HLBMORRHAGIE8. 253 



But the lymphatic glands may be hardened or tumified from 

 other acrimony besides the scrofulous, as the scorbutic, venereal, 

 and a portion of the matter of the exanthemata deposited there. 



" I have spoken vaguely of effusions not fit to be re-absorbed, 

 because I cannot ascertain the particular circumstance in which 

 that takes place : but we see that the matter poured out into the 

 cellular texture of the lungs, into the lymphatic glands or mu- 

 cous follicles, may be of a considerable variety ; and we readily 

 perceive, that many of them may be very different from the or- 

 dinary effusions of inflammation, very different from a matter 

 which is fit to be changed into a proper pus ; and may so prove 

 the cause of ill-conditioned ulcers : and this will account for 

 ulcers in the lungs being so often fatal and incurable. 



" Now I have taken an opportunity from this subject of giving 

 you the great lines of the pathology of phthisis pulmonalis, and 

 its connexion with haemoptysis : and I have endeavoured to ren- 

 der it probable, that when the disease seems to proceed from the 

 spitting of blood, this is not so much the cause itself, as rather a 

 symptoma causer. 



"To finish this subject, it has been remarked by authors that 

 phthisis proceeds from different sources : the ulcers may be the 

 consequence of ordinary peripneumonic inflammation, or of a 

 haemoptysis, depending entirely on a plethoric state without pre- 

 vious tubercles, or even of catarrh ; I say all these causes may 

 be the foundation of phthisis ; but considering how often the 

 suppuration following inflammation is in course healed ; how 

 often haemorrhagy from plethora occurs without producing ulcers 

 or phthisis ; and in how many instances we have catarrhal affec- 

 tions remaining almost through life without serious consequences, 

 we will be readily led to think, that in all cases where phthisis fol- 

 lowed in consequence of inflammation, haemorrhagy, or catarrh, 

 either other causes concurred to form the tubercles, or that these 

 circumstances acted as causes of the tubercles, and that a tuber- 

 cle, containing a matter not fit to be changed into pus, is the 

 chief foundation of phthisis." 



DCCCLXXXVI. It has been frequently supposed by phy- 

 sicians, that the phthisis is a contagious disease ; and I dare 

 not assert that it never is such : but in many hundred instances 

 of the disease which I have seen, there has been hardly one 



