one author, Dr. Stokes (Op. cit. p. 481), so that, as he properly remarks, the probability of a cure, and the efficacy of remedies, is much greater than has been supposed.]

We now come to consider if there be any case so hopeless and desperate that we can promise ourselves no advantage from the operation: if such case there be, it is when there is extensive tubercular development in the compressed lung; but even here Laennec does not hesitate to recommend the operation, from his conviction of the curability of phthisis even when there exists unequivocal evidence of a cavity in the lung.

Mr. Crompton has had considerable experience of the operation for empyema and its results; and of ten cases upon which he has operated, three have been attended with complete success. After operation, his practice is to inject a weak solution of chloride of lime, which he finds to have the effect of diminishing the discharge and of correcting its character. (See EMPYEMA.)

in France; the request was granted on certain conditions, and one of the conditions required was, that from that time forward the men of Poland should keep their heads shaved. Casimir on his accession enforced the tonsure through all his dominions, and to the present day a part of the ceremony observed in assuming the national costume of Poland consists of, shaving the head, a single tuft of hair being left to grow from the top of the scalp after the manner of the Tartar and some Indian bes. The poorer inhabitants of Poland being wretchedly lodged and clothed, and exposed to the combined injurious influence of a marshy soil and a damp variable climate, the general cutaneous exhalation is at all times below the healthy standard, and the secretion from the scalp being still farther diminished by the custom of keeping the head shaved, there is, according to Schlegel, an increased compensating action thrown upon the bulbs of the hair which has been allowed to remain; and hence arises the greatly increased growth of this portion of the hair, and the unnatural quantity of viscid secretion which is at the same time thrown out.

The hair grows to a very unusual length, and being not only plaited but matted together by a viscid fatty secretion of an abominably fetid odour, resembling the stench of rancid fat, and in most instances crowded with vermin, presents an ex

We have remarked that the operation of tapping the chest is more likely to be successful in chronic than in acute pleurisy; that is to say, if an untoward combination of circumstances demands operation in the early stage of acute pleurisy, such operation is more uncertain in its result than the same operation undertaken in chronic pleurisy at a period equally distant from its commencement. This fact, established by ex-tremely disgusting picture of filth and disease. perience, we would account for in one of two ways; either that the constitution sympathises less, or suffers less irritation from the admission of air into the cavity of the chest, covered with a dense coating of lymph, as is the case in chronic pleurisy, than from letting in the same fluid upon the naked pleura unprovided with any such protection; or perhaps it may depend upon inferior susceptibility of inflammation in one case than in the other. In chronic pleurisy, the older the disease is, the less likely is the operation to be successful, because the more chance is there that the lung is disorganized; and the longer the lung has remained under pressure of the fluid, the less likely is it to recover its natural elasticity. The more circumscribed the pleurisy is, the more promising is the prospect of a successful operation.

For further information on the subject of the present article, we refer the reader to EMPYEMA, PERFORATION, PNEUMONIA, and PNEUMOTHO

The hair of the scalp is that generally affected, but the disease is also seen in the axilla, on the breast, and the pubes. In a few rare instances the nails are altered in their appearance, become livid or yellowish, long, and crooked, so as to resemble the talons of a bird of prey: this change is generally in the nails of the toes. The length which the hair sometimes attains is almost incredible. Cases are narrated of its reaching to the heels, of its being in such quantity and of such a length as to fall on the floor over all sides of the bed on which the patient lay. In the museum of Dresden there is a specimen preserved nine feet long. Not the least singular circumstance in the history of plica is the extraordinary attachment the Poles entertain for this dirty appendage. If the hair do not become spontaneously matted and filthy, the Poles spare no pains to make it so; the men'put on dirty fur bonnets which have become coated with viscid secretion from being worn by others who laboured under the disease, or they interlace with their own hair masses of old plica steeped in PLICA POLONICA, from plico, to knit to- beer! The women wear their hair very long, and, gether. This disease derives its name from the to encourage the growth of plica, refrain from manner in which the hair is plaited or matted combing it, and fasten it in knots, and make it together, and, as its name also implies, is of most adhere by glue or rosin. They will for years frequent occurrence in Poland. It has, however, willingly suffer the greatest torture in carrying or been also observed in Tartary, among the Cos- dragging after them a mass of this matted hair, sacks of Russia, in Hungary, and in a few in- and beggars who are fortunate enough to possess stances in Switzerland and France. The people a good plica cherish it with the greatest care as of Poland believe that it was carried into their the most certain means of obtaining alms. In country by the Tartars in the twelfth or thirteenth some parts of Poland the lower classes look upon century. Schlegel, a physician practising in Mos-plica as a special favour from Providence, which cow, who published a work on plica in 1806, will preserve them from harm and sickness; in gives a singular account of its origin. The Poles on the death of one of their kings, Miceslas II. in 1034, petitioned Pope Benedict the Ninth to release from his vows Casimir the son of Miceslas, who had entered into a convent of Benedictines

BAX.

ROBERT LAW.

other parts it is viewed as an infliction coming from a malignant spirit, but not the less cherished, as it is then considered a protection from all other misfortunes. Lafontaine, a physician resident in Warsaw, who published a work on plica in 1792,

relates the case of a pregnant woman who had plica of four months growth on the pubes: during that period the urine was allowed to filter through the matted hair, and after labour commenced she could not be persuaded to permit the plica, which firmly resisted the protrusion of the child's head, to be incised, until her life was in the most imminent danger.

The prejudice in favour of plica is extended even to inferior animals. Horses presenting an appearance of the disease are valued beyond others, and hence the jockeys of Poland have learned to add another to the many arts practised by their brethren of other countries. It is said that in Poland, and in some parts of Russia, plica is occasionally observed in sheep, dogs, wolves, and foxes.

fant, and Robin, surgeon to Frederick the Great, who relates the following experiment. He shaved the heads of two boys on whom the disease was just beginning to appear, and then paid particular attention to the hair during its growth. His attention was in vain, for the disease re-appeared. Schlegel agrees with Lafontaine and Robin; and more lately among foreign physicians, Chaumeton and Mouton, who were attached to the French army when in Poland during the late war, hold the same opinion. It is further argued in support of their view, that if plica owed its origin merely to want of cleanliness, it would not be confined to Poland, but should be equally found among the Russian, Prussian, and Spanish peasants, who are as dirty in their habits as the lower classes of Poland; that its appearance frequently constitutes the marked crisis of some other disease; that it is accompanied with a peculiar secretion; that the nails, which are known to be merely a variety of the same tissue as the hair, are in bad cases engaged by a similar diseased action; and that the bulbs of the hair exude a peculiar viscid secretion, and are found swollen and acutely sensible. In conclusion, it is asserted that plica cannot be sud

The physicians of Poland have not escaped the contagion of prejudice. Kerckhoff, whose observations were made during the stay of the French army in Poland, relates a case illustrative of this. The patient, a boy of about fifteen years of age, complained of severe pains of his head. He lay in a most filthy state, and his black hair, knotted long and matted together, gave out an intolerable stench. The Polish physician in attend-denly removed without great danger to the paance strongly opposed Kerckhoff's suggestion of tient. On the other hand, Davidson, a Scotchcutting off the hair, on the ground that the hu- man, who was physician to one of the kings of mour exuded on the hair might turn in on the Poland, published a work in 1668, in which he brain and cause apoplexy. Kerckhoff entered pithily observes of the disease, "Nullus habet, into a compromise with the Polish doctor; and nisi qui non velit carere," and declares that he the hair was cut off in portions of two fingers' treated and cured more than 10,000 cases; that breadth at intervals of two and four days. In he always, without hesitation, cut off the plice, twenty days the whole scalp was cleared, and and that no injurious consequences supervened. then, by simply keeping the head combed and Larrey, Chamsern, Gasc, Kerckhoff, &c., who had washed, all the bad symptoms vanished. opportunities during the late war of investigating the disease in Poland, support the opinion promulgated so many years since by Davidson, and assert with him that the fear entertained of cutting off plica is a mere chimera. In support of their opinions they point to the facts, that Polish recruits are always cured by their hair being cut and their habits changed after their entrance into the army; that the disease is almost invariably confined to the lowest classes, and principally to the Jews, who form an immense proportion of the population of Poland, and are universally acknowledged to be the filthiest people on the face of the earth. They further state that strangers residing in Poland never contract the disease unless they sink so low as to approximate to the natives in manners and dirt, and that the disease is disappearing just in proportion as improved habits and comforts are extending; moreover, that in cutting off a plica, as in the case related by Kerckhoff, and which we have already noticed, the aggluti

Stories are related by some writers of the disease appearing very suddenly, and the hair preserving for years the particular form of dressing it possessed at the time of the seizure. These stories are, however, treated as fables by the best informed authors; and a statement generally made and believed in Poland, that the long hairs of plica are acutely sensible, and are the seat of great pain when touched, is equally void of foundation. In some instances the bulbs of the hair and the scalp are very sensible, owing to irritation, and pulling the hair ever so slightly gives acute pain; but Larrey and all modern observers positively assert that the hair may be cut at any part without causing the slightest pain, provided it be done without dragging the bulbs.

Pathology. On the nature of plica the most opposite opinions are entertained. By some it is pronounced as a disease “sui generis," having its seat essentially in the bulbs of the hair, and requiring very cautious treatment. Others as stoutlynated hair is found distinct and round at the roots. assert that plica is merely the product of neglect and dirt, and that it requires for cure nothing but the shears and cleanliness. This difference of opinion is not alone between foreign observers and the physicians of Poland, but the latter themselves are divided on the question. Among those who hold the first opinion are Lafontaine, who asserts that he saw the disease in a new-born in

* Observations Médicales pár Jos. Rom. Louis Kerckhoff, Doctor en Médecine-Médecin de l'Armée des Pays Bas, &c. Published in vol. vi. of Medical Transactions af College of Physicians in London.

To the last argument it is replied, and with justice, that the diseased action which produced the plica having ceased, the hair which has continued to grow will after a little time have pushed out from the scalp the agglutinated mass of hair, and hence that the soundness of the hair at the roots is no proof that diseased action had not previously existed. Larrey is further of opinion that the urgent symptoms, as pains in the bones, joints, &c., which occasionally precede or accompany plica, owe their origin to a complication of syphilis. Jourdan, the translator of Schlegel and Lafon

sensibility of the hairy scalp, followed by a copious secretion of a peculiar viscid sweat, of the consistence of honey, which speedily glues the hairs together. On the appearance of this secretion, the previous symptoms disappear. It is said in Poland that one of the most usual forerunners of an attack of the disease is a perverted appetite, and hence there is a saying, "Sæpe sub plica, latet seu fœtus seu plica." Of all the symptoms, however, none give a certainty of the approach of the disease except the breaking out of the viscid sweat. Cases are given by Alibert, Lafontaine, Schlegel, &c., of plica appearing as a crisis of, or alternating with internal diseases; according to their accounts, the internal affection was alleviated when the plica secretion was abundant, and vice versa. When the hair is cut very close, in what we may call true plica, a brownish fluid frequently exudes from the bulbs of the hair, and the appearance of this fluid has given rise to the belief that the hair poured out blood.

taine's works, and the writer of the article | lent itching sensation of pricking, and increased Plique" in the Dictionnaire des Sciences Médicales, suggests that there should be a distinction made of plica into true and false; true plica being that form of the disease described by Schlegel, in which the bulbs of the hair are inflamed, become enlarged and acutely sensible, produce a rapid growth of hair, and at the same time glue it together by a peculiar secretion which is poured out from the skin and the hairy bulbs, and even forces its way through the substance of the hair near the skin. False plica Jourdan considers as a mere accidental matting of the hair, dependent altogether on external causes. This view would probably reconcile many of the conflicting statements, but even in our investigation of the nature of what, according to this classification, we may call true plica, we meet with great difficulties. We have not information before us sufficiently accurate to enable us to say what is the precise source of the fetid secretion which glues the hairs together, -whether it is poured out by the bulbs of the hair, the sebaceous follicles, or the general surface of the skin. The surface of the skin where the hair is affected is described as being in a state of ulceration in some cases, but this may be an effect of the state of the hair rather than a cause of it; and finally, the state of the scalp may, for aught that we yet know, arise from the presence of some ordinary eruption, the matting of the hair and the viscid fetid secretion being complications added by the influence of extraneous circumstances. Lafontaine asserts that hair presenting shades of red is more liable to plica than hair of other colours, but Schlegel states that he never observed any difference of liability arising from colour..

Alibert makes three subdivisions of plica, according to the form it may chance to assume. He calls his first species "plique multiforme," where the hairs form a great number of ropes, hanging round the patient's face like serpents round the Gorgon's head; his second species, "plique à queue, ou solitaire," in which the whole hair is united into one long plica or tail, principally met with among females, and on those wearing their hair after the national Polish fashion. He calls his third species "plique en masse, ou larvée," in which the hair is all melted into one cake, covering the head like a helmet. These subdivisions are, however, useless; for the varied forms which the hair assumes, appear to be merely the result of external accidental circumstance.

The people of Poland believe that plica is contagious, but there does not appear to be satisfactory ground for this belief. Kerckhoff inoculated children and himself with the viscid secretion, and failed to propagate the disease; and Davidson, who had ample experience, is also a disbeliever in its contagion. Alibert, on Robin's authority, states that a Polish nobleman who kept a seraglio, of which four of the inmates had plica, never contracted the disease. On the other side, Lafontaine and some of the French observers of plica believe that it is a contagious disease.

Symptoms. The premonitory symptoms of an attack of plica, according to those who look upon it as a peculiar disease, are pains in the back and limbs, vertigo, lachrymation, with vio

Treatment. The directions for treatment, of course, vary as much as the opinions on the nature of the disease; those who look upon the disease as the product of dirt, directing us to cut off at once without dread the matted mass, and afterwards trust for a cure to soap and combing; and on the other hand, those who see in the cutaneous affection the elimination from the system of a poison, which they call "virus trichomaticus," warn us in the strongest language not to meddle, lest we turn the poison back on the brain or lungs, &c. Lafontaine extends the supposition of the existence of a peculiar virus so far as to direct us, when any symptoms appear which we suspect are premonitory of the approach of plica, to hasten its appearance by warm cataplasms, sinapisms, &c. to the scalp. Under whatever view we regard the disease, the supposition of the existence of a virus is a mere assumption, and the advice to force the eruption is only an illustration of the prevalence of the same bad principle which of old so erroneously directed us to force out the virus of other eruptive diseases, as small-pox or measles. Mouton, to whose opinions we have already alluded, says we may without fear cut off plica if it be dry, and if it be united to the scalp by hair sound near the roots, which he says indicates that the diseased action which had produced the plica had ceased; but that we ought not to interfere as long as the bulbs of the hair are inflamed and sensible, and continue to pour out a viscid secretion, keeping the hair matted at its roots.

Various remedies are recommended in Poland. Lycopodium is much used by the people, who use it both as an external application and an internal medicine; but there does not seem to be any settled rule or principle of treatment. Preparations of mercury, antimony, sulphur, zinc, baths, emetics, diaphoretics, and narcotics, have all in turn been recommended. Among these, the golden sulphuret of antimony is probably the remedy on which most reliance is placed. Patients who are debilitated or advanced in life require, it is said, the administration of tonics; and it is scarcely requisite to observe that an occasional application of strong mercurial ointment to the hair is requisite to destroy the vermin,

PNEUMONIA, (πvevpovía); peripneumonia, or peripneumony, (пeginvevpovía); pneumonitis, pulmonitis, peripneumonia vera, (from τvévμwv,ovos, pulmo, a lung, or the lungs ;) are names given to an inflammation of the parenchyma of the lung, which is the most common of all the dangerous inflammations.

Peripneumony and pneumonia are the names applied by Hippocrates, Aretæus, Celsus, and other ancient writers on medicine, to most of the acute diseases of the chest without severe pain; those connected with this symptom being termed pleurisies. Many succeeding authors have not admitted this distinction; and inflammations of the lung have been as often described under the name of pleurisy as under that of pneumonia. The earlier cultivators of morbid anatomy, Valsalva and Morgagni, were the first to prove the distinct existence of the two diseases, but they gave no means of distinguishing them before death. Hence Cullen, although he makes pleurisy a species of the genus pneumonia, expresses his belief that the term pleurisy might with propriety be applied to every case of the disease. It is only through the aid of auscultation that pneumonia and pleurisy have been recognised as distinct diseases, and it is therefore only in the writings of those who have employed this method of diagnosis that the truly distinctive characters of pneumonia can be found.

cally, therefore, pneumonia consists essentially of an inflammation of the parenchyma of the lungs, occasionally but not necessarily extending to the pleura investing them; which inflammation, although it usually occasions a certain combination of general symptoms, is not so essentially connected with these symptoms as to receive from them an infallibly pathognomonic character.

The pathological and anatomical characters of pneumonia, as well as its relation to general symptoms, have been industriously and successfully investigated by the French pathologists, particularly by Laennec and Andral; and it is to them we owe the most important matter of the following history. Andral calls the disease pleuro-pneumonia, from the circumstance of some part of the pleural covering of the lung being involved in the inflammation: we do not deem it necessary to deviate from the example of Laennec, who confines this term to that form of the disease in which the pleura is affected in a sufficient degree to modify the pulmonary inflammation. This will be noticed among the complications of the disease.

I. GENERAL HISTORY OF PNEUMONIA. Symptoms.-Like other severe inflammations, pneumonia is accompanied by a pyrexia, which often commences in a rigor, prior to any other symptom. Sometimes this shivering fit does not occur until after the establishment of pain, dyspnoea, and other symptoms; and in some cases, especially where the pneumonia succeeds to a bronchitis, or when the first attack is felt in bed, it is not observed at all. Frequently, a feeling of great depression and languor, with pains in the back and limbs, and a disordered state of the stomach and bowels, precede the attack; then a shivering fit comes on, followed by a violent reaction, with great heat of the skin, and during this hot stage the local symptoms of heat, pain and oppression in the chest, with more or less cough, are developed. The pyrexia is generally very intense, and in plethoric individuals is accompanied by great flushing of the cheeks, injection of the conjunctivæ, headache, and other signs of local determination of blood. This general fever may precede by a day or two the local symptoms, some times diminishing in intensity when they appear; and sometimes continuing and masking them. The pain in the chest, which when present is generally an early symptom, varies greatly in degree, being sometimes very intense, sometimes diffused and dull; frequently it is a deep-seated feeling of heat and weight rather than of pain. Most commonly it is deep-seated in the anterior parts of the chest, below the sternum or below the mamma, sometimes under the scapula; acute pains are more common in either of the sides. Andral The following is the character which we says that there is never any pain without an exwould give as most generally applicable to pneu- tension of the inflammation to the pleura; (Clmonia :Fever, with more or less pain in nique Médicale, tom. ii. p. 327 ;) Laennec asserts, some part of the chest; accelerated and some- on the contrary, that there is frequently pain, and times oppressed breathing; cough, with viscid sometimes a point of sharp pain when no pleurisy and rusty-coloured expectoration; at first the is present, (De l'Auscultation Méd. tom. i. p. 432;) crepitant rhonchus, afterwards bronchial respira- this is more in accordance with our own observation, and bronchophony, with dulness of sound tion, and it is remarkable that in several of the on percussion in some part of the thorax. In cases described by Andral, where there were varithis, however, as in many other diseases, patholo- ous degrees of pain, no mention is made of any gy is the only sure basis of definition: pathologi-inflammatory appearances on the pleura on ex

Cullen's generic definition of pneumonia more frequently holds good than his specific distinctions, on the correctness of which, as we have just remarked, he does not insist. Fever, pain in some part of the chest, difficult breathing, and cough, which he ascribes to the genus pneumonia, are, in the greater number of instances, present in both pleural and pulmonary inflammation; but there are cases of both kinds in which each of these symptoms is absent. The specific definitions of pleurisy and pneumonia are still more frequently at fault; thus the softer pulse, duller pain, constant dyspnea, and livid face, are as much the characters of severe bronchitis as of pneumonia, to which he ascribes them; and the hard pulse, acute pain, increased on inspiration, painful decubitus on the affected side, painful cough, first dry, and afterwards with expectoration, often bloody, the assigned characters of pleurisy, indicate pleuro-pneumonia as much as pleurisy, and are sometimes presented by bronchitis or peripneumony joined with pleurodyne.

bronchial membrane. This new feature added to the other symptoms is quite characteristic of the disease. The dyspnoea is frequently increased at this period, the inspirations being obviously short and quick; and if the disease is extensive, oppression becomes very urgent. The pain, on the other hand, is commonly diminished; sometimes it remains and prevents the patient from lying on the affected side. The most common posture is therefore on the back, as lying on the same side would restrain the supplementary expansion which is required there. Often connected with this posture, one of the cheeks is flushed, but there is no constant correspondence, as Dr. Stack has observed, between this and the side affected.

amination after death. (Op. cit. obs. 29, 38, 43, | appearance. The colour may vary in numberless 46.) There is commonly a cough at this time, gradations from a light reddish or greenish yellow which aggravates the accompanying pain, or to a deep orange red or rusty hue. All these causes a feeling of pain when none is otherwise tints proceed from various proportions of blood present. It is generally at first either dry or ac-intimately combined with the secretion of the companied with simple catarrhal expectoration, and short, not occurring in paroxysms, and is by no means proportionate to the intensity of the inflammation; it is sometimes so slight as scarcely to be noticed by either patient or attendants. The shortness of breathing or dyspnoea, which is commonly an early symptom, is a better measure of the extent and severity of the disease; but we should be mistaken if we always trusted to the feelings of our patients as to its presence or degree. In its slighter degrees they are not sensible of it, a supplementary quickness of breathing removing the sensation of dyspnoea; but an attentive observer readily discovers this quicker and shorter respiration, and the more perceptible elevation of the ribs and depression of the diaphragm that attend it. The number of respirations in a minute, which is in health about twenty in the adult, may now be counted at thirty and upwards, and in severe cases it occasionally exceeds sixty. In some examples, especially where the attack has been sudden, the dyspnea is greater and more obvious, causing the patient to assume one particular posture, on his side, or on his back with his shoulders elevated; and from their sensibly increasing his oppression, he avoids all exertions of movement and speech; this difficulty of breathing continues to increase as the disease advances. The pulse is quick, and in most instances sharp. With respect to its hardness, it is subject to great diver-lioration is a speedy process, and restores the pasity, but in many cases it is (notwithstanding Cullen's definition) both hard and full at the commencement of the disease. This character, however, rarely continues long, and often the pulse is weak and small from the beginning. Under the febrile excitement the urine is more highly coloured than in most other symptomatic fevers; and there is more or less of the thirst, white or brown fur on the tongue, loss of appetite, pain in the head and limbs, depression of the strength, &c., than usually characterize them, and blood drawn generally exhibits a buffed and concave crassamentum. This fever may affect particular organs especially, with the production of other symptoms; as the brain with delirium, the stomach with sick-cases manifests itself on the third or fourth day by ness, &c.; but these complications will be better considered hereafter.

The symptoms usually continue in this state from twenty-four to forty-eight hours. At a period varying within that space, the cough, which was hitherto dry or with the expectoration of common bronchitis, becomes accompanied by the expectoration of a very characteristic kind of sputa. They are of a yellow-reddish or rusty tinge of various shades, semi-transparent, tenacious, and running together into one mass. At first this expectoration scarcely exceeds the tenacity of the white of an egg, resembling in all but its colour the sputa of acute bronchitis, and, when poured out, falls in glutinous strings; but it often becomes so viscid that inverting the vessel and even shaking it in that position will not detach it. The same tenacity sometimes imprisons in the mass a multitude of little air-bubbles, which may produce a spumous

The disease may go on in favourable cases to the third or fourth day, and then decline in consequence of the resolution of the inflammation, which is indicated by a general alleviation of the symptoms. The pain and dyspnoea are considerably relieved; the cough becomes looser and less distressing; the expectoration less viscid and rusty-coloured, more abundant, and resembling the sputa of bronchitis. The pulse loses its sharpness, and more gradually its frequency; the skin becomes cooler, and sometimes moistened with perspiration; the urine is increased in quantity, and deposits a sediment. Sometimes this ame

tient to a state of convalescence in six or eight days; but it is sometimes more protracted, slight exacerbations recurring every evening, and some of the symptoms remaining stationary, and extending the duration of the disease to a fortnight or three weeks. The quickness of the pulse, and dyspnoea, sometimes, with cough, are the symptoms most apt to linger, with a temporary recurrence of the sanguinolent tinge of the sputa; and although there is a great improvement in other respects, they are to be regarded as signs of a lurking disease which a slight cause may be sufficient to aggravate into a severe relapse.

The increase of the disease in more formidable

an augmentation of the dyspnoea, which becomes so urgent as to oblige the patient to have his head and shoulders raised; and the inspirations short, forced, and amounting to from forty to sixty in a minute, are effected by sudden elevations of the ribs and depressions of the diaphragm; in some cases the side not affected obviously partaking disproportionately in the respiratory effort. The cough is sometimes more frequent, but this is not constantly present in aggravated cases. The viscidity and colour of the expectoration more exactly correspond with the increase of the disease; the tenacity reaches its acmé, so as to adhere strongly when the vessel is inverted, and even shaken in that position; and the colour is more deeply tinged with blood. The pulse becomes quicker, and often weaker and smaller. There is great depression of the bodily powers; and the patient's attention is engrossed by efforts to breathe under