pass into it.

Some of the diseases of childhood, particularly measles and hooping-cough, are frequently followed by tubercular affections of the lungs and other organs; but, in such instances, it will generally be found that they have acted only as excitants, and that the little sufferers have been previously delicate, or possessed some hereditary taint. These diseases usually pass away from healthy children without leaving them predisposed to phthisical

affections.

Syphilis seems to have no tendency to induce a consumptive diathesis, except through the effect it may have, in common with other diseases, upon the general functions of health. I have not found, amongst the phthisical patients at the Hospital for Consumption, an unusual proportion of persons who had been affected with syphilis; and I have very rarely seen secondary syphilitic disease in conjunction with phthisis. It is, however, so difficult to ascertain the truth upon this subject, that any

conclusion respecting it must be received with some degree of qualification; but the facts I have gathered, warrant the belief that there exists no special relationship between the syphilitic poison and the formation of tubercle.

A similar observation would, perhaps, apply to every other disease, with the exception of diabetes, which is well known frequently to terminate in consumption, and this even in cases where no other predisposing cause is discoverable.

The medicinal use of mercury has been sometimes accused of acting as the predisposing agent to a subsequent developement of consumption; but I have never met with a single instance where the commencement of this disease was fairly attributable to such a cause. Persons who have suffered in health through the use of this remedy, doubtless, often become phthisical; but I believe that in these cases it is seldom the mercury which has caused the mischief, but rather those vicious habits which, in the majority of such instances, have made its employment indispensable. The real sufferers from mercurial action are those whose diseases have been self-inflicted; for it does not appear that the proper use of this medicine in the ordinary class of inflammatory affections, is necessarily followed by injury to the health; and there is still less reason for ever attributing to it the origin of phthisis. It is, indeed, a truth which ought many times to have spared our art unjust

discredit, that there is nothing in the specific action, either of mercury or of any other medicine, at all calculated either to predispose to, or excite tubercular diseases.

The form of the chest, in its relation to the phthisical diathesis, requires to be referred to, since peculiarities in this respect have been generally classed amongst predisposing causes. I am satisfied, however, that the shape of the thorax has very little to do, primarily, with the developement of consumption; for it is equally common to see phthisis attacking persons of fine and well-proportioned chests, as those who are the subjects of some congenital or acquired thoracic malformation. The life-guardsman, the pugilist, the blacksmith, etc., notwithstanding the fully-developed chests which their several occupations induce, are, in fact, cæteris paribus, quite as liable to the inroads of phthisis as the mechanic or artizan, whose daily task leads to the opposite result. Continued observations upon phthisis, in all its multiform characters, have led me to the following conclusion:— that the best formed chests afford no security against the onset of the disease; whilst those which are comparatively ill-developed, or even deformed, do not appear the more liable, on that account, to become the seat of tubercle.

We have thus seen how the predisposition to phthisis may be either inherited or acquired. There

is usually a marked difference in the course of the disease according as it owes its origin to one cause or the other; cases arising from hereditary taint, being, for the most part, more intractable, of shorter duration, and less amenable to remedial agents, than are those in which the tuberculous diathesis has, from any cause, been acquired. The reason of this is obvious. In the one instance we cannot separate the patient from the cause of his disease, but, in the other, this very frequently can be accomplished. Hence, in forming the prognosis of any particular case, this point should be always taken into consideration; the answer to the question, --whether or not other members of the family have been consumptive, enabling us, very often, to form a more correct opinion as to the probability of our treatment proving successful.

Before closing this chapter, it is necessary to observe, that some of the circumstances I have included amongst the predisposing causes of phthisis, have been thought by others more plausible than demonstrable. I am, however, far from asserting, that even the most potent of them must, of necessity, lead on to consumption; for it is evident that one person may bear with impunity that which to another might be highly prejudicial. Every conclusion respecting the effects of a number of very different and variously combined agencies, upon anything possessed of such unbounded diversity as the human body, cannot be other than of a general