ABNORMAL FORMS OF NUTRITIVE PROCESS TUBERCULOSIS. 463 



the recovery of the organization proper to the part is more completely ef- 

 fected. 1 



;!78. In persons of that peculiar constitution, which is termed Scrofulous 

 or Xfrnuinttx, we find an imperfectly organ izable or cact>ji/it.<fic deposit, known 

 by the designation of Tubercular matter, frequently taking the place of 

 the normal elements of tissue; both in the ordinary process of Nutrition, 

 and still more when Inflammation is set up. A distinction must be drawn 

 between the condition known as acute Tuberculosis and Phthisis, the latter 

 being only one of the manifestations of the former. In Tuberculosis the 

 adenoid tissue so extensively distributed through the body takes on new 

 growth ; the cells of which it is composed proliferate, and swellings and 

 thickenings of the tissues composed of small cells and nuclei appear. In 

 the latter stages, the cells are often separated by an amorphous or somewhat 

 fibrous intermediate substance, and by their multiplication and pressure lead 

 to occlusion of the vessels, and their own caseous degeneration and softening. 

 The history of the formation of Tubercles in the lungs and other organs is 

 essentially similar ; it appears, in the first instance, to be a kind of metamor- 

 phosis of the ordinary Nutritive process; and in this manner it may proceed 

 insidiously for a long period, so that a large part of the tissue of the lungs 

 shall be replaced by tubercular deposit, without any other ostensible sign 

 than an increasing difficulty of respiration. In the semi-transparent, mil- 

 iary, gray, and tough yellow forms of Tubercle, we find clear evidence of 

 organization in the early stages in the form of cells and fibres, more or less 

 obvious ; these being sometimes almost as perfectly formed as those of plastic 

 lymph, at least on the superficial part of the deposit, which is in immediate 

 relation with the living structures around ; whilst they may be so degenerated 

 as scarcely to be distinguishable. In no instances do such deposits ever un- 

 dergo further organization ; and therefore they must be regarded as cacoplas- 

 tic. The larger the proportion of this kind of matter in a tubercular de- 

 posit, the more certainly does it compress the bloodvessels of the part, and. 

 by cutting off the supply of nourishment lead to its own death, and conver- 

 sion into cheesy matter, the surrounding lung-tissue almost always under- 

 going more or less fibroid change. Thus it may now be held as established 

 with certainty that Tubercular matter is always, even in its most amorphous 

 state, a product of cell-formation ; and that the difference between the amount 

 of organization which its several forms present, is due rather to a variation in 

 the degree of its subsequent degeneration, than to an original diversity in 

 histological condition. 2 



1 The Author has pleasure in referring to Mr. Paget's Lectures on Surgical Pathol- 

 ogy (veil, i), as containing, in his opinion, the best exposition of the subject of In- 

 flammatinn yet made public ; and in acknowledging his obligations to them for much 

 assistance in the short view of it given above. The fundamental doctrines on which 

 the Author would lay the greatest stress, however, are the same in all essential par- 

 ticulars with those which he taught in the earlier editions of this Treatise. An ex- 

 cellent account of the general phenomena and pathology of Inflammation has been 

 written by Mr. Simon in Holmes's System of Surgery, vol. i, p. i. The interesting 

 paper of Mr. Lister, On the Early Stages of Inflammation, in the Philosophical 

 Transactions for 1858, will also well repay perusal. The work of "Virchow, Cellular 

 Pathology, translated by Dr. Chance, contains a full account of the views of this 

 author on the pathology of Inflammation. (See chaps, viii and xvii.) 



2 See Mr. Paget, in the Pathological Catalogue of the Hunterian Museum, vol. i, 

 p 134; also Dr. Madden's Thoughts on Pulmonary Consumption. The subject of 

 the nature and affinities of Tubercle will be found interestingly given by Dr. Southey, 

 in the Gulstonian Lectures for 1867 ; and the question of its inoculability has been 

 the topic of discussion in the Parisian Academy of Medicine for nearly two years 

 past. Although it can be scarcely said that any definite conclusion can be drawn, 

 the preponderating opinion appears to be in favor of its inoculability, especially in 



