CONSUMPTION OF THE LUNGS. 225 



tern examination, we shall arrive at the conclusion that not a single 

 tubercle exists in very many phthisical lungs, and that consolidation 

 and destruction are solely due to a disorganizing pneumonia. 



We believe, however, that Virchow goes too far in asserting that 

 the doctrine of miliary tuberculosis of the lung is also almost entirely 

 erroneous, and that nearly all so-called miliary tubercles of the lung 

 are foci of bronchitic, peribronchitic, or pneumonic inflammation. It 

 not unfrequently happens that these translucent grayish nodules which 

 are scattered through the lungs, as well as in most other organs in 

 acute miliary tuberculosis, and of whose tuberculous nature there can- 

 not well be any doubt, are also met with in phthisical lungs. Hence, 

 we must also acknowledge the yellow caseous deposits found in the 

 lungs (notoriously regarded as miliary nodules) to be of tubercular na- 

 ture, when they coexist with the gray miliary tubercles, and when the 

 latter, together with caseous tubercles, are found in other organs at 

 the same time. There are no means of proving that the caseous 

 nodules are the product of vesicular pneumonia, and not tubercle, as 

 we have no criterion for the distinction between caseous tubercles and 

 caseous miliary nodules of inflammatory origin. I again express my 

 opinion that, exclusive of tuberculosis of the bronchial mucous mem- 

 brane, the development of secondary tuberculosis in phthisical lungs is 

 of very frequent occurrence. 



Hitherto we have been describing the anatomical lesions found in 

 pulmonary consumption, as it occurs in the vast majority of cases, 

 wherein the malady, throughout its whole course, is solely dependent 

 upon chronic pneumonia, or in which tuberculosis does not appear until 

 at an advanced stage of the phthisis, when, although it must be re- 

 garded as a most serious complication, it takes but little part in the 

 disorganization of the lungs. 



In tubercular consumption, in our acceptation of the term 

 that is, in the form of phthisis in which destruction of the lung is 

 caused by the breaking down of tubercles, and by secondary pneu- 

 monia dependent upon the tuberculosis the tubercle generally first 

 develops in the mucous membrane of the bronchi, as was first shown 

 by Virchow. Even in the trachea and larger bronchial tubes we 

 often find extensive granular patches, consisting of innumerable miliary 

 tubercles, or ulcers with the characteristic marks, according to Rokir 

 tansky, of primary or secondary tuberculous ulceration. In addition 

 to this, however, in the finer bronchi, besides the evidences of purulent 

 catarrh, we find small whitish or yellow nodules, and, upon examina- 

 tion of a successfully-prepared fine section, we may satisfy ourselves 

 that the development of the tubercle has spread from the bronchus to 

 its lateral and terminal alveoli According to the line of the sectioo, 

 16 



