PHTHISIS. 77 



form, and unite, till the patient's lung is riddled with cavities, and 

 he dies exhausted. One or more bronchial tubes are found opening 

 into each vomica. 



Tubercle generally occasions some degree of pleurisy and conse- 

 quent adhesion ; this diminishes the frequency of what, nevertheless, 

 happens sometimes, viz., ulceration of the pleura, and escape of the 

 matter from a vomica, and, of course, of air into the pleural cavity; 

 constituting a kind o^ pneumo-thorax, sometimes met with in the 

 last stages of phthisis. 



Ulceration of the larynx, tubercular deposits in, and ulceration of 

 the intestinal glands, and a peculiar fatty condition of the liver, are 

 morbid appearances often met with in the phthisical. 



Tubercles most frequently are found in the upper lobes^ and gene- 

 rally at first in the left lung; pneumonia in the loiver lobes of the 

 right lung. 



Symptoyns which mark the 07iset of pulmonary phthisis. — Before 

 the signs of pulmonary tubercles are observed, we may often remark 

 first, a tendency to simple inflammation of the mucous membrane of 

 the air-passages ; secondly, one or more attacks of haemoptysis ; 

 thirdly, an inflammation of the pulmonary parenchyma, or of the 

 pleura. 



Among the acute exanthemata, there is one in particular af^er 

 which we frequently see pulmonary phthisis makes its appearance 

 — that is, measles. The reason of this will be readily understood if 

 we reflect that in measles, much more than in small pox or scarla- 

 tina, the bronchi are the seat of either an active congestion or an 

 acute inflammation. 



Symptoms which appear during the progress of pulmonary 

 phthisis. — Three stages of the affection are described by Dr. Stokes. 



In the first stage, the tubercle is developed, but not yet suppurated ; 

 in the second, small ulcerations are formed ; and in the third, we 

 have vast caverns excavating great portions of the lung. 



" First stage. — The more prominent symptoms are those of irri- 

 tation, cough, pain, and quickness of pulse, which in certain cases 

 are preceded, but in the greater majority followed, by an unac- 

 countable emaciation ; the cough is almost always dry during the 

 first few weeks, unless where the tubercle has succeeded to catarrh ,* 

 it may occur in every variety, but it is most commonly a slight, 

 frequent, and irritating cough, referred by the patient to a tickling 

 sensation in the trachea. The expectoration, when occurring, is 

 scanty, and consisting of a thready, grayish, and nearly transparent 

 mucus, occasionally dotted with blood ; a slight wheezing sometimes 

 accompanies the cough. 



" With these symptoms the patient frequently complains of pain, 

 which may be situated in any part of the side. In some instances, 



it is only felt in the lower, while in others it occupies the upper part 



7# 



