HALL, ON THORACIC CONSUMPTION. 165 



nuclei apparent. Others, again, are compressed aud elongated ; aiiotlicr 

 set may be seen of a spherical form, which are filled with granules of fat or 

 pigment, and these are often in process of disintegration ; and, lastly, 

 corpuscles may be seen with depressions, from which nuclei have been 

 extruded. The first kind of corpuscles. Dr. A. Clark considers to consist 

 of very young epithelial cells aud extruded nuclei ; the other varieties are 

 uuriuestiouably diseased epithelial cells, in various stages of degeneration. 

 The jagged outlines of the corpuscles (to which allusion is made in the 

 case described pp. 46 aud 47), is a point of great interest to the practitioner, 

 and almost certainly diagnostic of phthisis. Dr. C. Radclyffe Hall has 

 drawu attention to the appearance in the sputa, of enveloped blood-corpuscles, 

 at the commencement of thoracic consumption. In a great majority of the 

 cases in which I have examined the sputa this microscopic haemoptysis has 

 been evident, even when to the naked eye there was no trace of blood, and 

 the opinion of this physician, that this appearance is seldom absent in 

 cases of the disease in which the more obvious expectoration of blood is 

 wanting, is strictly in accordance with what I have observed. 



" The next kind of expectoration is met with at a more advanced stage 

 of thoracic consumption. A highly characteristic example is given (pi. i, 

 fig. 6) of this flocculeut sputa, in which will be seen a large piece of the 

 curled elastic tissue s\n-rounding the pulmonary vesicles. The expectoration 

 was obtaiued from Sarah Ann Chambers, aged 18, admitted during the 

 month of October, 1856, under my care, at the Sheffield Public Dispensary, 

 with signs of softening at the apex of one lung. It is at the period of the 

 formation of these excavations in the lung that I most frequently observe 

 the elastic tissue forming the areolae of the air-vesicles, partially obscured 

 by masses of molecular matter in which tubercle-corpuscles may be seen, 

 and it then becomes an important aid to the formation of a correct diagnosis. 

 I may observe that the elastic tissue shown in the plate is exactly a quarter 

 of the actual size of one of the pieces in the preparation put up by me, 

 from which Mr. Tuffeu West's drawing was made. The pus globules, 

 shrivelled cells, disintegrated nucleated cells, &c., &c., found in the sputa of 

 this patient, will be described at the end. I have never yet met with a 

 case in which I discovered, with the microscope, the elastic tissue of the 

 lungs in the absence of all other symptoms indicative of thoracic consump- 

 tion. Such a case, however, has occurred, in which that accomplished 

 physician. Dr. Bennett, after a careful examination with the stethoscope, 

 could not detect any physical sign of consumption. The case was seen 

 with W. T. Iliff, jun., Esq., of Kennington. Professor Bennett says, ' the 

 chest was well formed ; careful percussion and auscultation elicited posi- 

 tively nothing ; the percussion note was normal and equal on both sides ; 

 tiie respiratory murmurs were normal, and there was no increase of vocal 

 resonance.' There was cough and muco-puruleut exi)ectoration. This 

 patient, a lady, aged 23, had an impression she was in the habit of spitting 

 up fragments of her lungs. Some of them were examined by Dr. Bennett, 

 Mr. Quekett, Mr. Rainy, and Dr. Beale, all of whom agreed as to the fact 

 of the expectorated matter containing portions of human lung. After a 

 time the physical signs of the disease became more cleai', aud on examina- 

 tion after death extensive tubercvdous disease of both lungs, with cavities 

 in their apices, was found. This case has fully impressed Professor Bennett 

 with the importance of a microscopic examination of the sputa whenever the 

 symptoms and a suspicion of thoracic consumption exist, without any clear 

 evidence derivable from auscultation being present ; and when such signs 

 are present as lead to the conclusion that a cavity is just forming, micro- 

 scopic appearances of the sputa, such as are shown on the sixth figure of the 



