1G2 



Hints on the Pathology, Diagnosis, Prevention, and Treat- 

 ment of Thoracic Consumption. By J. C. Hall, M.D. 

 London : Longmans. 



In the ordinary course of noticing works interesting to 

 those who use the microscope, we are not often called on to 

 bring before our readers works devoted to the practical 

 departments of medical science. At the same time, we are 

 convinced that this does not arise from any deficiency in the 

 microscope; but from the want of skill in the use of it 

 amongst those who practise the medical profession. In an 

 art so dependent on a correct appreciation of facts only 

 known to exist by sight, it must be evident that the mi- 

 croscope will become essential to all conclusive investiga- 

 tions, and that scarcely any correct diagnosis will be made 

 without its aid. We notice, therefore, Dr. Hall's book, 

 because in the first place we think he has made good use of 

 the microscope in the diagnosis of disease, and in the second 

 place because he has been kind enough to put one of the 

 plates, illustrating his work, at our disposal (PI. X.) We shall 

 not, however, criticise Dr. Hall's book, but let him speak for 

 himself on the subject of the use of the microscope in the 

 diagnosis of tubercle. He says : 



" Since the publication of the former editions of this work the microscope 

 has thrown no little light on the true nature of tubercle, which may, in 

 almost every instance, be regarded as an exudation of proteiue material 

 rapidly passing into the solid form, and never advancing beyond the lowest 

 grade of development. In examining tubercles from the lungs, it has ever 

 appeared to me that considerable difficulty must be experienced in arriving 

 at a correct histological definition ; for no little risk is of necessity inc\irred 

 of regarding half-destroyed tissues as new products, and hence one reason 

 for the different opinions expressed by different writers on this subject. 

 With regard to the seat of tubercle in the lungs, it may be stated that 

 tuberculous matter is deposited primarily on the free surface of the lining 

 membrane of the air-vesicles, the inter-vesicular passages, or the lobular 

 bronchi. Dr. Clark, in his remarks made to the Pathological Society on 

 the preparations illustrative of the seat of tubercle, shows that the deposit 

 of tubercles takes place primarily on the free surface of the lining membrane 

 of the air-vesicles, the inter-vesicular passages, or the lobular bronchi — that 

 it extends to the walls of the air- vesicles, the areolar tissue around the 

 blood-vessels and bronchi ; and between the lobules only at an advanced 

 period of growth, when such retrogressive changes have set in as involve 

 destruction of the structural elements of the lung ; and that it does not 

 occur wdifferently at any point external to the blood-vessels. 



"There are two principal varieties of tubercle known ^^ gray tubercle and 

 yellow tubercle., of which the admirable delineations of Mr. Tuffen West in 

 the plate convey to the eye a correct representation. The tuberculous 

 matter for the most part assumes a spherical form, its origin being in a 

 blastema exuded from the adjoining capillaries, which, effused in a iluid 



