DISEASES OF THE PARENCHYMA OF THE LUNG. 



f ound in the expectoration, and which are often thought to be actual 

 tubercles by the laity, consist almost always of thickened secretion 

 from the tonsils, although now and then they are small diphtheritic 

 sloughs from the walls of the cavities. 



Chemical examination furnishes no test for the distinction between 

 the sputa of simple bronchial catarrh and that of consumption. 



Fever is one of the most constant symptoms of consumption both 

 in the tuberculous form and that which proceeds from chronic pneumo- 

 nia. Ziemssen has demonstrated that in children the invasion of the 

 air-vesicles by catarrh is always accompanied by considerable elevation 

 of temperature and acceleration of pulse. This is equally true of the 

 commencement of catarrhal pneumonia in adults. . The statement of 

 LOUISA that, in the majority of cases of tuberculosis (four-fifths), fever 

 only arises at a more or less advanced stage of the malady, is based 

 upon the observations of that author, taken from Laennetfs point of 

 view, according to which the precursory catarrh itself is due to the 

 presence of tubercle. We have repeatedly called attention to the 

 dangerous consequences of this error, and believe that we may declare 

 that, by precise observation of the temperature and the frequence of 

 the pulse, and by the most careful treatment of all cases, in which fever 

 arises during the course of a protracted catarrh, the development of pul- 

 monary consumption may often be averted. 



Not only is the fever an important sign of the extension of the 

 catarrh from the bronchi to the air-cells, but its continuance furnishes 

 the main evidence that the pneumonic process has not subsided. The 

 curves, by means of which we represent upon paper the morning and 

 evening fluctuations of temperature, usually show a wonderful degree 

 of similarity, and we may infer the existence of a consumption from 

 them with the same certainty with which we diagnose abdominal 

 typhus or pneumonia. The difference between the morning and even- 

 ing temperature is about a degree and a half or two degrees Fahren- 

 heit ; very seldom less, and frequently much more. In the morning 

 the temperature is often almost normal, while in the afternoon and 

 evening it may rise to 102 F., or even higher. Such fluctuations of 

 temperature are not peculiar to all kinds of exhausting fever. Upon 

 comparison of the thermal curve of a patient with pulmonary consump- 

 tion with that of one who is suffering from a tedious peripheral caries, 

 a great difference will be observable, particularly in regard to the 

 regularity of the morning remission and evening exacerbation. After 

 extended study of the hectic fever of phthisis, especially as to the 

 cause which interrupts ; ts regular march, we have as yet come to 

 no conclusion upon the subject. We may mention, however, that the 

 variations in the morning and evening temperature of a true tubercu- 



