248 PRACTICE OF PHYSIC. 



agitation of the lungs in coughing, will produce some of those 

 tubercles which are presently to be mentioned as the most 

 frequent cause of phthisis. 



DCCCLXXIII. It must be particularly observed here, 

 that nothing said in DCCCLXXII. should allow us to ne- 

 glect any appearance of catarrh, as is too frequently done ; for 

 it may be either the beginning of a phthisis, which is mistaken 

 for a genuine catarrh, or that even as a catarrh continuing long, 

 it may produce a phthisis, as in DCCCLXXII. 



DCCCLXXIV. Many physicians have supposed an acri- 

 mony of the fluids eroding some of the vessels of the lungs, to 

 be a frequent cause of tdceration and phthisis. But this ap- 

 pears to me to be a mere supposition : for in any of the in- 

 stances of the production of phthisis which I have seen, there 

 was no evidence of any acrimony of the blood capable of eroding 

 the vessels. It is true indeed, that in many cases an acrimony 

 subsisting in some part of the fluids is the cause of the disease, 

 but it is at the same time probable, that this acrimony operates 

 by producing tubercles, rather than by any direct erosion. 



DCCCLXXV. It has been mentioned in DCCCLXIII. 

 that an asthma may be considered as one of the causes of 

 phthisis ; and by asthma I mean that species of it which has 

 been commonly named the Spasmodic. This disease frequently 

 subsists very long without producing any other, and may have 

 its own peculiar fatal termination, as shall be explained here- 

 after. But I have seen it frequently end in phthisis, and in 

 such cases I suppose it to operate in the manner above alleged 

 of catarrh, that is, by producing tubercles, and their con- 

 sequences, which shall be presently mentioned. 



DCCCLXXVI. I come now to consider the fifth head of 

 the causes of phthisis, and which I apprehend to be the most 

 frequent of any. This I have said, in general, to be tubercles ; 

 by which term are meant, certain small tumours, which have 

 the appearance of indurated glands. Dissections have frequent- 

 ly shown such tubercles formed in the lungs ; and although at 

 first indolent, yet at length they become inflamed, and are 

 thereby changed into little abscesses, or vomicae, which break- 

 ing, and pouring their matter into the bronchiae, give a purulent 

 expectoration, and thus lay the foundation of phthisis. 



