PATHOLOGY. 
purulent, mucus; general fo reliefs of the cheft,. with 
tranfitofy pains fhifting from fide to fide. Chiefly pro¬ 
duced by catching cold, or the neglect of a common ca¬ 
tarrh. 
$. Pht. apoftematofa, apoftematous confumption : 
Cough fevere but dry ; fixed, obtufe, circumfcribed, pain 
in the cheft, fometimes pulfatory ; difficult decumbiture 
on one fide; at length fudden and copious difcharge of 
purulent matter, occafionally threatening fuffocation ; the 
other fymptoms temporarily,^rarely permanently, relieved. 
Chiefly the refult of repeated htemoptyfis. 
y. Pht. tuberculofa, tuberculous confumption: cough 
ftiort and tickling ; excretion of a watery whey-like fa¬ 
iries, fometimes tinged with blood; pain in the cheft 
flight; habitual elevation of fpirits. Ufually the refult 
of a fcrofulous diathefis.. 
We cannot, however, minutely follow the.above divi- 
iTon of confumption, becaufe, in common with many 
other divifions, they are becoming generally abandoned 
in confequence of the advance of pathological knowledge. 
It mull be granted that catarrh is often accompanied by 
tubercles, and that thefe formations often precede apof- 
tema ; but the peculiar fymptoms and the fatality of 
phthifis belong only to the third variety ; the two former 
varieties being confidered as fevere forms of Bronchitis, 
or Apcftema vomica, which fee. The word Phthifis is 
therefore reftrifted in this treatife to thofe diforganiza- 
tions of the lungs known by the name of tubercles, and 
to the fubfequent alteration in ftrufture thefe tubercles 
undergo. The only diftinftion that can be made out, as 
far as we conceive, will depend on whether the patient be 
ftrumous or not. 
• Now, as to the formation of tubercles in the lungs, 
this is a point little known. We have before had occa- 
iion to notice, that two explanations had been afforded 
of the appearance of tubercles ; that one theory affirmed 
them to be organizations of lymph previoufly effufed by 
an inflammatory procefs ; that, on the other hand, ffome 
referred the production of tubercles to an undefined dif- 
eafe in the abforbent fyftem; and, as a coincident opinion, 
that the firft germ of the tubercle was an hydatid. We 
are not prepared to decide between the oppofite parties; 
but we incline to fuppofe that tubercles may originate in 
both ways. And firft, of the formation of tubercles 
from inflammation, we conceive fome evidence is to be 
found in viewing their remote caufes. Variable weather, 
more efpecially if in a cold and humid climate, has the ef¬ 
fect of preventing the due aftion of the whole of the cu¬ 
taneous vefiels; confequently internal circulation is in- 
creafed. This increafe in the circulatory fluids is parti¬ 
cularly felt in the lungs. This fact is evident to every 
one ; for the mod common obferver has not failed to no¬ 
tice the extreme feeling of diftention in the lungs which 
follows the application of cold to the furface of the body. 
Now, if it be admitted that plethora can be induced in 
the lungs by cold and moifture applied to the Ikin ; if it 
be admitted alfo, that confumption is molt prevalent in 
thofe liruations where, from the degree of cold and moif¬ 
ture, or from their variability, thefe conditions can aft 
moll forcibly on the Ikin ; then, knowing as we do that 
impediment in the cutaneous increafes the pulmonary 
circulation, and that plethora is the chief condition of in¬ 
flamed parts, we cannot hefitate to aferibe the production 
of tubercles to an inflammatory origin in lb me cafes. 
Further proof of their origin in this lource might be ad¬ 
duced from the frequency of phthifis after the pneu¬ 
monia. 
With refpeft to the origin of the tubercles in difeafed 
abforbents, this, though capable of lefs direft proof, is 
Hill probable. It refts greatly on the fuppofed locality of 
fcrofula, the latter dileafe being ufually confidered an 
affeftion of the lymphatic fyftem ; and, as fcrofula and 
phthifis are frequently complicated, as in fcrofulous pa¬ 
tients tubercles even in other vifeera are the moft com¬ 
mon degenerations, the origin of phthifis being the fame 
Vo l. XIX. No. 1303. 
28-3 
as fcrofula has been juftiy contended for. It refts alfo- 
on the grounds, that many people expofed to the vicif- 
fitudes of climate, and who are fubjeft to frequent pneu- 
monites and catarrhs after fever, enjoy neverthelefs im¬ 
munity from confumption. Moreover, tubercles have 
been found in the lungs of the foetus. Indeed fo evident 
is the faft that phthifis and drama are often the fame dif- 
eafes, that we believe it has never been difputed. The 
only queftion to be decided, is whether chronic pneumo¬ 
nitis will not end in phthifis, even in conftitutio'ns not 
ftrumous. The very general fuffering of the French 
army in Holland, and the teftimony of Brouflais, who 
fays that all the tuberculous cafes he diflefted there 
were preceded by catarrh or pheumonia, go to prove the 
affirmation. 
Leaving, however, thefe fpeculations, on which we can¬ 
not throw' fo much light as we wifli, we proceed to con- 
fider thefe tubercles when formed, their progrefs, and ac¬ 
companying fymptoms. 
Laennec, in his excellent work on “Mediate Aufcul- 
tation,” ftates that the earlieft ftage of tubercles he lias 
met with is when they form final! femi-tranfparent grains 
of a grey hue, but fometimes diaphanous and almoft co- 
lourlefs. Their fize, in the firft inftance, varies from 
that of a millet to that of a hemp-feed; they at length 
become larger, opake or yellowifh, at firft in the centre, 
and fuccefiively throughout their extent. Thofe molt 
adjacent unite as they develope themfelves,and form then 
more or lefs voluminous manes, of a pale yellowifn co¬ 
lour, opake, and of a denfity fimilar to that of the hardeft 
fort of cheefe ; they are then termed crude tubercles. It 
is ordinarily towards this epoch of the difeafe, that the 
tifiue of the lungs, hitherto healthy, begins to become 
hard, greyifti, and femi-tranfparent, around the tuber¬ 
cles, from a new production of tuberculous matter in 
the firft ftage of its formation, which infiltrates the pul¬ 
monary ftrufture : the latter is fometimes found without: 
tubercles. The pulmonary tifiue, thus engorged, is denfe, 
humid, and wholly impenetrable to the air. Numerous 
fmaller opake yellow fpots then become difperfed in it, 
and at length extend throughout it. 
In whatever way tubercles are formed, they terminate, 
after a period of various duration, by becoming foft, and 
at length liquid. This foftening begins in the centre of 
each mafs, and gradually extends to the circumference. 
Tuberculous matter at this ftage is in two different 
ffates : it either refembles a thick inodorous pus of a 
deeper yellow colour than the tubercles, or it is fepa- 
rated in two parts, one of which is very liquid, more or 
lefs tranfparent or colourlefs, unlefs it be tinftured by- 
blood ; the other opake, and of the confidence of loft 
and friable cheefe. The latter, M. Laennec fays, is par¬ 
ticularly found in fcrofulous fubjefts. When the tuber¬ 
culous matter is completely foftened, it opens a pafiage 
into fome one of the adjacent bronchial tubes; this open¬ 
ing is fmaller than the diameter of the cavity left after 
the evacuation of the matter, and remains fiftulous. 
Many excavations of the above kind generally co-exift ; 
and cavities fuccefiively formed often open into each 
other, forming anfraftuous excavations of various forms 
and extent. Bands or columns of condenfed pulmonary 
tiffue, often infiltrated alfo by tuberculous matter, fre¬ 
quently traverfe thefe excavations. Baylehas Hated that 
thefe hands were traverfed by blood-vefl’els; but M. 
Laennec has hardly ever found a veflel of any conlider- 
able fize in them. The vefiels naturally exifting in the 
pulmonary-ftrufture are obliterated in thofe bands. The 
tuberculous matter, on being developed, prelles afide the 
proper ftrufture of the lungs, and its blood-vefiels are 
found often very large in fize, winding about the parie- 
tes of the cavities foon after the foftening of the tubercu¬ 
lous matter, and forming even part of thofe parietes. 
Thefe vefiels are ordinarily flattened ; they are rarely ob¬ 
literated ; but thofe of their ramifications which are di- 
refted towards the excavation or towards the tuberculous 
4- D malfes, 
