CONSUMPTION OF THE LUNGS. 213 



it is sometimes, though rarely, absent in consumption. As has 

 already been stated, in certain very chronic insidious cases of 

 phthisis we find extensive slaty indurations in the upper lobes of 

 the lungs, in which we shall in vain search for any trace of a 

 cheesy deposit. 



The opinion of Buhl is in direct opposition to the views an- 

 nounced in a previous edition of this work, that the pneumonia 

 which induces phthisis has no distinct and special nature, but that 

 any form of pneumonia may under certain conditions end in case- 

 ous degeneration. He maintains that the inflammation which induces 

 phthisis is a peculiar one, the essence of which is to be sought, not 

 in superficial inflammatory disorders, as in catarrhal and croupous 

 pneumonia, but in a gelatinous, albuminous infiltration, and in other 

 changes in the vascular stroma itself. Under the term peribronchi- 

 tis, Buhl also describes an analogous condition of the finer bronchi, 

 in which the whole bronchial wall, and above all the adventitial 

 envelope of the bronchus, is attacked. This peribronchitis is com- 

 bined with the above-described parenchymatous pneumonia. Buhl 

 calls his pneumonia desquamative pneumonia, because, besides the 

 grave processes in the parenchyma, a proliferation and accumula- 

 tion of cast-off epithelium take place in the vesicles and bronchi, 

 and because the diagnosis is based upon recognition under the mi- 

 croscope in the sputa of the desquamation. The disease may ter- 

 minate in various ways. If the proliferation in the connective tis- 

 sue predominate, there may be hypertrophy and induration with 

 anaemic necrosis of tissue, followed by cheesy degeneration. This 

 happens when, besides the cell-growth in the stroma, a further pro- 

 liferation takes place in the envelopes of the arterioles. Their cir- 

 culation soon becomes obstructed by the resulting pressure, and ne- 

 crosis ensues. Cheesy degeneration and softening follow. 



Rindfleisch favors the doctrine of a special inflammation, the 

 specific product of a constitutional anomaly, as the cause of phthisis. 

 He calls it tubercular inflammation, on account of its close relation 

 with miliary tubercle ; and, with Buhl, he regards it as parenchyma- 

 tous. But JKindfleisch ascribes this infiltration to special tubercle- 

 cells, distinguishable from white blood-cells and pus-cells by their 

 richness in finely-granular protoplasm. He believes that chemical 

 action has to do with the cheesy metamorphosis, as well as pressure 

 of the infiltration. The disease shows close histological relationship 

 to other specific inflammations, such as typhus, syphilis, lepra, and 

 the like. 



Although the origin of phthisis would thus seem to be a specific 

 one, yet we may well assume that in a predisposed subject a catarrh 



