confess ourselves incompetent to understand the interpretation which he gives of them. Then are adduced extracts from d'Alembert, Galen, Haller, Bacon, Horace, Boethius, Cullen, Pinel, Friend, and a host of others, to prove or illustrate we hardly know what.

The second section of the preface treats of the various definitions and divisions of consumptive diseases; the nosological, pathological, and nosopathological modes of classification, which, we are assured, "are harmonious, and complemental of one the other." The following two sentences are extracted from one page, and we must leave it to the ingenuity of our readers to make them, if possible, harmonious and complemental.

"The symptoms alone, on the other hand, cannot be made the ground-work of pathological distinction, for under similar symptoms we find several organic lesions, various in appearance, but similar in kind." The forms of pulmonary disorganization which are pathologically different, will be found to exhibit a cognisable diversity in the combination or succession of the symptoms; although that diversity may escape the perspicacity of careless observers." xvi.

The third section is occupied with numerous extracts from several authors, strung together with somewhat random profusion, if not sometimes confusion. Baglivi, Alison, Bishop Berkeley, the Edinburgh Review, Dr. Baron, and Dr. Whately (from whose work on rhetoric we are favoured with a long quotation on what constitutes experience"), are the names which figure in Dr. B.'s pages.

The preface, which occupies no fewer than 24 pages, being thus discussed, we proceed with our analysis. The very first sentence of the first chapter has these words :

"The Pathology of the Lungs comprehends three genera of disorders; the Inflammatory, the Consumptive, and the Nervous. The Consumptive Affections include all the cachectic disorders which are characterized by cough, purulent sputa, hectic fever, and emaciation." 1.

Now, if consumptive diseases are quite distinct from inflammatory ones, how will the definition quoted from Mason Good be upheld? for we are told that consumption is a cachectic disorder, and that a cachectic disorder is " a depravity which originates from, or manifests itself in, the sanguineous function, as it regards the vessels or the fluid." Are not inflammations depravities, that is, abnormal changes, or aberrations from a healthy state, in the sanguiferous system? But, waiving this objection which more pertains to critical accuracy than to practical importance, is it possible that Dr. Blackmore has never seen a case of unequivocal phthisis, accompanied with symptoms of obstinate inflammation during life, and exhibiting undisputed proofs of the result of inflammation after death? Does he not know that an attack of pneumonia or of pleuritis, in a person hereditarily disposed to consumption, will often, very often, lead on the melancholy train of hectic fever, cough, and purulent expectoration? These three symptoms our author considers as pathognomonic of the disease; and so widely comprehensive is

"The term Cachexy is used to signify ‘a depravity which originates from, or manifests itself in, the Sanguineous function, as it regard the vessels or the fluid.' Dr. Mason Good, physiol. nosolog. p. 223. All organic diseases are properly herein comprised.'

No. XXXIV.

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his definition of consumption, that he admits even fatal cases of organic disease in the abdominal viscera, with cough and purulent sputa ;" and yet, in his preliminary classification of thoracic diseases, he adopts the most palpably-erroneous arrangement on which an author could well stumble; namely, into such as are inflammatory, consumptive, and nervous. In which of these classes or orders is the learned author to find a place for hæmoptysis, edema, and emphysema of the lungs, pulmonary apoplexy, and so forth ? We allude to this fatal error, occurring, too, at the very commencement of the book, as exhibiting the unpardonable negligence with which it has been got up. Proceeding, step by step, we find ourselves lost in a forest of names, to each of which is tacked a disjointed sentence; and when we have at length emerged, we discover that there are two orders of consumption, the "spurious" and the " genuine."

That is genuine Phthisis, in the language of Celsus, when decline originates in a disease of the Lungs ;-and the epithets Tabes, Atrophia, Marasmus, are used by recent nosologists to designate consumption from disease in other organs. When the lung is affected secondarily, and its disorder in itself minor and innocent, disease in another part being the primary affection, and the essential cause of death, such a malady may be properly designated Spurious or Secondary phthisis: and a diverse order of succession in the symptoms will distinguish this case from the primary idiopathic affection of the Bronchial membrane which is termed Mucous or Catarrhal Consumption." 6.

And again

"If it is correctly assumed that phthisis is essentially a fatal pulmonary affection, a case of hectic from suppuration in the lungs is not truly phthisical; for such a condition is sanable; this may be styled spurious consumption, in distinction from those cases which are necessarily mortal. To apply the term, however, to an insanable case of pulmonary disorder with phthisical symptoms, because the lungs are not visibly disorganized, is to introduce confusion into Nosology and Pathology." 6.

And again

"The general arrangement adopted in this Treatise, will exhibit Two distinct ORDERS;-First, the cases with the usual symptoms of consumption, apparently hopeless, but ending in recovery. (See chap. III.) And Secondly, the cases progressively passing on to a fatal termination. In some of the cases in this latter division the disorganizing malady is seated in other organs than the lungs ; the cough and puriform expectoration being secondary. In these, the supervenient pulmonary affection (which in most instances is confined to the mucous membrane of the Bronchia,) is not the proximate cause of the hectic and emaciation; nor is it essentially fatal: the primary disorder, however, has often been so completely disguised by the supervenient affection as only to have been detected on dissection.-(See Dr. Hastings on Bronchitis, p. 117.) An organic disease in the abdominal viscera may subsist in a latent or tranquil state for years; and then on the rise of a slight pulmonary disorder the patient will be rapidly cut off: so that this secondary affection, which by itself would be innocuous, will in this complication be of important consequence." 8.

Bewildered and confused as we have been in the maze of errors and inconsistencies, we scarcely, however, expected to find that one of the forms of consumption is designated chronic, remittent, and inflammatory, after the boundary line had been drawn in the memorable first sentence of his book! To render the inconsistency still more inexcusable, read the following sen

tences, which the author indites preliminary to the detail of cases exemplifying the first form.

"Two Orders of cases will be given;-First, those which were seen in a state of pulmonic inflammation, but ascertained by their result to be of a truly consumptive nature, although life was destroyed before the completion of the phthisical disorganizing process; and Second, cases seen in the state of confirmed phthisis. In some the affection was chiefly seated in the bronchial membrane, or in the interior of the lung,-consisting in a suppurative action, with or without Tubercles; in others, the symptoms indicated an affection of the exterior or Serous membrane of the lung and of the chest. The former may be styled Empneumonic, the latter Peri-pneumonic cases. Some cases again are simple, the Lungs alone being diseased; in others, there is an important complication of other maladies." 11.

"The phthisical inflammation may be regarded, first, as to its seat in the substance of the lung, or in its serous membrane; secondly, as to its distinct nature in the several forms of consumption. 1.-There is a variety of peripneumony where there is no pain, which is longer and severe, the lung is very dark.'* There is a similar fallacy in the symptoms of this variety to that which Professor Burns has remarked of Bronchitis in infants,-' a pale face, and oppressed look, which delude into a trifling mode of cure.' It is important not to be deceived by a low oppressed pulse. There is a practical observation of Huxham worth remembering, that in pneumonic inflammation, pain at the bottom of the chest, with borborygmi, and a swelled belly, is relieved by clysters,'-the intestines being the seat of disorder." 215.

We deem it quite unnecessary to select any number of cases from the present work; they have been fished from all possible sources, and are reported with such prolixity, as to render them tediously uninteresting and little instructive; every minute particular is wearisomely enumerated, and we sometimes in vain search, in the report of the dissections, for the pathology of the disease in question. Strange that our author should be guilty of an error, which he reprobates himself in the words of Haller, quoted in the preface:

"Sincere et simpliciter enarrare quæ vidi, et breviter; vereor enim ne parum ii scriptores legantur qui nimia abundantia exiguorum accidentium historias suas producunt, et lectuis tædium movent." viii.

But to satisfy our readers that the above strictures are warranted by impartial justice, we shall allow them to judge for themselves of the following cases, which are transcribed verbatim.

“ CASE XIII.—A. T. a 22, (Jan. 1831,) of high sensibility and genius, in June, 1829, after a severe cold, was affected with cough, and pain at the left chest, which was neglected for three months. In the winter she suffered much

from fatigue and mental anxiety. In the spring of 1830 she spat blood, and the pain of the side became acute. Leeches and blisters were then used, general bloodletting being neglected: the cough persisted during the summer, with expectoration of one ounce of matter in a week, like soft cheese mixed with common mucus, which on drying became friable ;-the matter of Tubercles? A physician then thought her to be in consumption, and prescribed the lichen island. and change of climate. She has never worn flannel; and has persisted in the use of wine and animal food. There is now a deep sonorous cough, occasional

hoarseness of the voice, evening fever, and some emaciation; the menstrua irregular. 6th to 11th—An attack of Measles, during which the cough and sputa were suspended, and diarrhoea came on. Kino, creta, and flannel were then prescribed. After the measles severe pain at the side returned, with a harsh cough, and difficult expectoration. (Nitrat. potass. liq. ammon. acet. tr. digit. pil. hyos. p. Jacobi, ipecac. hirudines.) 14th-Respiration very quick, costiveness, a rapid but softer pulse, (110-120) a loaded dry tongue, intense thirst. (Calomel. scammon. tr. scillæ. ung. hydr. antim. tart.)-17th-Cough less harsh, but in severe paroxysms at night with more excretion of viscid opake bloody mucus, without a vestige of pus, or tuberculous matter; four stools a day, which are more natural; hectic at 2, p.m. pulse 120, tongue clean and moist. (Hyosciam. scilla, cum aceto.) 18th-Cough relieved; some blood from the nostril. Percussion painful below the clavicle, and betwixt the shoulders, where also by the stethoscope the respiration is inaudible. The voice is so raucous and low that pectoriloquy cannot be ascertained. (Acid. nitric-hydrodyanic. narcotic, h. s.) 19th-The narcotic has been of admirable effect; hectic at noon, during which there is oppression at the lungs, with hard cough and laborious respiration, and appetency for solid food. Interm. acid. nitric.-hydrocyan.) 20th-Good stools, pulse 110; defect of voice remains, but no irritation at the larynx. (E. C. hyos. cum digital. vesp.) 21st-Fever and cough relieved, sputa less viscid, tea vomited, but no nausea; pulse 100. (Acid. nitric. victus ex carne decocto.) 24th-Cough severer, sputa more copious, ragged and viscid, tongue loaded, the legs ache, vertigo on exercise, much emaciation, no hectic, soreness at the larynx, fetid stools. (E. c. alia ut 6to. supra.) 27th-Since the severe weather the symptoms have become worse, the arm is numb as if the ulnar nerve were struck; some roast chicken eat. (Acet. scillit. hyosc. &c.) 28th-The sputa sink in water, are fetid and caseous, seeming to consist of pus or soft tuberculous matter; hectic high, with tightness at the chest, which some leeches relieved, pulse 100.-The adhesive inflammation in the lungs seems to have prevented the opening of the tubercles into the bronchia before now; the inflammatory stage, which began in the measles, has ended in a month. 29th-The -caseous sputa enveloped by viscid mucus. (Infus. calumb. aurant. acid. nitric. prussic t. d. hyosciam. scilla. o. n. pil. cath.) 31st-More cough, and fawncoloured sputa; pulse 120, soreness beneath the sternum. (Omitr. victus excarne, et tonica. St. scil. et digital. hiruds.) Feb. 1 and 2, relief. (E. c.) 3rd -Pulse 130; less pus and blood in the sputa. (Infus. humuli cm. digital. t. d. liq. opii sedat. hyosciam. ipecac. o. n. vegetable diet.) 10th to 14th-Stupor and delirium from the narcotics; the sputa now consist of pure pus; aphthæ and diarrhoea, tremors from debility, pulse 110 to 130. (Infus. calumb. cm. aceto. liq. calcis, catechu, acet. morphiæ.) Diet of yolk of egg and beef tea.

By these remedies the diarrhoea was stopped, the thrush disappeared, and the system was composed, but copious purulent cream-like sputa, with colliquative sweats, continued.

19th-Mild delirium from exhaustion, after transporting religious emotion. On using some cold lemon-tea, she complained of a sense of suffocation as if dying; this was relieved by external heat; pulse very small and rapid. (Claret ordered.) 22nd-Aphthæ have recurred; much cough, less easy expectoration; the sputa are large, and seem to come from large cavities in the lungs ; little fever. The subsidence of fever, when fits of syncope and suffocation supervene, marks the approach of death. 25th-Porter and animal jelly used, little medicine but magnesia and rhubarb; more cough, hectic and debility; dyspnoea in paroxysms. (E. canth.) 26th-Relief of suffocation, but the odour of death observed all the day. At 6, p.m. mortal exhaustion ensued on her making a slight effort; at 7, consciousness was entire, her mind full of christian peace and hope; then followed a dreadful agony of suffocation, which was relieved by admitting the fresh air; at eight o'clock the pulse was gone and the limbs cold; then

mild delirium and risus sardonicus, which were succeeded by coma, the respiration continuing, but performed chiefly by the auxiliary respiratory muscles, then it became suspended at intervals; shortly after a rattle in the throat the last. breath was expired, her countenance remaining beautifully tranquil ;—a faint emblem of the bliss of her saintly spirit in the presence of her Saviour and her God!

The measles certainly excited into fatal action the disease in the lung, which had probably long ago formed tubercles and induration. The softening and evacuation of tubercles is here seen to be a distinct condition of the lung from inflammation; although this is often an adjunct which essentially promotes that state. The symptoms in January were obviously distinct from the simple debility hectic and purulent expectoration which existed during February: the change observed in the sputa from a viscid to a cream-like character marked the entire subsidence of inflammation. The utility of sedatives, narcotics, and counterirritants was very manifest. The unusual definiteness and alternation in the symptoms and the phenomena of dissolution render this case very interesting.

CASE XIV. Horral, m. a. 30 (February 20, 1829), of a florid strumous aspect, has been ill for six weeks, from cold, with cough, sputa and much dyspnoea. He has had diarrhoea lately; at present tremors, a white tongue, and rapid pulse. Several of his relatives have died of phthisis. (Colchic. scilla, digitalis, creta cum opio.) 24th-Much better. (Acid. nitricum, rheum, E. C.) March 4thNo cough, but some pain at the side, and breathlessness on exertion, a quick pulse and a white expanded tongue. 11th-Much breathlessness; aspect delicate. (Sulphas ferri, digital.) 16th-Cough, perspiration, red urine, a rapid pulse; in other respects better. (Sulphas potass. cum rheo, scilla, et alia.) Pain at the stomach like heartburn, ascribed to the medicine; little cough, mind dejected. (Magnes. E. Canth.) 30th-Cough, with breathlessness and fainting, but the stomach is better. (Scilla, æther, digital.) April 6th-Complains of heat at the stomach and sleeplessness. (Magnes. digit.) 8th-Vomiting and ischury. 15th-Phthisis advancing; the legs swell, and he is sick and giddy; all the medicine, even soda-water, is vomited; gastritis erythematica developed, hectical aspect. (Nitric. acid. digitalis, hirud. magnes. in aq. cinam.)—The mildness of the phthisical symptoms, and their alternation with the dyspeptic, deserves remark. 20th-Much anasarca. (Acetum scillit.) 26th-Death.-The disease ran its course in four months.

A well marked instance of the acute scrofulous cousumption; it forms an interesting subject of comparison with Langdon's and Urquhart's; the tonics were here also injurious. See Louis, in chap. II. for the morbid appearances in the stomach in similar cases."

"COMPLICATED WITH DISEASE IN THE BRAIN.

CASE LXI. Rendel, m. a. 60, of a tense spare habit, and temperate, (Aug. 1829,) has long had pain at the head, vertigo, and a gradual loss of vision, more entire in the right eye, which is small and retracted, while the left is large and protruded. In September he had much aching through the forehead; complete blindness on the right eye, but the pupil was moveable, the sight of the left imperfect. Various means were used at the Eye Infirmary without effect. At the end of Oct. he had a severe attack of pain in the right side, for which he was once bled; he then went into the Poor-house Hospital, where cough and dyspnoea continued, and the disorder in the head, with low nightly delirium, increased. Dec. 8th-Little cura adopted ;-death this morning.

Inspection-10 hrs. p. m.-Much blood in the integuments of the head, the inner table of the frontal bone at the sinuses and crista galli was widely separated from the exterior, and inclined inwards on the brain; the left orbitar plate destroyed; the back part of the orbit filled by a tumor the size of a large