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lately described; and dulness and hardness on percussion, and restricted movements with diminished capacity of the corresponding walls of the chest, are the result; often, also, with the loud and diffused bronchophony and tubular breathing, caused by extensive dilatation of the bronchial tubes.

When, on the other hand, the disease arises out of severe and prolonged bronchial inflammation, this affects rather the roots and upper parts of the lungs; the inflammation becoming deeper seated, reaches the submucous and connective tissue around the large bronchi; and as the parts become thickened with this peribronchial deposit, there may be little or no dulness in the walls of the chest, but the constriction of the tubes will cause wheezing rhonchi and prolonged expiration of the asthmatic kind; in fact, if this state of things continues, the lungs may become emphysematous, and the disorder pass from the category of consumption to that of asthma. But if the tendency to decay be greater, the tight, prolonged wheezing is soon replaced by loose crepitation, with shorter but easier breath; more or less dulness will be manifest at or near an apex or root of a lung, with tubular voice and expiration; whilst the expectoration of opaque matter, shreddy or purulent, abounding in dead and decaying corpuscles, disintegrated fibrin, and epithelium cells, indicates the removal of some of the consolidating matter. Such cases may terminate favourably or unfavourably, according to whether the lung texture to which the deposit has reached does not or does participate in the decay and disintegration by which the deposits are removed. If the lung does break down, fragments of its tissue may be found in the expectoration, when carefully examined by the microscope; and signs of softening and excavation will become apparent in the affected part of See Dr. Fenwick's Paper, Med.-Chir. Trans. vol. xlix. p. 209.

VARIOUS RESULTS OF LUNG INDURATION.

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the chest. Yet I can recollect several instances of deepseated bronchitis in which the signs of lung consolidation threatened the destruction of its texture, but they have been completely removed after free expectoration of a quantity of very ugly-looking opaque matter, differing in no particular from phthisical sputa, except in the absence of filaments of lung tissue. Some of these cases, having thus narrowly escaped from lung disease in one attack, have been less fortunate in a subsequent one, and have eventually lapsed into phthisis. All these facts point to the conclusion that the diseases included under the term consumption present many degrees, and that however intractable and hopeless those may be, in its worst and most extensive forms, yet that much may be done to counteract and arrest the more limited and milder degrees of the disorder. And as we have found that in many instances the development of the disease may be traced to inflammation, and that this also often has an aggravating influence on its course, the prevention and removal of inflammation will be among the chief indications in the treatment. And yet we have found that there must be something more than inflammation to produce consumptive disease; and that something we have been led to trace to a defective vitality, and therefore a decaying tendency, in the plasma, the nutritive materials of flesh and blood. The most recent researches seem to point to the sarcophytes (alias bioplasts, leucocytes, or pale corpuscles) as the representatives of this living protoplasm ('bioplasm,' Beale); and any means by which their vital and euplastic properties can be exalted and preserved may be deemed of paramount importance, above and beyond the mere prevention and treatment of inflammation.

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Sarcophytes of the Lymphatics; subject to the same changes, and producing the same results, as those from blood-vessels-Leucocythemia.

WE are now brought to the consideration of the consumptive or scrofulous diathesis or constitution, in which the seeds of decay may arise independently of inflammation. And guided by what we found the sarcophytes, as representatives of protoplasm, capable of doing in connection with inflammation, we have to enquire, Are these or similar bodies to be met with elsewhere, existing independently of this process?

These sarcophytes, or pale corpuscles, exist in the blood in health, but in very small numbers. It is in the lymphatic system that they are commonly found in the greatest abundance; in fact, this is their normal source and habitation; and they constitute the multitude of organic particles, contained in lymphatic vessels and glands, in Peyer's patches, in the lacteals and mesenteric glands, and in the pulp and Malpighian bodies of the spleen.

'The lymph corpuscles are now universally admitted to be identical in all their characters with the colourless corpuscles of the blood. They show in particular the same constantly varying form, and the same phenomena of contractility as long as they are living; whilst they assume the spheroidal form, which was formerly considered to be their natural shape, as soon as they die. The

ADENOID OR LYMPHATIC PHTHINOPLASMS.

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manipulations, that up to a recent period were adopted for microscopical examination, very easily kill them; and thus a fatal effect is produced by evaporation, by the addition of water, or of saline solutions containing more than two per cent. of salt. Even mechanical agencies, as the weight of the covering glass, are sufficient to rapidly extinguish all indications of life.' (Von Recklinghausen. Stricker's Histology,' vol. i. p. 34.)

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The lymphatic system, then, seems to be the nursery or seed-bed of these flesh-germs, these primary elements of flesh and blood; and, as in that exaggeration of the nutritive process-inflammation-we found these sarcophytes to be the chief agents in the formation of its products-euplastic, cacoplastic, and aplastic-so we may be prepared to expect the same bodies to manifest similar tendencies, in all these varieties, in the lymphatic glands and tissues where they mostly do congregate. And this is what we see completely answered in the diseases of the lymphatic system, which form some of the principal features of what is called scrofula. Take, for instance, enlargement of the glands, which may proceed to such enormous extent by rapid multiplication of these lymph corpuscles as to form large tumours (lymphomata), particularly in the neck, armpits, groins, mesentery, and bronchial glands. These swellings are for the most part indolent, until they become hard or inflame; and then they undergo various changes of caseation, irregular suppuration, and ulceration, with the discharge of a variety of curdy, cheesy, and purulent matters, resulting from the fatty degeneration and disintegration of the enlarged and hardened gland, together with the inflammatory products of the more vascular connective tissue and skin involved in the swelling. In Peyer's patches, and other adenoid appendages of mucous membranes, similar changes occur on a smaller scale, producing tuberculous ulcerations.

In these several lymphatic enlargements, there is considerable difference in the consistence and tendencies of the swelling. It may be simple hypertrophy, consisting of increase of lymph corpuscles and containing tissues in equal proportion; and the result is a soft indolent body, which may attain a large size without causing much discomfort, and may be dispersed without undergoing further change. It is different where the swelling is hard, from the excessive crowding of the lymph cells, and probably also from their harder condition, together with an overgrowth of their fibrous stroma. This crowding must have the effect of lowering their vitality; and if, in addition, they have become hardened, there must be a loss of those remarkable properties of mobility and other vital endowments which distinguish these sarcophytes in their state of healthy activity. Therefore, in proportion as they are crowded and indurated, they will be prone to decay and disintegration, in the way of caseation and softening, a process to be considered hereafter; and their decay may cause the irritation, inflammation, and ulceration of the adjoining tissues.

Thus we find in the morbid changes to which the lymphatic glands are subject another illustration of the rapid production, accumulation, and decay of the protoplastic material, the sarcophytes: in this instance, not necessarily induced by inflammation, but often resulting from hypertrophy or excessive production in the proper receptacles of these corpuscles. But to complete the history, we have to add the notable case of grey or miliary tubercle, which, as we have found, Dr. Burdon Sanderson and Dr. Wilson Fox, in independent investigations on their artificial production, were led to identify with the same lymphatic or adenoid tissue. But they are not merely overgrowths of this tissue. Their hardness and grey colour denote an altered structure, which the micro

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