CONSUMPTION OF THE LUNGS. 235 



losis (in the narrow sense of the word), and of a tuberculosis superven- 

 ing upon chronic pneumonia, are generally much less. Hence, if the 

 fever be a remitting fever approaching the intermittent type, the prog- 

 nosis will be better than if the fever assume a more continued form. 

 In the former case we have often succeeded in moderating, or even in 

 completely allaying the febrile action, and thereby greatly improving 

 the strength and nutritive condition of the patient ; but we cannot 

 claim any such results where there was no morning remission. When 

 the caseous masses become incapsulated, or liquefy, and are absorbed, 

 the fever may cease altogether. Patients are often seen who have 

 large cavities in the apices of their lungs, but no fever whatever. In 

 such cases (the pneumonia having resulted in induration) the physical 

 signs presented, and the globular masses of sputa, which the patient 

 spits up morning after morning, form a striking contrast with his 

 apparent good health, his fresh, vigorous look, his nutritive condition 

 and strength. We have already shown that, in spite of their partial 

 recovery, such persons are still liable to die of consumption, either 

 through recurrence of the pneumonia or through consecutive tubercu- 

 losis ; and we would advise that the condition of the patient as to 

 weight and temperature be still kept under observation, that we may 

 be apprised of it, in case either event occur. We see, then, that, in 

 the diagnosis, prognosis, and treatment of consumption, the use of the 

 thermometer is as great as, if not greater than, in any other disease. 



The subjects of emaciation and deterioration of the blood, the 

 symptoms to which consumption owes its name, properly succeed 

 that of fever, since there can be no doubt that it is to fever that they 

 are mainly due. A most striking proof of the soundness of the theory, 

 that the elevation of temperature in fever is dependent upon an in- 

 crease in the calorification, consists in the rapid loss of weight which 

 the body sustains even in a fever of short duration. For years, at my 

 clinic, the fact has been established, by dint of innumerable measure- 

 ments and weighings of consumptive patients, that their loss and gain 

 in weight stood in direct proportion to the increase or diminution of 

 their fever. There is a very pretty theory, that a continued fever of 

 moderate intensity consumes less (especially if the patient keep his 

 bed) than a hectic fever like that of phthisis, in which the temperature 

 fluctuates daily between a condition almost normal and one of a con- 

 siderable degree of intensity. There is no doubt that both calorifica- 

 tion and consumption of the constituents of the body go on with great 

 rapidity during the rapid rise in the temperature, as has been proved 

 by Immermann, but we still hesitate to accept the absolute truth of 

 the above hypothesis. Knowledge of the fact, that it is the fever 

 which consumes both the strength and substance of phthisical pa- 



