the first to the second stage may be positively announced. (i.) If there be slight flattening under one clavicle, with deficiency of expansion movement, harsh respiration, and slight dullness under percussion, without the local or general symptoms of phthisis, the first stage of tuberculisation cannot be diagnosed with any surety, unless there be incipient signs at the left apex also; the conditions in question, limited to one side, might depend on chronic pneumonia or on thick induration matter in the pleura. (k.) The existence of limited though marked dullness under one clavicle, with bronchial respiration and pectoriloquy, so powerful as to be painful to the ear, the other apex giving natural results, will not justify the diagnosis of phthisis. I have known this combination when the apex of the lung was of model health, and a fibrous mass, the size of a walnut, lay between the two lamina of the pleura. I would even go farther and say, that the combination in question is rather hostile than otherwise to the admission of phthisis, as, had tuberculous excavation formed at one side, the other lung would, in infinite probability, have been affected in an earlier stage. (1.) Pneumonia limited to the supra and infra-clavicular region on one side, and not extending backwards, is commonly, but not always, tuberculous. (m.) Subcrepitant ronchus, limited to one base posteriorly, is not, as has been said, peculiar to tubercle; it may exist in emphysema, and in mitral disease. (n.) Chronic peritonitis, in a person aged more than fifteen years, provided cancer can be excluded, involves, as a necessity, the existence of tubercles in the lungs. To this law of Louis's it is necessary to add the qualification, provided Bright's disease be also absent. (o.) Pleurisy with effusions, which runs a chronic course in spite of ordinary treatment, is, in the majority of cases, tuberculous or cancerous; the character of the symptoms, previously to the pleurisy, will generally decide between the two. (p.) Double pleurisy, with effusion, is not, as has been said, significant of tubercle; for it may depend on Bright's disease. If the latter disease can be excluded, carcinoma and pyohæmia remain as other possible causes. (q.) If a young adult, free from secondary syphilis and spermatorrhoea, and not dissolute in his habits, speedily lose flesh without clear cause, he is, in all probability, phthisical, even though no subjective chest symptoms exist. (s.) But he is not by any means certainly so, for he may have latent cancer in some unimportant organs, or he may have chronic pneumonia. (t.) Nay, more, he may steadily lose weight, have dry cough, occasional diarrhoea, and night sweats, and present dullness under percussion, and bronchial respiration under both clavicles, and yet be non phthisical. I have known all this occur in cases, both when the lungs were infiltrated superiorly with primary encephaloid cancer, and when they contained secondary nodules of the same kind. (u.) Failure of weight becomes less valuable as a sign of phthisis, the longer the thirtieth year has been passed. (v.) The discovery of cardiac disease with marked symptoms, deposes against, but does not exclude the existence of active tuberculisation. (w.) The existence of cancer in any organ is unfavorable to the presence of tuberculous disease, but tubercle and cancer may coexist, even in the same lung. [Walshe on Diseases of the Lungs and Heart. New Journal. New candidates for favor are now so frequently springing up that it is a task to keep the run of them. We have hitherto failed to notice "The East Tennessee Record of Medicine and Surgery," a quarterly of 100 pages, published, under the auspices of the East Tennessee Medical Society, at Knoxville. It is edited by our friend FRANK A. RAMSAY, A. M., M. D., than whom Tennessee can boast of no more energetic, devoted or reputable practitioner. Dr. R. is already well known as a writer and an industrious as well as accurate observer in his profession. His bold and decided position in favor of progress and reform in American medicine should command for his journal the liberal support which we feel sanguine that it will merit as a record of valuable knowledge. We trust that it will never die of the prevailing disease-want of support. ERRATA IN MAY NUMBER. Page 246, line 13, for "local" read "vocal." Same page, line 28, insert "off" before "the." Same page, line 43, for "deliquiem" read "deliquum.” Page 247, line 2, for "typhus" read " "typhous." Same page, line 41, for "correspondents" read "readers." Same page, the paragraph ending at "avail" should end with the word "attack," in line 9, and “Cerebral Congestion" should be the head of the third class. PURE 888 Much of the Chloroform of commerce being very impure, and its use having in some cases been attended with unpleasant consequences, we have been repeatedly urged to make some at our Laboratory of a quality superior to that generally for sale in this market. We would, therefore, inform the Medical Profession, that we have prepared an article the purity of which can be implicitly relied on. NITRATE OF SILVER. Can also be obtained from us perfectly PURE, either in sticks or crystals, manufactured at our Laboratory. MORPHINE. Our Morphine having acquired a reputation superior to any other, those who have occasion to use the article will be satisfied of its excellence by giving it a trial. WE ALSO PREPARE THE SYRUP OF IODIDE OF IRON. Now so highly esteemed as a remedy in Scrofulous Complaints. These articles (which it is of the greatest consequence to Physicians to have of reliable quality) are, with our other Preparations, offered to the notice of those desiring We take this occasion to inform our friends and the public that we have, at great expense and much labor, laid in the fullest supply of materials for executing all kinds of PRINTING AND BOOK BINDING promptly, and on reasonable and satisfactory terms. The new" Code of Virginia," "Stethoscope," and the "Mineral Springs of Virginia," by W. Burke, M. D., present a fair specimen of the typographical capacity of our office, and we are prepared to execute all kinds of work in the same style. JOB PRINTING Of every description neatly executed, in VARIOUS COLORS, (Gold, Bronze, &c.) BLANKS For Lawyers, Clerks of Courts, Sheriffs and Constables, printed to order. BLANK BOOKS For Merchants, Clerks of Courts, &c. made to order, and ruled to any pattern. Old Books re-bound. PRINTING INK. News, Book and Job Ink of different colors and the finest quality, always kept on hand. Address tf RITCHIES & DUNNAVANT, ADIE & GRAY, APOTHECARIES AND DRUGGISTS, RICHMOND, VA., (SUCCESSORS TO ALEXANDER DUVAL,) Dealers in all kinds of Medicinal Preparations, English, French, German and American Chemicals of the most approved makers. Also, the well known Pharmaceutical Preparations of Herring & Brothers of London, Howard & Kent, Morson and others. Surgical and Dentists' Instruments, Paints, Oils, Dyes, Window Glass, Perfumery, Brushes, &c., &c. Physicians and others may rest assured that their orders will meet with prompt attention and be supplied with articles of unquestionable quality. ROBERT M'NAMEE, MAKER OF SURGICAL & DENTAL NSTRUMENT tf Asks the attention of Physicians and Dentists to his stock, which will be found to comprise all kinds of Dental and Surgical Instruments, Trusses, Cutlery, &c. He likewise makes to order and repairs all descriptions of Instruments. Thankful for the liberal patronage he has already received, he trusts to be able to merit a continuance of it, by increased business facilities, and a determination to give entire satisfaction to his patrons. tf We would call the attention of Physicians, Apothecaries and Druggists, to our list of Pure Extracts and Annexed Testimonials. TILDEN NEW YORK. And other varieties frequently used, as soon as they can be reached. Extract from a letter of Professor Clark, of the College of Physicians and Surgeons of New York, to the editor of the New York Journal of Medicine. "I have lately visited the manufactory of these extracts. After inspecting the whole process, and examining a large number of preparations, I became so fully persuaded that these gentlemen have fallen upon the best plan of concentrating and preserving the active principles, especially of the narcotic vegetables, that I have voluntarily offered to them any assistance that I can render in introducing their medicines to the notice of the profession; being persuaded that these extracts must possess the efficiency and the uniformity of strength so necessary to the successful use of this class of remedies, and, I may add, so long sought for in vain. "Should your conviction of the value of these preparations correspond with my own, after you have examined them and tried them in practice, perhaps you may think it due alike to the profession and to the gentlemen who are improving the instruments by which we work, to all the attention of your readers to the improvements which I cannot doubt this process secures." "Medical Society of the State of New York. "Resolved, That this society, having seen and examined, and several of them having used the various Vegetable Extracts made by Messrs. Tilden & Co., of New Lebanon, New York, and being satisfied of the valuable character of these preparations, hereby recommend them to the members of the profession generally. "P. VAN BUREN, Secretary. "Albany, February 6, 1850." Massachusetts Medical Society for the Berkshire District, Resolved, That this society, having seen from various sources entitled to respect and confidence, commendatory notices of the excellency and purity of the various medicinal extracts prepared by the Messrs. Tilden, of New Lebanon, New York, and having tested them and used them ourselves, do most cordially recommend them to the medical profession. H. H. CHILDS, President pro tem., And President of the Berkshire Medical College. For sale in Richmond, Virginia, by the Agents, PURCELL, LADD & Co., |