This is a constitutional affection manifesting itself in most essential changes in the tissue of the lungs. It may be acute or chronic. The acute form, or galloping consumption, commences with chills, fever, rapid pulse, cough, pain and difficulty of breathing, which are soon followed by night-sweats, hectic fever, great emaciation, exhaustion, and if its course is not arrested, death. The chronic variety is, however, that which we usually meet with.

For the sake of convenience, I will class the symptoms of consumption into four general stages, viz, the Incipient stage; the Solidification stage; the Maturation or Softening stage; and the Ulceration and Suppuration stage.

The first stage of Tubercular Phthisis is generally stated to be that to which the physical signs indicate a deposit in the lungs. Evidently, however, there is, and must be, an antecedent state of disordered health before the most skilful observer can detect the sound which indicates the least shade or degree of solidification of the lungs, whether by means of the stethoscope, or other methods usually resorted to by the profession for such purpose. When the physical signs are observed, the use of the stethoscope, etc., may be regarded as little more than professional display, without a particle of advantage, except as developing in some degree the actual amount of lesion or injury then sustained by the tissues of the lungs. There must be a causative agent that originates the predisposition or tendency to the deposit of tubercles in the tissues, or which elaborates or prepares the material in the system, from which only tubercle is formed. But we should not wait to see the physical signs develeoped if we would expect uniform and hopeful treatment of tubercular consumption.

From my own long experience in the specialty of thoracic diseases, I do not hesitate to say that the actual first set of symptoms of consumption consists simply in the wasting of flesh, particularly if this is attended with, or by, a low scale of health and strength. Such loss of muscle, plumpness, as well as juices and fat, is first noticed in three principal places. The first region of flesh-consuming is usually the face; the second, the hands; the third, over the sacral or hip bones. The sacral region, where it first gives out, is lame and sore. The hands look poor and "scrawny;" the muscles of the arms and legs are soft and flabby.

If the face shows it first, the eyes stare; the brow, temples, and scalp look lean; the muscular tissues of all the limbs soon waste, and the pectoral muscles, as also all the chest muscles, waste away, and then the breathing is already become imperfect and weak.

The diminished respiration is soon attended with cough; then pains are felt through the breast or thorax.

The patient next is sensible of something wrong, and is conscious of a sense of general debility. The fact is, nutrition is lost. The vital powers are flagging, for the wasting of the body, in spite of eating, is more rapid than the repair.

Then comes a state of spirit depression -- not the cause of consumption, but caused by the already deficient vitality, and all the more helping on the grand catastrophe; for it is a law of our being, that where nerve structure is not itself nourished, it, too, will fail in its work, just as surely as muscle fibre fails of power from the same cause. To recapitulate:--

1. -- Incipient stage. This may present itself at a very early age, or may appear in middle age, and the first indications are, generally, a subdued and saddened feeling, the former buoyancy of spirits subsides, and the person becomes languid. The face begins to assume a sickly hue, and, to a practised eye, tells a sad tale. The skin becomes whiter, and a nervousness and sometimes irritable disposition of mind appears; and if any hint be given about consumption threatening, the person rebels against it, and will not tolerate such an idea. The appetite and digestion frequently become impaired, and may manifest itself in capricious fancies for certain sorts of food. A slight cold or any excitement will bring on diarrhoea. The breath is short, and the breathing hurried; running or walking up an incline, or ascending a flight of stairs, is unpleasant, and attended by a fluttering and palpitation of the heart. The strength and weight of the body dimish, but this varies. The sleep is disturbed, the skin becomes hot, there are turnings of the palms of the hands, and cold feet; a short, dry, teasing cough, or tickling, or hawking up of mucus from the throat appears. There is also a feeling of feverishness and uneasiness after meals, which are unfavorable symptoms, indicating the first mal-assimilation of the food, which, if not rectified, will inevitably deposit the germ of tubercles, and hence no time should now be lost in opposing the disease, before it lays siege to the citadel of the body.

2.-- Solidification. The cough, which at first appeared very trifling, now begins to assume an anxious aspect, and becomes troublesome. It may not as yet be attended with expectoration, and if it be, the matter expectorated is of a ropy and viscid nature. The breathing becomes more impeded; hectic fever sets in, with chills and heats, while the weakness of both body and mind increases, although the intellect is sometimes extremely bright or sound to the very last. Pains, like those of pleurisy, are felt about the chest, and are indications of those inflammatory effusions and adhesions which attest the progress of the disease, and the infraction of the lung structure, and the impeding of the access of air to the cells of the lungs. The blocking up of the air cells constitutes the stage of Solidification, and thus interferes with the due motives or functions of the chest, and, if not arrested, creates an afflux of fluid to the parts, thus promoting congestion and fresh deposits in the lungs.

3. -- Maturation and Softening. In this stage, all the former symptoms are aggravated, and consumption is now confirmed. Fresh deposits in the lungs occur, and hasten the maturation and softening. These local lesions in their turn re-act on the system at large, aggravating the general infection and depressing the vital powers. Hence the advancing inertia of all the vital powers -- the universal languor, loss of flesh, and strength, and weight. The cheeks and lips become blanched -- painfully contrasting with the circumscribed hectic patch of the former. The expectoration is changed, and becomes more copious, opaque, and viscid, more massive, and frequently streaked with blood, or mixed with flocculent, wool-like, or curdy particles. It is most troublesome in the mornings, and when going to bed. The feverishness and general exhaustion increase; restless nights, with perspirations, hurried breathing, change in voice, and emaciation also increases. The appetite fails -- either constipation or diarrhoea, more frequently the latter, comes on, with great increase of cough and vomiting after meals. If the disease advanced to this stage, it will require much vigilance and judgment to arrest its progress, as the mischief in the lungs is now very great, and ulcers, rapidly forming, constitute what is called tubercles.

4. Ulceration and Suppuration. The disease now assumes a totally different aspect, and becomes exceeding formidable in its nature and results. The cough becomes more severe, and the expectoration greenish, yellow, or even sometimes like tufts of wood chewed, appearing, when viewed in water, like jagged round balls. Hemorrhage, or bleeding from the lungs, is likely to come on, and the difficulty of breathing is very great. The patient can scarcely lie down; many times he must be kept with his head bolstered up in a chair, or in his bed, when sleep is desired. Sometimes the voice is reduced to a mere whisper, while in others it remains quite strong to the last. The perspiration, or night-sweats, are very copious, and very exhaustive of the vitality of the organism. The ulcers or tubercles in the lungs increase, causing large excavations, from which issue copious expectorations, sapping and undermining the foundation of the entire system.

The most unpractised eye can now at once detect the ravages of this disease in the altered appearance of the whole frame; the body is reduced to a mere skeleton; the eyes are sunken; cheek bones prominent, with sunken cheeks; the head bends forward; the chest is wasted, and the breathing becomes distressingly painful. The mental faculties generally become impaired; yet a gracious God, amid all this suffering, frequently permits the faculties to remain intact until the last ember burns out.

TREATMENT. -- This resolves itself into such a management of the case as will tend to prevent the development of the disease, or its removal when it exists. It will be seen that consumption has its origin in a vitiated and defective condition of the general organism. This may occur as the result of hereditary predisposition, or from defective nutrition, or from imperfect development of either a part or the whole of the organic structure, and general disobedience to the physiological law of the general organism. Whenever this predisposition exists, the defective organization, as far as practicable, should be remedied by a faithful adherence to the laws of physiology and dietetics. Children possessing this organization should not be confined too closely in schools or to study, but should be reared in the country, and be exposed to fresh air and out-door exercise. Both boys and girls should be allowed to ramble through the fields, and indulge in those gymnastic exercises which tend to give strength and vigor to the system generally, such as jumping the rope, rolling the hoop, flying the kite, hoeing, wheeling, riding on horseback, etc., and not be studiously confined in-doors, because it is a "delicate child."  Tidy mothers should not be horrified if they find their child of frail organization making mud-pies, or that he has torn his frock in climbing an apple-tree. Their diet should be plain and nutritious, consisting of bread and milk, oatmeal porridge, baked apples and milk, vegetables, and a liberal amount of meat once or twice a day. Their sleeping apartments should be well ventilated, and they should be warmly clad in all seasons. Misses, upon the approach of the catamenial flow, should be well instructed that the feet should be kept warm and dry, that washing and bathing in cold water should be avoided, and all exposure to cold and moisture is hurtful.

The medicinal treatment of consumption has been extensive, and to enumerate all that has been tried and recommended would fill a volume. Some recommend inhalations; these answer their purpose well for temporary relief. The disease must be treated upon general principles. The cough should be allayed by appropriate remedies, the occasional diarrhoea checked by the astringents, the debility removed by tonics, and vitality stimulated by alcoholic liquors. It is beyond question, that spirit-drinking has been beneficial in a number of cases, if taken regularly and moderately. Phosphorus is a good remedy, especially if given in a form as it exists in erythrozylon coca. External irritants, as Croton oil to the chest, answer very well. The blood of the consumptive contains too much oxygen, and too little carbon; hence to supply this deficiency cod-liver oil, which is a highly carbonaceous food, is excellent. It gives warmth to the body, and supplies the disease with material for destruction, without expense to the body. The chalybeates may also be given to give strength and enrich the blood in its red particles. Change of climate is rarely beneficial. The diet must be highly nutritious; fresh air, occasional baths, and plenty of friction, should not be neglected. While investigating the best means of treating this disease, I deemed that if a combination could be made that would prove remedial to all the morbid characters of consumption, that would antagonize each pathological condition as they arose thus holding the disease in abeyance, and allow the forces of reparation and recuperation to mend the ravages of the disease, that such a combination would most surely cure the disease. After various experiments, I finally, by intimate knowledge of the chemical elements of plants and the pathology of the disease, was led to compound the "Acacian Balsam," which has stood the test for years, and the thousands of testimonials of the permanent cure of many bad cases of consumption attest its virtues.

It is a superior exhilarant. It purifies all the fluids and secretions in the shortest reasonable period. It nourishes the patient who is too much reduced to partake of ordinary food. It will supply the place of food for a month at a time. It strengthens, braces, and vitalizes the brain. It heals all internal sores, tubercles, ulcers, and inflammations. It stimulates, but is not followed by reaction. It at once obviates emaciation, building up wasted flesh and muscle, as the rain vivifies and enhances the growth of the grass. It is without a rival as a tonic, and it immediately supplies electricity or magnetic force (as if it were a battery) to every part of the enfeebled and prostrate body. In conjunction with the balsam, I also advise external application of the "Herbal Ointment" (which answers all the purposes of counter-irritants) to the chest, throat and back, and the bowels regulated with the "Renovating Pill" (see page 469).