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Similar changes disseminated through adenoid tissues of other
organs—Is the infecting influence specific poison like that of Con-
tagious diseases ?—Facts tend to associate it rather with common
noxious or septic influences, capable of blighting or injuring the

. sarcophytes, as heat does—The most potent infecting matters were

those in a state of common corruption—Few animals, except guinea-

pigs and rabbits, susceptible of artificial tuberculization—Spon-

taneous Miliary Tubercle in Man described—Occasionally pro-

duced by Bronchial Inflammation or Exanthematous Irritation; but

more commonly the result of Dissemination through the Lymphatic

system, as in Artificial Tuberculisation. Clinical experience finds

Tubercles succeed to unhealthy local suppurations; to Caseation

occurring in Lymphatic Clauds, or in other parts ; to grey Consolida-

tions, and other Phthinoplasms previously existing—It has yet to

prove that they may be produced by common wounds in the integu-

ments, as in the experiments of Drs. Sanderson and Fox—But in

these cases of natural production of tubercle, as in the experiments,

some predisposition, or co-operating cause, is necessary—This may

be either defective vitality of the sarcophytes, or some additional

corrupting influence in the body or in the air—Parallel cases of

Pyaemia and Acute Tuberculosis—The latter promoted by Heat,

Damp, and Foul Air; Inflammatory and Chronic Phthisis more by

Cold. Other causes of constitutional weakness favour the develop-

ment of Tubercles, and when in excess may suffice to originate them

in their acute form, exhibiting characters almost malignant—Grey

Tubercles then soft, plump, and without fibre or stroma to circum-

scribe them—Influence of Climate and Altitude on different forms

of Consumptive Disease . . . . . .96

CHAPTER XV.

FAMILY PREDISPOSITION AND CERTAIN OTHER CAUSES OF

CONSUMPTION.

By De. C. Theodore Williams.

Causes general and local — Family Predisposition — Consumption

proved to be hereditary—Opinions of Niemeyer, Virchow, and Wal-

denburg—Family Predisposition explained—Hereditary Tubercu-

losis in sheep, cattle, guinea-pigs—Offspring of Gouty, Syphilitic,

Asthmatic, and Aged Parents often Consumptive—Prevalence of

Family Predisposition—Evidence of Louis, Copland, Cotton, Fuller,

Pollock, Briquet, and the Author—Its more frequent occurrence

among Females than Males—Paternal and Maternal Transmission—

Influence of Age on attack—Private and Hospital Practice—In-

fluence on Symptoms—Cases—Influence on duration—Relations

affected—Age at Death—Conclusions—Other Causes of Consump-

tion—Impure Air, and Improper Food—Continued Fevers—Scarla-

tina and Measles—Cessation of Discharges—Unfavourable Confine-

ments, and Over-lactation—Mental Depression—Damp—Buchanan

and Bowditch's Researches—Dusty Occupations—Consumption not

Infectious . . . . . . . .109

CHAPTER XVI.

HAEMOPTYSIS AND THE HEMORRHAGIC VARIETY OF CONSUMPTION.

By De. C. Theodobe Williams.

Haemoptysis—Its Significance—View of Louis, Laennec, Andral, Wat-

son—Niemeyer's Explanation of large Haemoptysis—His Com-

parison of Bronchial Haemorrhage with Epistaxis inappropriate—

Differences in the Bronchial and Nasal Tracts —Niemeyer's Views of

the Relation of Haemoptysis to Phthisis discussed—Origin of Phthisis

from Haemoptysis unproved and improbable—Author's experience—

Haemorrhage of early Phthisis explained by Fatty Degeneration of

Vessels—Of later stages, by Pulmonary Aneurism—Varieties and

Pathology of hitter—Haemoptysis from Congestion—Influence of

Age and Sex on Haemoptysis—Influence of Stage—Illustrative

Cases—Influence of Form of Disease—Hemorrhagic Phthisis; its

Characteristic Symptoms and Exciting Causes—Examples—Effects

of Haemoptysis in Phthisis; general and local Pneumonia—When

and why set up—Results—Illustrative Cases—Influence of Haemop-

tysis on Duration of Life ...... 138

CHAPTER XVII.

OUTLINE OF PHYSICAL SIGNS OF VARIETIES AND STAGES OF

Pulmonaby Consumption.

By Db. Williams.

Signs of Phthisis originating in Bronchitis—Of Breath-sounds and
Crepitation—Signs of partial Consolidation affecting Percussion;
Tubular Sounds; Expiration and Voice—Situation of Signs—Signs
of Softening and Excavation replace Signs of Constriction—Signs
of Pneumonia passing into Phthisis—Explanation of Loud Tubular
Sounds of Hepatisation—Give place to Gurgling and Cavernous
Sounds—Signs of Abscess —Signs of Phthinoplasms after Pneumonia
—Signs of Contraction and Dwindling, with those of Emphysema —
Signs of Congestion passing into Phthisis, or into Emphysema-
Signs of Miliary Tubercles, scattered and clustered—True explana-
tion of Wavy Respiration, and its value as a sign of Phthisis—

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Subclavian Arterial Murmur—Signs of Caseation and Excavation—

Signs of Miliary Tubercle more scattered; from infecting tendency

—Signs of Extension of Disease—Corruption—Signs of Cure and

Arrest of Phthisis—Complete—Partial—Residuary Lesions and

Signs—Contraction and Emphysema—Calcareous Expectoration

after Obsolescence . . . . . . .168

CHAPTER XVIII.

ABSTRACTS OF CASES ILLUSTRATING THE NATURE, VARIETIES

AND TREATMENT OF PULMONARY CONSUMPTION.

Large number of Cases—Grounds of Selection—Division into Groups

—First group, Phthisis originating in Inflammation—Acute and

Chronic—Pneumonia and Pleurisy—Fibroid and Caseating—Indu-

rations and Excavations—27 Cases ..... 180

CHAPTER XIX.

Aestracts Of Cases, &c.—continued.

Asthmatic Phthisis—Usually originating in Inflammation—Arrested

Phthisis passing into Asthma—Asthma passing into Phthisis—8

Cases ........ 208

CHAPTER XX.

Abstracts Of Cases, &c.continued.

Scrofulous Pneumonia and Acute Tuberculosis; grouped together as

representing the most rapid forms of Phthisis: but Scrofulous

Pneumonia arrested in 3 out of 7 cases—Acute Tuberculosis—

8 cases, all fatal, one in 21 days—Several from purulent infection . 216

CHAPTER XXI.

Aestracts Of Cases, &c.—continued.

Scrofulous Phthisis from Infection through Lymphatics, connected

with Glandular Scrofula, Fistula, Abscess, Purulent Otorrhcea, &c.,

12 Cases; generally arrested several years—Fatal Dyspnoea from

Caseous Bronchial Glands—Empyema threatening Phthisis; Re-

covery . . . . . . . .232
CHAPTER XXII.

Abstracts Of Cases, &c.—continued.

PAGE

Chronic Phthisis and Chronic Tuberculosis—Anatomical difference

between Acute and Chronic Tubercle; Chronic more limited and

local, therefore more tractable—Of First Stage 6 Cases, arrested and

cured—Of Second Stage 5 eases, arrested and cured—Of Third Stage

25 cases, retarded, arrested, or cured: surviving for periods varying

from 3 to 27 years . . . . . . .242

CHAPTER XXIII.

Abstracts Of Cases, &c.—continued.

Miscellaneous Cases—Utero-Gestation in Phthisis—Disease arrested

12 years; healthy child born : death 4 years after from Dropsy, &c.—

Phthisis retarded 10 years; three living and two dead children born

—Phthisis during Pregnancy: death after Childbirth—Phthisis

arrested before marriage; relapse after second Childbirth: arrested

again; and two more children—Phthisis after injury to chest; 2

cases—Pneumothorax: 4 cases; all recovered—Phthisis with Heart

Disease: recovery—Caseous Pneumonia arrested: uric acid neph-

ralgia, eczema, and calcareous expectoration after—Syphilis and

Phthisis: recovery—Senile Phthisis—Phthisis from Inflammation:

Chronic Bronchitis for 30 years after ; death at 84 from Hemoptysis 273

CHAPTER XXIV.

THE DURATION OF PULMONARY CONSUMPTION.

By De. C. Theodore Williams.

Estimates of Portal, Laennec, Andral, Louis, and Bayle compared with

those of the Brompton Hospital, Fuller, and Pollock—Differences

explained by Class of Patients and Mode of Treatment—Author's

Thousand Cases selected from wealthy Classes—Ground of Selection

explained—Method of Tabulation of Cases—Sex—Age of Attack—

Family Predisposition—Origin and First Symptoms—Cases of In-

flammatory Origin; their Proportion and Course of Symptoms—

Haemoptysis—State of Lungs at first Visit as evidenced by Physical

Signs—Classification by Stages adopted, with Restrictions—Majority

of Patients in First Stage, and consequent favourable Prognosis—

Mortality in each Stage—State of Lungs at last Visit—Classification

into 'Healthy,' 'Improved,' 'About the Same,' and 'Worse;' and

Percentage of each—Relative Liability of Lungs to Attack, Excava-

tion, and Extension of Disease—Number of Deaths—Causes—Long

Duration—Living Patients more numerous, and with higher average

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Duration—Present State described as 'Well,' 'Tolerably well,' and

* Invalid'—Large Proportion of First Two Classes—Hopeful Prog-

nosis—Causes of long Duration—Influence of Age and Sex on Dura-

tion—Among Females Duration shorter, Age of Attack earlier, and

Age at Death younger than among Males—Great Age reached by

some Patients—Relation of Age of Attack to Duration—Prolonging

Effect of Inflammatory Origin—Pneumonic, Pleuro-pneumonic, and

Bronchitic—Duration of Pathological Varieties of Consumption

difficult to determine—Diagnosis of Tuberculosis and Caseous

Phthisis obscure ....... 287

CHAPTER XXV.

Tbeatment Of Pulmonary Consumption.Summaby View.

By Db. Williams.

Author's Retrospect of Forty Years—Discovers a Great Improvement

in the Results of Treatment, chiefly due to the introduction of Cod-

Liver Oil and the Tonic Plan—Duration of Life in Phthisis quad-

rupled—Modern Treatment chiefly Sustaining and Tonic; but not

excluding moderate Antiphlogistic Measures, where required; soon

returning to Tonies and Oil—Mode of Action of Oil—Summary of

Directions and Cautions concerning ita use—Necessity of enforcing

its continued use—Adjuvant Remedies—Iodine—Hypophosphites—

Sulphurous Acid—Inhalations—Mineral Waters in Consumption—

Mountain Cure—Air and Climate . . . . .316

CHAPTER XXVI.

TREATMENT OF PULMONARY CONSUMPTION.

Treatment of Forms and Varieties—Acute and Chronic not Synonymous
with Inflammatory and Non-inflammatory—May,be Acute from
rapidity of Decay, as well as from Inflammation—Decided Anti-
phlogistic measures chiefly required for Sthenic Inflammation—In
other cases limited measures—Blisters very useful: their manage-
ment—Croton Oil—Opium, and other Sedatives—Treatment of As-
thenic Inflammation by Stimulants and Tonies—Cautions—Treat-
ment of Sub-acute and Chronic Inflammations; Iodine: Counter-
irritants—Rest and Quiet—Conservation of Strength . .831

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