210 DISEASES OF THE PARENCHYMA OF THE LUNG. 



Physical examination in diffuse pulmonary gangrene at first affords 

 well-marked tympanitic sound, and afterward a dull one on percussion. 

 Upon auscultation, we hear indistinct breathing and rdles, and after- 

 ward bronchial or even cavernous sounds. 



TREATMENT. The treatment of gangrene of the lungs is some- 

 what ineffectual. The inhalations of turpentine, recommended by 

 Skoda, deserve consideration, as being recommended by an author 

 distinguished by his skepticism in therapeutics. Whether it be of 

 service in other forms of pulmonary gangrene than those which arise 

 about bronchiectatic cavities, may be doubted. Nourishing diet, 

 wine, infusion of bark, and stimulants may be required by the gen- 

 eral condition of the patient. They are of no avail against the gan- 

 grene itself, any more than is acetate of lead, creasote, or charcoal. 



TUBERCULOSIS OF THE LUNGS. 



THE term pulmonary tuberculosis continues to be the expression 

 most commonly used to signify consumption of the lungs, a proof that 

 the majority of modern physicians and clinical teachers still adhere to 

 the teachings of Laennec, and only recognize one form of pulmonary 

 consumption, the tuberculous form. I have long contested this doc- 

 trine, and, upon various occasions, have declared, in direct contradic- 

 tion to it, that destruction of the pulmonary tissues, the establishment 

 of cavities and consumption of the lung are much more frequently a 

 result of chronic inflammation than of tubercular deposit. And I hope 

 that these views, of whose justness any one may easily satisfy himself 

 who will only study the subject with calmness and without prejudice, 

 will ultimately obtain general acceptation. 



The error into which Laennec and his disciples have fallen is not 

 that they regard tubercle as a neoplasm, but that they look upon 

 solidifications of the lung, due to entirely different causes, as products 

 of tuberculosis. Even according to modern views tubercle still ranks 

 among the pathological neoplasms, although, however, but one form, 

 the miliary form, and one mode of origin, miliary tuberculosis, is rec- 

 ognized. It is one of the characteristics of tubercle, that it always 

 appears in the form of small nodules, scarcely as large as a millet-seed, 

 and that the individual nodules never grow into voluminous tumors. 

 The larger so-called tubercular nodules consist always of an aggrega- 

 tion of many small miliary tubercles. All the extensive indurations 

 and enlargements formerly described as tuberculous infiltration, or as 

 infiltrated tubercle, depend neither upon infiltration of the tissues with 



