ture abiding and conforming to the nature and habits of the tissue of the part. This is all euplasia (healthy healing) hardly differing from normal nutrition, and tending to no decay.

But when inflammation becomes intense, or endures long, the hyperplasia exceeds the bounds of euplasia, and the bioplasm suffers in its vital properties, and tends to form products more or less prone to disorder and decay; in other words (as I expressed them forty years ago), the results of the inflammation are less vital and less susceptible of lasting organisation, and constitute a material producing further disorder, and sooner or later falling into decay. We are now able to define more precisely the kind and form of these degraded products of the plastic process, and some at least of the particulars in which they differ from each other, and from the healthy sarcophyte or bioplast, which is the representation of healthy nutrition. For in declaring the corpuscles of the fibrinous exudations of inflammation, pus-cells, and grey and yellow tubercles to be only modifications of the same sarcophytes, which are known as the pale corpuscle of the blood and the lymph globule of the lymphatic system, I only express what all the most recent and most careful observations have concurred to establish. In the remarks preceding the table, and in the table itself (p. 60), an attempt has been made to explain the nature of these variations from the healthy sarcophyte; the truth of this explanation has to be tested by further investigation. In the meantime, a brief further consideration of these elementary variations will supply an intelligible clue to the diverse forms and phases which we meet with in consump

1 In Dr. Burdon Sanderson's interesting lectures on Experimental Pathology, in the Medical Times and Gazette of the present year, and in his able essay on the Process of Inflammation in Holmes's System of Surgery, the reader will find an admirable summary of the most recent researches which have been made on this and kindred subjects.

SCROFULOUS SUPPURATION.

69

tive diseases, and may help us better to understand their

nature.

The first morbid variety of the sarcophyte presented in the table is the pus-cell, which, although still lively and proliferating, is distinguished by its solvent and disintegrating power. This is undoubtedly a frequent element of consumptive disease; for there is more or less of suppuration or ulceration, mixed up with the advancing work of phthisical destruction in the lungs and other parts of the body. But the formation of healthy pus in suppuration and abscess, although consuming and destroying tissues, does not carry with it the progressive habit of destruction, such as we find in true consumptive disease. On the contrary, suppuration tends to rid the body of the destroyed matter; and under the protective and repairing power of the healthy and active sarcophytes and tissue cells of the empty abscess-walls, the breach is repaired and the part is healed. Healthy suppuration, therefore, has no tendency to produce consumption; and I can cite numerous cases of abscess of the lung ending in complete and comparatively speedy recovery.

It is far different in scrofulous abscess, or in any kind of suppuration in unhealthy subjects. Not only is the pus in these instances imperfectly formed, and mixed with flakes and curdy matter, which render the suppuration incomplete and the abscess cold and chronic, and as likely to caseate as to discharge, but the surrounding consolidation is formed of cacoplastic material, tending either to contract or to caseate, according to its degree of degeneracy, and perhaps, too, according to the predominance of the fibroid or of the corpuscular constituents. These results must be referred to defective vitality of the sarcophytes, which, instead of actively completing the processes of clearing, resolution, or suppuration, choke up the textures with an obstructing and decaying matter, which involves them in continued disorder and consumption.

Undoubtedly, also, suppuration and ulceration are largely concerned as secondary results of the softening and breaking up of tubercles and other cacoplastic consolidations of the lung. Where there is intervening healthy tissue with sufficient circulation, inflammation may be excited, and go on to the more complete formation of pus and partial abscess; and often in phthisical lungs little abscesses containing chiefly pus may be found between the tuberculous cavities. The common, and sometimes abundant, presence of pus in the expectoration of the consumptive might be supposed to be another proof in point, but it must be admitted with some reserve, as much of this often proceeds from the bronchial membrane. Still, this is part of the general process of consumption; and where the larynx is also affected with ulceration, we have exemplified another form of the disease-laryngeal phthisis.

There is another relation, which the formation of pus bears to consumptive diseases, which must not be overlooked. The outbreak of pulmonary consumption, even in its most destructive forms acute tuberculosis and scrofulous pneumonia-has, in some instances, been preceded by the existence of an abscess or purulent wound in some other part of the body. The most common case is that of fistula in ano, but I have known the sequence after abscess in the jaw, in the cervical glands, in the inguinal glands, and lumbar abscess, and not always in cases distinctly scrofulous.' The sudden healing of old ulcers, and of the suppurating wounds of setons and issues, is often quoted by authors as a cause of pulmonary consumption; but it is not clear that the cessation of the discharge may not be due to the morbid change in the lungs having already begun. Compared with the artificial production of tubercle in animals, which we shall hereafter notice, it appears as likely that the presence of 1 Examples will be given in the abstracts of cases.

PYÆMIA AND TUBERCULOSIS.

71

pus in any part, whether by production or inoculation, may have a deteriorating influence on the sarcophytes of the blood and lymphatics, as that the cessation of suppuration should have a similar effect. But it is quite rational-and, perhaps, the safest view-to admit both influences in different cases. A comparatively healthy subject may, under some unknown conditions, get his blood contaminated by the occurrence of suppuration in any part of the body. A scrofulous subject, whose blood already abounds in sarcophytes of low vitality, which have been habitually drained off by a suppurating wound, is likely to suffer from their accumulation and mischievous effects in other parts, if this wound be suddenly healed. In the latter case, the decaying material, which was escaping from the body, is retained. In the former case, a deteriorating or decaying influence set up in a part is communicated to the contents of the lymphatics or bloodvessels, and results in a degeneration of sarcophytes into pus-cells or concrete adenoid corpuscles; and thus, under certain unknown conditions, a suppurating wound may produce pyæmia or tuberculosis-I say unknown conditions, for the sequence is rare compared with the very common process of local suppuration; but as the occurrence of pyæmia seems to be promoted by close habitations, foul air, and concentration of animal effluvia, so it may probably be found that similar influences, associated with damp soil and malnutrition, favour the production of tuberculosis as a result of the deteriorating influence of a local suppuration on the living sarcophytes. The zymotic character of these developments of pyæmia and tuberculosis may be further argued from the increasing evidence which we have of the preventive and salutary influence of antiseptics, and, above all, of the pure dry air of a healthy locality; or, better still, of a high mountain. This subject will claim our attention again under the head of Treatment.

CHAPTER X.

VARIETIES OF CONSUMPTIVE DISEASE: INFLAMMATORY

PHTHINOPLASMS-continued.

Red and grey Indurations of the lung; consist of multiplied concrete Sarcophytes, with more fibroid, tending to contract and wither; with less fibroid, tending more to caseate and excavate-Varieties and Results---Obsolescence and Calcification.

LEAVING the suppurative element of consumption, we now come to that which consists in the sarcophytes becoming concrete and comparatively inactive, although they retain at first their proliferating powers, so that they multiply into numerous cells, which stuff and condense the containing tissue. This, in the pulmonary texture, forms a consolidation, at first red and of moderate firmness and consistency; but as the multiplying cells supersede the blood-vessels and their contents, the solid becomes harder and of a light buff colour, which may be rendered more or less grey by the black pulmonary matter which is not removed. This consolidation may occur in small spots, or in lobules, or may extend to one or more lobes. The latter more diffused variety commonly arises from pneumonia or pleuro-pneumonia of a subacute or chronic type, and occurs chiefly in the lower and middle lobes; whilst the lobular or more limited variety may originate in phlegmonous bronchitis, and affect the upper lobes in preference. It is this last kind of consolidation which is induced in persons habitually exposed to cold and damp, or to the inhalation of an atmosphere containing dust of