PHTHISIS. 81 



wards. After the complete evacuation of the tubercles, the expecto- 

 ration puts on various forms of purulency, but frequently assumes 

 one particular character, which has always appeared pathognomonic 

 of phthisis, although the more accurate and extensive observation of 

 modern pathologists has proved the same to exist occasionally in 

 simple catarrh. The expectoration alluded to, consists of a series 

 of globular masses, of a whitish-yellow colour, with a rugged woolly 

 surface, and somewhat like little rolled balls of cotton or wool. 

 These commonly, but not always, sink in water. This kind of ex- 

 pectoration has appeared most common in young subjects, of a 

 strongly-marked strumous habit, and in whom the disease was 

 hereditary. At other times, in the cases in which these globular 

 masses are observed, and also in those in which they have not 

 appeared, the expectoration puts on the common characters of the 

 pus of an abscess, constituting an uniform, smooth, coherent, or 

 diffluent mass, of a greenish, or rather grayish hue, with an occa- 

 sional tinge of red, (from intermixed blood,) and sometimes more 

 or less foetid." Dr. Stokes considers the expectoration, in which 

 the globular ragged masses here described are expelled, more pecu- 

 liarly allied to» phthisis than any other. He also adds, " I do not 

 recollect a single case in which I observed this character, that did 

 not turn out to be phthisis." 



TreaUnent. — In the treatment of consumption there are two grand 

 rules — to diminish irritation or inflammation in the chest ; and to 

 support the general health and strength. 



Preventive treatment. — When persons are known to be disposed 

 to phthisis, they should most carefully avoid every imaginable source 

 of irritation in the chest ; for a bad catarrh or pleurisy is exceed- 

 ingly apt to bring consumption after it. A warm sheltered residence ; 

 exercise in the open air, especially on horseback ; and a diet calcu- 

 lated to keep up the strength without producing feverishness, are 

 very important. A prolonged course of iron is often of service. 



If the complaint has actually appeared, and is complicated with 

 bronchitis, the patient must be confined to his room, and all exertion 

 of the lung be prohibited. If he be of a robust habit, and has a full 

 pulse, a single abstraction of blood from the arm is indicated ; the 

 bowels must be kept gently open, and the diet consist of milk, fari- 

 naceous substances, and light vegetables. But it is on local deple- 

 tion and counter-irritation we must chiefly rely. Leeches should be 

 frequently applied to the sub-clavicular and axillary regions of the 

 affected side ; the number used on each occasion should be small, 

 and they ought to be applied alternately in each region. After this 

 treatment has been persisted in for a short time, blisters and other 

 derivatives are to be frequently applied under the clavicles and over 

 the scapular ridge. Issues may also be established. During this 

 treatment the cough is to be allayed by mild sedatives. In fine 



