symptoms, which taken together are typical of phthisis. In later stages there are recurrent paroxysms of fever called "Ilectic," and profuse sweatings. The disease is very wide-spread in this country, and exceedingly fatal.

Acute pneumonic phthisis.—A condition in which pneumonia, -inflammation of the structure of the lungs,-is developed, in its acute forin, in persons susceptible to phthisis.

Chronic pneumonic phthisis.-A condition in which chronic pneumonia is developed in the same constitutions.

Acute miliary phthisis.-A condition in which there is development or deposit in the lung of a tubercular material of a miliary character, resembling millet seed and widely distributed.

True tubercular phthisis.-A condition in which the ordinary form of tubercular substance is deposited in the lung in small separate masses, tubercles, which become centres of irritation, inflammation, and suppuration, followed by destruction of tissue, and cavities.

Industrial phthisis.-A condition in which the mischief in the lung structure, leading to phthisis, is produced by inhalation of substances to which persons following particular industries are subjected. Millstone dust, coal dust, flax dust, give rise respectively to millstone workers' phthisis, miners' phthisis, flax-dressers' phthisis.

Alcoholic phthisis.-The consumption of drunkards. A definition, first applied by myself, to a form of phthisis peculiar to some persons who indulge freely in alcohol. As a rule it occurs after middle age.

શ્રી

The various conditions leading to pulmonary phthisis fill up one of the greatest chapters in the history of disease as a whole, and the greatest of all the chapters in the local history of pulmonary diseases. Of all the organs of the body the lungs are most open to invasion of disease from causes operating both from within and without the body; and as in respect to every one of the phthisical maladies the hereditary law of descent is maintained, the lungs are, taking all in all, the organs most liable to the acquired as well as to the inherited types of the malady.

DISEASES OF THE PLEURA.

The pleura is the thin, elastic, semitransparent membrane which can so easily be stripped from the surface of the lungs. It envelops each lung as in a serous bag or sac, which is reflected

on to the inner walls of the chest, covering them, and which between its two surfaces produces a serous fluid for preventing friction or adhesion.

The pleura is liable to several varieties of local disease.

Pleuritis. Inflammation.

Inflammation of the pleural membrane in whole or in part is called pleuritis. The inflammation may be acute or chronic. In the acute form it is marked by fever, and by great pain in breathing. The membrane is injected, inflamed, and extremely sensitive, being brought in the act of breathing to rub on adjacent structures. In the chronic form the symptoms are modified and prolonged, but the pain in breathing remains exquisitely acute when a deep breath is fetched, or when cough is severe. risy, acute and chronic, is most apt to occur in persons of rheumatic and gouty constitution. It may exist as an independent affection, but is more frequently connected by sympathetic or organic influence with some other affection of the lung. It is a frequent complication of the other acute diseases of the lungs.

Етруета.

Pleu

Empyema is an accumulation of purulent fluid or matter in the cavity of the pleura; that is to say, between the two layers of the pleural membrane. Practically, it is an abscess of the pleural cavity, resulting from inflammation, and from the inflammatory products thrown out during the inflammation.

Adhesion, Thickening, and Ossification of the Pleura. Adhesion means the uniting together of portions of opposing pleural membrane which, in the natural state, would glide smoothly over each other with perfect freedom. Thickening means an enlargement, from deposit of plastic exudative material on the membranous structure, in patches or over the whole surface. Ossification is a transformation of a part of a pleural surface into hard structure, from calcareous or any deposition.

Hydrothorax. Dropsy of the Pleura.

Hydrothorax is an accumulation of watery or serous fluid in the cavity of the pleura. It is usually the result of inflammation, but sometimes is due to venous obstruction. The fluid may in

crease until it fills the cavity, presses on the lung of the affected side or on both lungs, and even displaces the heart itself.

Pneumothorax.

Pneumothorax is a condition in which air has entered, and partly occupied, the cavity of the pleura. The accident sometimes occurs from rupture of the vesicles of the lungs together with the pleural covering of the lungs. At other times it is from an injury to the chest, as from fracture of a rib. In very rare instances it is from gases developed in the blood.

The pleural membrane may also be the seat of cancer, simple tumor, tubercle, and parasitic growths.

DISEASES IN THE MEDIASTINUM.

The space between the lungs, formed by the two pleural membranes which cover the lungs, and called the mediastinum, is sometimes a point in which local disease is manifested. Three such forms of manifestation are recorded.

(a) Abscess, or accumulation of purulent matter.

(b) Cancer, or formation of malignant tumor.

(c) Simple tumor, or growth of tumors which are "non-malignant," not cancerous.

OTHER PULMONARY AFFECTIONS.

The lungs, finally, are liable to become the local seats of cancer and of parasites. They are subject to mechanical injuries from without, wounds; to impactions from inhalation of solid foreign materials; and to injuries from inhalation of corroding and irritating gases or vapors.

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CHAPTER V.

LOCAL DISEASES OF THE NERVOUS SYSTEM.

In the nervous system the parts and organs subject to disease are the brain and its membranes; the spinal cord and its membranes; the nervous cords and their peripheral surfaces; the ganglia and nerves of the sympathetic chain.

The diseases of the nervous system are divisible into those which are functional and those which are organic. In fact, no diseases are so distinctly divisible into the two forms of functional and organic as those affecting this system of bodily organs.

It is always most difficult during life for the physician to make an absolutely correct diagnosis, or finding out, of either the acute or chronic diseases of the different parts of the brain and its membranes. The parts lie in close proximity; the sympathy between them is most intimate; and, the direct physical examination of them is impossible. It has therefore been necessary to invent a terin that shall include in a word any one, or more than one, of the individual inflammatory diseases of the parts enclosed within the skull, and that word is Encephalitis, inflammation of the brain or its membranes.

At the same time the different parts, as examination of them in post-mortem inquiries have demonstrated, are the special seats of acute inflammatory diseases and of other resultant or degenerative changes.

DISEASES OF THE MEMBRANES OF THE BRAIN.

The membranous coverings of the brain and spinal cord are subject to both acute and chronic diseases.

Acute Meningitis. Brain Fever.

The old physicians gave the name of brain fever to a condition of disease which we moderns call acute meningitis, or inflam

mation of the membranes of the brain. The dura mater, the firm external fibrous covering of the brain, is the part most frequently affected, but the irritation which is set up usually extends deeper, to the more delicate membranous structures beneath, the arachnoid and vascular pia mater. The disease is extremely serious, is attended with a high degree of fever, with extreme pain in the head, and with violent, often furious, delirium. It lasts for many days, and when recovered from often leaves permanent evidence of failure of nervous power. As an uncomplicated disease it is exceedingly rare.

Membranous Vascular Congestion.

The vascular membrane of the brain, the pia mater, may be the seat of extreme congestion. This is common under alcohol, and is a cause of the excitement which is present in that form of alcoholic poisoning known as delirium tremens. In one instance in which a man while in this state committed suicide by casting himself under a railway carriage, I saw the brain within four minutes after death, while still the fumes of whiskey were most readily detectable from it. The pia mater was injected to the extremest degree, lying like a velvety pile over the brain, and within the convolutions. In such examples the membrane, after many excitements, becomes firmly attached, in parts, to the substance of the brain.

Tubercular Meningitis.

In children and young persons of scrofulous or tuberculous constitution, the membranes of the brain are apt to become the seats of tubercular deposit from the blood. The deposition takes place, as a rule, beneath the dura mater, between it and the arachnoid; but I have seen it also in the upper surface of the membranes, between the dura mater and the inner lining, or periosteum, of the skull. Purulent matter may form with this exudation. The symptoms of the disease are practically those of brain fever, and the malady is usually fatal. It is a more frequent form of disease than simple acute meningitis, and it is followed in some instances by effusion of serous fluid and dropsy of the membranes of the brain, "Acute hydrocephalus.”