2M PATHOLOG Y. 
maflfes, are evidently fo 5 and liquids injected into thofe 
veflels will not pafs into the cavities, as Dr. Baillie long 
fince obferved. 
The ramifications of the branchiae appear to be rather 
enveloped in, than prefied a fide by, tuberculous matter; 
and the compreflion excited on them, apparently, prompt¬ 
ly deftroys them, for they can hardly ever be diilinguifhed 
in the tuberculous mafies 5 and yet it is very rare to find 
an excavation, however fmall, in which one or more 
bronchial tubes of different diameters do not open, and 
in a direction which makes it evident that thofe tubes 
were originally extended through the tuberculous mat¬ 
ter. The parietes of thofe excavations, in proportion as 
they are formed, become lined with a fort of thin, fmooth, 
foft, and almoft friable, falfe membrane, of nearly an opake 
white hue, and which is eafily removed by fcraping it 
with a fcalpel. Sometimes a finer membrane of the fame 
kind is formed in fpots on the fides of the cavities; or 
fuch a membrane will exift beneath the former, but not 
adherent to it, and which is attached more intimately 
than the former to the texture which it lines. It feems 
to be the firft degree of development of the former. 
Sometimes neither of thefe membranes is prefent, and 
the fides of the excavations are formed by the pulmonary 
texture, ordinarily hard, red, and infiltrated by tuber¬ 
culous matter, in different degrees of development. 
From this falfe membrane, as well as from the bron¬ 
chial lining, (a very large portion of which becomes in¬ 
volved in the fame aftion,) pus is fecreted. At times 
alfo blood is poured forth, giving rife to the fanguineous 
fputa fo common in the latter ftages of confumption. 
If the difeafe now remain ftationary, there is deve¬ 
loped, here and there, beneath this falfe membrane, flakes 
of greyifh-white and femi-diaphanous matter, of a tex¬ 
ture analogous to cartilage, but a little fofter, and which 
adheres intimately to the pulmonary tiflue. Thefe 
flakes at length increafe fo as to unite, completely line 
the ulcerous excavation, and terminate, as by continuity 
of fubftance, in the internal membrane of the bronchial 
tubes which open into thofe cavities. Sometimes this 
cartilaginous fubftance is of a light-red colour, appa¬ 
rently from a development of very fine blood-veflels ; 
fometimes this formation is as ancient as the tubercles 
themfelves, an affe&ion which conftitutes the encyjied tu- 
lercle. It adheres ftrongly to the furrounding ftrufture 
of the lungs, but the tubercles it envelopes can be fepa- 
rated from it, although alfo firmly adherent; and the in¬ 
ternal furface of the cyft is then found fmooth and po- 
liflied, although unequal in its furface. 
In cafes of recovery, the above cartilaginous cyft, 
forming a communication with the bronchial air-cells, 
and lined with the polilhed membrane before mentioned, 
which has the fame character as mucous membrane in 
general, becomes no longer a fource of irritation, and, the 
unnatural cavity alone remaining, the confumption is 
arrefted. A ftili more perfeft cure is effefted if the car¬ 
tilaginous cyfts cicatrize in confequence of an approxi¬ 
mation of their fides. 
By the above-mentioned procefles, then, phthifis is 
fometimes cured. In almoft all cafes, however, other 
terminations enfue. The tubercles coalefce, and form 
enlarged tubica; and then preflure on the branchiae ex¬ 
cites a fevere bronchitis, which terminates in death, or, 
if life be more prolonged, the cyfts degenerate into foul 
ulcerations. 
The following, then, is the procefs of pulmonary tu¬ 
bercles •. Firftly, diaphanous miliary granulations ; fe- 
cpndly, grey tubercles, more voluminous, and yellow 
and opake in the centre; thirdly, tubercles entirely opake, 
but ftili of firm confidence ; fourthly, foftened tubercles, 
efpecially in the centre ; fifthly, excavations, more or 
Jefs completely empty; fixthly, the excavations lined by 
a mucous membrane, and their external covering formed 
of cartilage; or, on the other hand, an ulcerous cavity 
fecreting pus and blood 5 laftly, the cartilage cicatrized, 
or, fatally and more generally, the fubftance of the lungs- 
deftroyed. It is to be remarked alfo, that, as in other 
parts of the body, the tubercular cyft in the lungs fome¬ 
times contains varieties of morbid matter, as a medul¬ 
lary or cerebriform matter, a melanofe or black matter, a 
cancerous matter, &c. It is needlefs to fay that thefe are 
hopelefs cafes, and moft diftinguifiiable from each other, 
or from Ample tubercles, during the life of the fufterer. 
They are fortunately rare. 
Our talk is now to trace the fyrnptoms which accom¬ 
pany the above-mentioned morbid changes. We have no 
fear of being contradicted when we fay, that, notwith- 
ftanding all that has been written on phthifis, the early 
fyrnptoms of the tubercular formations have never been 
correCtly defcribed. This has arifen partly from the con- 
fufion of terms; for, till lately, moft authors have treated 
of chronic catarrh, apoftema, vomica, and other infidi- 
ous difeafes of the lungs, under the title of confumption; 
while, in more recent accounts, the fame deficiency ftili 
exilts from the paucity of examples the phyfician has had 
an opportunity of witnefling. Not indeed that there is a 
fcarcity of phthifical patients, but becaufe the abfence of 
pain or uneafy fenfation prevents them from applying to 
medical men in the beginning of the difeafe. 
From what we have been able to colled by perfonal 
obfervation and from contemporary authors, we conceive, 
that a remarkable pallor of the ficin, a diminution of 
perfpiration, and a removal of all thofe trifling cutaneous 
roughnefles or defcedations from which fcarcely any one 
is entirely free, are among the earlieft iigns of confump¬ 
tion. To thefe alfo is added a feeling of tightnefs in the 
cheft on unufual exertion, as running or the like. Some¬ 
times this tightnefs is abfolutely a pain ; fometimes it is ab~ 
fent, and a mere quicknefs of breathing follows flight ex¬ 
ertions. A peculiar placidity of manner is ufually obferved 
in patients at this period, and fomewhat of fulnefs in the 
face. The next fymptom is a cough, which feems to the pa¬ 
tient to arife from irritation in the glottis, like that pro¬ 
duced by the accidental prefence of a hulk of corn, or 
other dry fubftance. It is familiarly known by the name 
of an bulky or tickling cough. This, which is ufually 
worfe towards night, is not however always prefenr. 
Thefe fugacious fyrnptoms are of courfe little to be de¬ 
pended on, fince they are met with in trifling gaftric irri¬ 
tations ; but they may ferve to direft our attention to the 
accelfion of phthifis at an earlier period than it would 
otherwife have been done. 
The l’ufpicion that thefe fyrnptoms denote phthifis will 
be confirmed, if hereditary predifpofition, or if external 
fyrnptoms of ftruma, fliould alfo be prefent. The above- 
mentioned appearances do not always produce more formi¬ 
dable fyrnptoms. They do fo, however, in fo large a pro¬ 
portion of cafes, that the following defcription may juftly 
be called the fecond Jlage. We believe that when it is 
the firft ftage, or, to fpeak more plainly, when phthifis is 
fuddenly manifefted, and is rapid in its courfe, a chro¬ 
nic pneumonitis is always very evident, pain and fever 
being for the moft part met with. 
In the progrefs of this affe< 5 lion, the pallor of the coun¬ 
tenance is interrupted by partial flu-ftiing of the cheek. 
This is attended with a fenfation of burning heat in the 
part flufhed : it is not confined to the cheek ; a fenfe of 
burning and rednefs being often feen and felt round the 
palms of the hands or foies of the feet. The pulfe be¬ 
comes frequent 5 a difficulty of lying on one fide comes 
on, attended with pain in fome particular pflrts of the 
cheft, which is increafed by fudden changes of pofition. 
One portion is generally preferred during the whole dif¬ 
eafe. The irritation being now communicated to the; 
mucous membrane of the branchiae, or the irritability 
of that membrane being now fo far increafed that flight 
variations of temperature aft'eft it with inflammation, the 
cough, before dry, becomes attended with copious expec¬ 
toration. The refpiration is quick and eafily accelerated, 
and the noftrils are forcibly moved by it. As this dif- 
