132 THE AMERICAN MONTHLY [May, 



PRETUBERCULOSIS. 



The idea that diseases have periods of incubation pre- 

 ceeding their full development accords with other facts 

 in animal and plant-biology. It is to be expected that 

 tuberculosis of the lungs for example has a pre-stage. 

 In fact pretuberculosis exists and clinically means that 

 the morphology of consumptive blood is present to a 

 lesser extent than in tuberculosis, that the essence of 

 pretuberculosis is in these vegetations in the blood, which 

 coming from the fermentations in the alimentary canal, 

 pass the barriers of the intestinal epithelia and float 

 about in the blood stream of consumption any ti7ne dur- 

 ing one year before the 7iecrosis or sphacelation or break- 

 ing down of the lutigs, sufficient to be detected by the usual 

 signs, furnished by auscultation and percussion. It is 

 evident that in such spongy bodies as the lungs small 

 deposits may escape physical macroscopical exploration. 

 But the microscope will detect this stage. 



STATEMENT AS TO SUBJECT. 



When consumption or tuberculosis is suspected from 

 bowel troubles, cough, loss of flesh and strength, pallor, 

 weakness, short breath, loss of appetite, hemorrhage 

 from the air passages, &c. ; such a case is apt to be a 

 puzzle to the diagnostician, from absence of positive 

 physical signs of lung lesion. For it may or may not 

 be consumption and the usual plan is to watch and wait 

 till lung lesions are manifested. In other words the 

 case is in the dim border land which interdigitates 

 between health and disease. The line of demarcation 

 between health and disease is not always clear. Such 

 cases of consumption are a great trouble to physicians 

 and patients. I know this from subjective experience, 

 for the late Dr. H. I. Bowditch once explored my thorax 

 after I had expectorated blood and cretaceous tubercles 



