"Phthisis means a wasting away, or a consuming; but of late years the term has been mainly restricted to that species of wasting disease which consists in the occupation of the lungs by tubercular matter, and the changes which that matter suffers and works. But it would be an error to suppose that the disease is limited to the lungs in these cases. The lung disease would be sufficient at length to destroy life; but its mortal tendency is aided and accelerated, in most instances, by disease of a like kind, situated in other organs. ' The pulmonary consumption (as Dr. Latham justly observes) is no more than a fragment of a great constitutional malady.' But that malady plays its part most conspicuously in the lungs."

The tubercular matter, which may be called the essence of the disease, occupies most frequently the upper lobes of the lungs, and the upper and back part of those lobes; invading gradually the lower lobes, from above downwards, as the disease advances. Both lungs are, commonly, affected at the same time, though in unequal degrees. Among one hundred and twenty-three instances of Phthisis, Louis found that the tubercles were limited five times to the left lung, and twice to the right.

These tubercles often continue to multiply, until at length their number, or size, or effects, become incompatible with the further continuance of life.

The disease may be limited to one small portion of the lung, and the part so occupied may undergo a kind of repair. But the disease when so limited, may cease in another way. The moister parts of the morbid secretion may be absorbed; and the earthy salts it contains may concrete; and the whole be converted into a shrivelled, hard, chalky, or mortar-like mass, which sometimes is coughed up, sometimes, in favourable cases, remains for years in the lung, an inert and almost harmless body. Sir Thomas Watson says: "Let me state, while I think of it, that the expectoration of these chalk-like concretions, denoting, as it usually does, the existence of pulmonary consumption, marks at the same time the chronic character of the case. I am acquainted with a gentleman who, though delicate, enjoys a very fair share of health, and who has for years been coughing up at intervals, little branching fragments, like bits of white coral, consisting principally of carbonate and phosphate of lime, and evidently moulded in the smaller bron; chial tubes."

Tubercular Phthisis is not necessarily a mortal disease.

When the tubercles are numerous-or rather, when they lie near to the surface of the lung, as, they are likely to do when they are numerous-they very generally give rise to dry or adhesive pleurisy. So that, in a person dead of consumption, it is a very rare thing to find the lungs free from adhesion to the ribs.

In addition to tubercles on the lungs in Consumption, there is generally ulceration of the glands of both the small and large intestines. Louis met with ulceration of these glands in five-sixths of all the fatal cases of Phthisis that he examined.

Consumption often arises upon the foundation of a scrofulous constitution; and there are many occupations which act as exciting causes of the disease, by lowering the tone of the general health, or by the direct application of local irritants to the lungs themselves. The workmen whose employments have a directly irritating operation upon the respiratory organs, are stone-masons, miners, coal-heavers, flax-dressers, brass and steel polishers, metal-grinders, needle-pointers and many others who of necessity inhale (luring their labour an atmosphere loaded with irritating particles of matter. But then, most of these men work also in towns, and remain for many hours, day after day, in a constrained position, in crowded or in close apartments. Moreover, some of these occupations, being sedentary, and requiring no great muscular power, are unfortunately selected, for that reason, by persons who are naturally of feeble or delicate constitution. On the other hand, butchers, fishermen and their families, and farm-servants, are said to be comparatively free from Phthisis. Dr. Knight, of Sheffield, informs us that fork-grinders, who are what are called dry-grinders, die there of the grinder's asthma or grinder's rot, before they are forty-two years old. Razor-grinders, who grind wet and dry, live a little longer. Table-knife grinders work on wet stones, and survive till they are between forty and fifty. Sir Thomas Watson asks, "Is Phthisis contagious f and answers the question thus:

No: I verily believe it is not. Neither can the disease be easily (if at all) generated in a sound constitution. Nor is it ever imparted, in my opinion, even by one scrofulous individual to another. Yet in Italy a consumptive patient could not be more dreaded and shunned if he had the plague. And in this country the suspicion will now and then arise that the disease may be infectious. A girl dying of Phthisis is nursed by her sister, who afterwards droops and dies of the same complaint. Here the presence of the peculiar diathesis is strongly presumable. But the parties may be different in blood. A wife watches the deathbed of her consumptive husband, and presently sinks herself under consumption: and there may be no traceable or acknowledged example of scrofula in her pedigree. Yet even here the latent diathesis may fairly be presumed to have existed. Very few families are perfectly pure from the strumous intermixture. The predisposition may be slight; it may be dormant for a generation; or, like other inherited peculiarities, it may alight capriciously on some individuals only of the kindred. In both the supposed cases there have been other influences at work, more authentic than the alleged contagious property, in calling forth the fatal malady: watching, the want of rest, confinement in the unwholesome air of a sick chamber, and above all, protracted mental anxiety, than which, no single cause perhaps has more power to foster and forward the inbred tendency to Phthisis. The disorder, I am satisfied, does not spread by contagion. Nevertheless, if consulted on the subject, I should, for obvious reasons, dissuade the occupation of the same bed, or even of the same Bleeping apartment, by two persons, one of whom was known to labour under pulmonary consumption.