HJEMORRIIAGIES. 251 



the state of tubercles, there is a variety not yet accounted for ; 

 but all this must be left to future observation and inquiry. 



" Why are ulcers occurring in the lungs healed with more 

 difficulty than in other parts of the body ? By some the cause 

 is referred to the particular state of the lungs subject to its pe- 

 culiar motions ; by others to the situation of the lungs, exposed 

 to the external air. Both of these answers, however, are by no 

 means satisfactory : as appears from the fact, that there are a 

 number of cases of ulcers of the lungs arising from certain 

 causes, which are readily enough cured. 



" I conclude, therefore, very confidently, that the difficulty of 

 cure arises not so much from the peculiarity of the seat or place 

 of the ulcer, as more probably from some ill condition, some 

 cachectic state of the ulcer. 



" The first observation which occurs in explanation of this is, 

 that persons of a scrofulous habit are frequently liable to phthis- 

 is ; that many cases of phthisis depend upon the same cause, 

 a scrofulous habit ; and that it is very common in the case of 

 phthisis to find that the lymphatic glands of the neck and other 

 places of the body are affected ; and, in short, frequent dissec- 

 tions in the case of phthisis have shewn that the lungs are af- 

 fected with tubercles, little round or variously formed nodules, 

 putting on the appearance of glands, and which, from many cir- 

 cumstances, have appeared to be lymphatic glands thus tumified. 

 These tubercles of the lungs are very frequently found on dis- 

 section ; and we meet with many cases where the disease had 

 not been preceded by any spitting of blood. But, at the same 

 time, nothing is more common than to find these same tubercles 

 in cases which seemingly begin with spitting of blood, or in 

 which the spitting of blood began very early ; from this it is 

 to be suspected, that the spittings of blood which commonly 

 prove the beginning of phithisis, are frequently from the begin- 

 ning combined with tubercles ; for they occur in the scrofulous 

 habit, and with other symptoms of scrofula present at the same 

 time. Nay I am disposed to push this further that perhaps hard- 

 ly any spitting of blood does prove the forerunner of phthisis, 

 unless where the spitting of blood is connected with, and probably 

 produced by tubercles. 



