70 JOURNAL AND rROCE:EDINGS 



chances are exceedingly good that such a nidus will be 

 surrounded gradually with fibrous tissue, the bacilli will be 

 rendered inert, the damaged tissues gradually absorbed and a 

 " cure " will be the result. 



Suppose, however, that such a patient feeling himself 

 recovered, and therefore under no compulsion to persevere in 

 that method of life which has brought about such marvellous 

 results in his plijsical conditon, and in such comparatively 

 short time, returns to his old life and his old habits, some of 

 which are by no means commendable, he finds himself once 

 more on the downward road, and often to his no small 

 surprise. 



Such a one perhaps has a foctis of diseased tissue in his 

 lung cut off for the time being from the bronchus or larger 

 air tube with which the air vesicles now consolidated once 

 communicated. As a result of some indiscretion, he becomes 

 temporarily run down in health, the protective wall around 

 the focus of diseased lung weakens, the focus expands and 

 spreads until it comes in contact with the wall of another air 

 tube. This it invades cutting off its blood supply, first of the 

 outside layers, then of the inner layers until, by a process of 

 ulceration, the tube becomes perforated, and a large quantity 

 of soft, cheesy, tuberculous material, in which the bacilli are 

 imbedded, becomes discharged into the main tubes of the 

 respiratory tract. Some of the material becomes expectorated, 

 the remainder being inhaled again more and more deeply 

 until ever increasing areas of ptilmouai> Li,-:.sue are invaded to 

 become in turn foci for the repetition of the process. 



In most cases, when this state of affairs intervenes, our 

 patient has lost such a considerable area of lung tissue, either 

 as a result of consolidation or of the formation of cavities, 

 that nature is not in a position to respond to the demands 

 made upon her. Even shoiild such a patient recover for the 

 time being, he cainiot inider any circumstances be regarded 

 as cured. He may, however, with proper care, lead a useful 

 if not an active life. 



A patient who has once suffered from tuberculosis and in 

 whom the disease, as far as our imperfect measures can teach 



