176 NOTES AND ILLUSTRATIONS. 



long here testify. This has even been sensible to me, though I have been but about 

 twelve years in this country ; /, therefore, doubt not bat it will, in time, become one of 

 the most agreeable and healthy climates on the face of the earth. As it is at present, I 

 prefer it to the climates of England, and, I believe, most people that have lived any con- 

 siderable time here, and have returned to England, will confirm this." 



If the climate of New-York was formerly thus mild and healthy, and a constant ame- 

 lioration in its temperature is consequent upon our numerous settlements and improvements, 

 as has been maintained by many distinguished writers, to what shall we ascribe the extra- 

 ordinary mortality occasioned by pulmonary consumption at the present day? None 

 will deny this disorder to be influenced by climate, and independent of effects arising 

 from particular employments, and modes of living ; but we will, perhaps, find the most 

 satisfactory answer to this question, in considering phthisis in its various forms as the 

 offspring rather of increased dissipation, of great imprudence in dress, and of consequent 

 exposure (o sudden changes of temperature, than of any peculiarity in our climate and 

 seasons. 



This opinion of the origin of this disease is further confirmed, upon reflecting upon its 

 nature. Consumption is reckoned, by a practical observer, Dr. Hosack, who has devoted 

 a large share of attention to this subject, (Quarterly Reports on the Diseases of New- 

 York,) as being in a great majority of instances in its primary or forming stage, an in- 

 flammatory complaint, the effects of cold ; and as yielding to the treatment indicated for 

 the removal of inflammation, when affecting other parts of the chest. 



" We have, in many instances, employed blood-letting with the most happy effects, in 

 many cases of incipient phthisis, even where strong hereditary predisposition existed. 

 Indeed, we are induced, from some late observations on this subject, to express the 

 opinion, that in the commencement of phthisis, as in peripneumony, blood-letting is not 

 sufficiently employed, but is too frequently neglected until the inflammation has so far 

 extended that suppuration becomes inevitable. Nor do physicians, in general, appear to 

 have been sufficiently attentive in describing the symptoms characteristic of the first or 

 inflammatory stage of phthisis, and, consequently, have been regardless of that active an- 

 tiphlogistic treatment which alone can prevent the tuberculous or suppurative stage. In- 

 asmuch as suppuration, or a purulent secretion from the lungs necessarily implies preced- 

 ing inflammation, we conceive too early attention cannot be given to the premonitory 

 symptoms which announce the inflammatory stage, but which are frequently so inconsi- 

 derable, being seated in the less sensible, the cellular portion of the lungs, that both phy- 

 sician and patient are alike regardless of the present symptoms, and of the consequences 

 to which they lead. Instead, therefore, of trusting to sirups, anodynes, pectorals, or 

 ptisans, to allay the occasional dry hacking cough and pains of the chest, which indicate 



