amination showed slight dulness under the left clavicle; bowels natural; no other change in the symptoms. Upon enquiry, I find he descended from syphilitic parentage, his grandfather, on his mother's side, having had that disease; and also that most of the male children from the same descent died in infancy. Prescribe hydriodate of potash grs. ijss. three times a-day, which was gradually increased to grs. iv. This was persevered in for about three weeks, when, seeing no improvement, but rather a gradual increase of his cough and his weakness, a resort was had to tonics, quinine, and stimulating expectorants, but with no benefit except relieving his cough a little at night.

Feb. 14th.-A neighbouring physician was called in, who pronounced his disease to depend on torpidity of the nutritive system. Prescribed hydriodate of potash grs. iij. three times a-day, under which prescription he remained until his death, which took place the last of February, being confined to his bed but three or four days before he died. He complained of no pain except a neuralgic affection of his knees for about a fortnight, and soreness of his hips from lying in bed. His bowels remained natural to the last.

Post mortem examination fifteen hours after death. Body extremely emaciated. Upon laying open the cavity of the thorax, the left pleura was found adherent throughout its whole extent; the heart and lung upon this side was perfectly studded with tubercles, of a cheese-like consistency, about the size of small buck-shot; the right lung was tuberculous, but not to the same extent as the left; a few tubercles on the upper surface of the liver, otherwise it was tolerably healthy; the spleen and peritoneum were equally affected; the pancreas, stomach and bowels healthy.

This case is given as an example of several occurring in the same family, four of whom have died, one is now at the point of death, and the disease seems to be extending to other families. I have not had an opportunity of seeing those sick in other families yet, but doubt not from the description of the symptoms that they are affected in the

same way.

Thus far every one who has been attacked has died in a time varying from five weeks to four months-their symptoms varying in some particulars. One's bowels were badly affected for several weeks before death. In another, a large vomica bursted, and considerable matter was coughed up on the day preceding her death, which was probably the immediate cause of it. They all seemed to be taken sick by surprise, and died thinking they were getting well, except the mother of the family, who lived but five weeks after she first began to complain, and but two after she first felt sick enough to take to her bed, and she supposed she was "tricked."

Dr. Terrel, of Sparta, recommends the use of iodine to the remaining members of the family, as the only means of preventing the extension of the disease. Possibly it might be of service if used in season. But the probability is, that the disease may be advanced to an incurable state before the first symptoms appear, and besides it

is so insidious in its approach, that it is some time before the patient knows the nature of the attack. A disease similar to this prevailed some years ago in Maj. -'s family, of Wilkes county, and between twenty and thirty died. I hear also it is prevailing in Tennessee, to an alarming extent in some neighbourhoods.—Southern Med. and Surg. Journ.

Ship Fever. Both Journals of Medicine and the newspapers, generally, are bringing frightful intelligence of the extension of ship fever in Europe, and all the Atlantic ports, north of Philadelphia, in this country. Vessels are continually arriving here with vast multitudes of miserable human beings, from famine-stricken Ireland, who were both physically and morally enfeebled before commencing a voyage which disease tracks across the ocean with an unerring certainty. Complaints are made that the ship fever is by no means confined to the emigrant vessels, but that it appears on shore, clinging to the Irish emigrant, and breaking him down even far in the country, after he has escaped from the confinement of a ship hold. This is true to a degree; but had these thoughtless, head-strong, imprudent people one ray of discretion when they get on land, their sufferings would be less than they are. Cases of ship fever would be fewer in number, and less severe in character, were the emigrants influenced by the advice urged upon them by kind-hearted, benevolent physicians and others. Soon after leaving the vessel, however good their condition at the time, they seize with ravenous avidity upon every possible variety of edible that comes within their reach, to say nothing of drinks-and the result is a sudden engorgement of the stomach. Nature seeks relief from this plethora, in some instances by a diarrhea; in others, a peculiar state of the system is induced, remarkable for the turbulence of the blood, which seems to boil and foam in the vessels-and this is ship fever, with all its bad concomi

tants.

Bad food, and the huddling together of men, women and children in the hold of a ship for weeks, engender the disease which is brought to our shores. When those who have escaped the action of a poisoned atmosphere between decks, afterwards sicken on land, exhibiting the same degree of intensity in the symptoms, the disease is brought on, in a majority of cases, as already remarked, by the uncontrolled appetites of the victims to the malady.

A constant professional intercourse with multitudes of Irish emigrants, who arrive in the port of Boston, furnishes opportunities for witnessing ship fever in all its phases. The only efficient remedy, certainly the first source of relief, is a fresh atmospheric exposure. It is delightful to contemplate the changes effected by this simple process. Very little medication is required in the management of patients from sea. Of the kind of treatment most satisfactory with the other class, those sickening from over-eating, and other irregularities, there may be a variety of opinions. The disease terminates fatally, very quickly, at sea; but the worst forms, on being removed

to cool, airy apartments on shore, are at once ameliorated, unless the low, muttering delirium exists. Under such circumstances, a recovery is exceedingly doubtful. Petechial spots, referred to by foreign authors, have in no instance, thus far, been observed on those dying here.

Next-is the disease infectious? Does it re-produce itself in persons exposed to the emanations from those labouring under it? These are questions seriously agitated by the mass of the people. Many persons consider that it is not thus propagated, but that it is only generated in the manner represented in these observations. Fatigue, debility, a tainted atmosphere, or badly-ventilated apartments, together with direct exposure to those in the advanced stages of the fever, without doubt, may produce it. Hence, cases are perpetually occurring in public institutions, where foreign paupers are admitted, and in narrow streets, and old decaying tenements where emigrants congregate on reaching the city. The views of correspondents on this engrossing topic are solicited, since the public health should not be neglected by medical practitioners.-Boston Med. and Surg. Journ.

A few Remarks on Phthisis, and on its Physiological Treatment. By M. BOUCHARDAT. Translated for the Medical Times by ALFRED MARKWICK, Esq., Surgeon to the Western German Dispensary, and formerly Externe to the Venereal Hospital, Paris, &c.-The anatomical doctrine which prevails at the present day has, in more than one instance, substituted facts for errors; it has, in more than one disease, replaced bad therapeutics by a rational and efficacious mode of treatment, and has more than once, by pointing out to us the fallacy of science being already perfected, contributed to delay the period of useful and fruitful research. In pulmonary phthisis, in particular, the true nature of the disease consists, in the opinion of all our anatomico-pathological writers, in the specific alteration of the lungs; and it may be observed from its commencement, and followed throughout all its stages. This opinion being adopted, the origin of the disease is considered to be a specific irritation of the organ; and upon this supposition, medical men direct their treatment against the local affection, and torment their patients by the local application of leeches, cauteries, and moxas!

This opinion on the nature of pulmonary consumption is one of the worst that can be formed; the reality is not sought for, but a vain fancy followed, and the disease itself allowed to increase daily in severity, and at length to become incurable, without any useful means being resorted to oppose it.

I am about to defend an opinion which is to lead to quite a different mode of treatment, but which will often present, in its application, numerous difficulties, and require special researches to be made.

According to a careful microscopical examination, and a complete chemical analysis, the results of which I intend to publish elsewhere, it appears that tubercule is formed by the reunion of particula

globules which have no existence in the animal economy in the healthy state. These particular globules become developed spontaneously in the bodies of animals that are placed under certain circumstances which will presently be more particularly alluded to. These globules unite and coalesce, and become destroyed by giving rise to secondary products, and to fresh organized globules; they invade every organ, but more particularly the more susceptible onesthose, in fact, of the most delicate structure, such, for instance, as the lungs.

If this opinion be admitted a priori, and its value is proved by subsequent experience, we are then naturally led to inquire after the cause or causes which place the animal economy in such a condition that the tubercular globule becomes spontaneously developed. If we are fortunate enough to discover the cause or causes, then all doubts as to the treatment ceases; it becomes then truly physiological.

The majority of those physicians who at the present day adopt an opinion analogous to the one I have just expressed on the nature of the tubercular affection will reply without hesitation. But the true cause of the disease is a particular diathesis; and to them, this word diathesis is something mysterious-something inaccessible to our researches. This habit of being contented with words is but too common in pathology, and is almost as dangerous as being in error.

If we apply this method to the study of phthisis, we at once find that the tubercular globule becomes developed in individuals that are reduced either by bad nourishment, or by the excessive, continued, and unrepaired loss of some fluid essential to the animal economy, such as the lymph and serum, from too abundant suppurations, or the spermatic fluid from venereal excesses, &c.

It will be perceived that the causes of debility which may bring about the spontaneous evolution of the tubercular globule are both complex and numerous. I shall not now attempt to touch upon all parts of this problem, which, indeed, is beyond my capabilities; but shall merely take a case that has fallen under my own observation, and follow, with regard to it, the plan I have described; the case in question is one of tubercular affection occurring in a diabetic patient.

On the connection which exists between Diabetes and the Tubercular Disease.

In all my writings on diabetes, I have alluded to the tubercular complication which has been very justly insisted on by several authors. In all the diabetic patients comprised in the first series of cases, on whom a post-mortem examination was made, and who did not die from any intercurrent accident, tubercles were found in the lungs.

I am convinced that many tubercular affections have originated in slight attact of diabetes which has been overlooked, and I cannot too strongly recommend medical men to carefully examine the urine of patients threatened with phthisis. By adhering to the rules I laid

down when speaking of "the means of detecting the presence of starch sugar in urine, and of measuring its quantity;" it is possible in many cases to ward off or arrest an affection which is so difficult to be overcome when once it has manifested itself. I will not quit this interesting subject, of the affinity between diabetes and the tubercular disease, without making a few remarks, the truth of which must eventually be proved in practice.

In the majority of cases, the truly positive ætiology of pulmonary phthisis is still enveloped in great obscurity. Of late years some very exact researches have been made which have been the means of proving, with great certainty, the existence of tubercles when they are present in the lungs. The Parisian school has brought the methods of percussion and auscultation to the utmost perfection. One may almost foretel the alterations that will be found on post-mortem examination. This part of the science, the results of which act on the minds of students, has been cultivated with so much spirit that physiological atiology, which alone can lead to a rational and really effectual mode of treatment, has, in consequence, been perhaps a little too much neglected. It is, no doubt, useful to be able to detect, either by the aid of instruments or by our own improved senses, those lesions which would escape a less practised ear; still it is of far greater importance to prevent them, and to stop, if possible, their progress.

The excellent understanding of a great number of celebrated physicians of our time has led them to abandon the uncertain doctrines of our predecessors, and to introduce into medicine the positive methods of the other sciences of observation. Great perseverance has been employed, not only to determine the physical alterations of the diseased organs or tissues, but also to find out the nature of these hidden alterations by means of a strict diagnosis; but, being unable to introduce into the research after the true causes this precision, the study of the nature of diseases has been repeatedly declared of but little importance, and those investigations which, in my opinion, can alone lead to a satisfactory mode of treatment, have been neglected. I am aware that these investigations are difficult, and that more than one false step has been made in this direction; but within the last fifty years sufficient progress has been made in both physics and chemistry to enable us to foresee the time when we shall be able to unravel the mysteries of many of the organic phenomena which have hitherto been considered as unfathomable. Medicine will never assume a truly scientific and exact character until, aided by physics and chemistry, it possesses positive data respecting the nature of diseases.

We will now attempt to handle the very difficult question of the physiological ætiology of the tubercular affection, and will proceed, as in the exact sciences, from the known to the unknown. We commence with the following principle, which may be considered as a law of pathology, viz:—

"When a patient, labouring under diabetes dies slowly from the constant progress of the disease without the occurrence of any other accident, tubercles are invariably found in the lungs after death."