The prominent feature and primary object of this essay has been, to establish the distinction between primary and secondary Phthisis Pulmonalis. Although, perhaps, the minute parts of the arrangement may not have been distributed, in every instance, with perfect accuracy, I feel confident that the general plan is correct. Farther observation and experience will probably suggest a more accurate disposition of the varieties of Phthisis, under the two orders which I have proposed. Probably from the want of the distinction between primary and secondary Phthisis, may be explained the various and contradictory practice, proposed by physicians of deserved eminence. A more frequent opportunity of observing one or the other form of the disease, has determined with each, his mode of treatment: and hence in diseases bearing the same name, we may see blood-letting and a rigid antiphlogistic regimen adopted by one party, and bark, iron, and a nutritious diet by another. Any error which may arise from these contradictions, may be corrected by the distinction, which has been proposed. It has also been my object, to call the attention of the practitioner, to the earliest symptoms and first dawnings of Consumption. Were they not so much neglected by the physician, as well as the patient, our bills of mortality would not continue to present so frightful a picture of the ravages of this disease; while, on the other hand, a prompt attention to these incipient symptoms, and the interference of an active practice, would afford a reasonable prospect of saving many from Consumption, who are now its victims. FOOTNOTES: [1] Amer. Med. and Phil. Reg. Vol. I. [2] Dr. Lettsom observes, that Consumption is decreasing in Great Britain. _Med. and Phil. Reg._ [3] The following judicious remarks on this subject are made by Bayle, in his “Recherches sur la Phthisie Pulmonaire, D’après la notion que j’ai donnée de la Phthisie Pulmonaire, on voit que je dois regarder comme Phthisiques des individus qui n’ont ni fièvre, ni maigreur, ni expectoration purulente: il suffit que les poumons soient affectés d’une lésion qui tend à les désorganiser et à les ulcérer. On ne doit pas regarder cette lésion une simple cause de la Phthisie, mais comme le premier temps de cette maladie, puisque la Phthisie est cette lésion même dont la continuation et le developement successif amènent la mort. Il seroit donc bien peu raisonnable de vouloir attendre, pour reconnoitre la Phthisie Pulmonaire, qu’elle fut constamment parvenue à son dernier degré qui est le moment où ses symptômes pathognomoniques sont bien marqués.” [4] Dr. Reid. [5] Dr. Hosack. [6] Dr. Lind states, that out of 360 patients whom he attended between July 1, 1758, and July 1, 1760, in consumption, the disease was brought on one fourth of them by falls, bruises and strains, received a year or two before it made its appearance. [7] Dr. Reid. [8]