RC311 W72 1891

PREFACE.

As some years have elapsed since this book was announced for publication, some apology might be expected for the delay in its appearance. But although I could plead personal excuses for this delay, I hope that our readers will find the most satisfactory apology in the clearer light which we have been enabled to throw on our subjects, derived from some of the most recent discoveries in histology. I have long been led to the general inference, that Consumptive Diseases arise from a defect in the living plasma, or formative material, from which textures are produced and nourished; but it is only within the last few years that the nature and properties of this plasma or germinal matter have been made known through the researches of Lionel Beale, Recklinghausen, Stricker, Cohnheim, Max Schultze, and others; and it is not until now that we have been able to carry our inferences, connecting this matter with consumptive disease, into any precision of detail. The whole subject still teems with matters for further research; and many of the conclusions, to which we have been led by analogy and reason, will have to be brought to the additional test of direct observation and experiment.

A very cursory glance through the pages of this work will suffice to show that its great object is practical: to

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find out and explain what nature and art have done, and may do, in the treatment of a disease, which has been commonly considered one of the opprobria medici: and the introduction of theoretical views as to its intimate nature is so far from being unpractical or unprofitable, that these views are really the results of extensive observation and experience; and without some generalisation of this kind, the multitudinous facts and opinions with regard to Pulmonary Consumption are at the present day in a state of incomprehensible and unmanageable confusion. Any reasonable attempt to bring this chaos into order can hardly be objected to; but the competency of any individual who makes the attempt may be fairly challenged.

In assuming (or rather resuming) the position of an expositor of the nature of Pulmonary Consumption, I trust I may be excused the egotism of alluding to the facts: that during a period of nearly fifty years it has been one of the objects of my most constant study :—that under the tuition of Alison, Laennec, Andral, and Chomel, I learned what those distinguished men had to teach, at the bedside, and in the dead-house :-that in the subsequent twenty years, the knowledge thus acquired was continually applied and extended, especially in St. George's and University College Hospitals, successively; where I attended the wards almost daily, and never missed the post-mortem examinations; at the latter hospital always superintending them myself:-that during this period the publication of several works sufficiently proved my proficiency in the diagnosis and pathology of diseases of the chest, whilst, in the successive editions of the Prin

ciples of Medicine,' were analysed and applied the leading facts and opinions in General Pathology and Therapeutics:—and, lastly, that my experience in diseases of the chest in private practice during the last forty years has probably not been exceeded by that of any other physician :-all these proofs of qualification being taken into account, I trust that the present attempt to place in a clearer light the nature and varieties of Pulmonary Consumption will not be deemed presumptuous or premature, and will be not the less favourably received in. conjunction with an account of modes and results of treatment, which give evidence of considerable improvement on any former experience on record, and afford encouragement to hope for still further success in the future.

It is not possible to convey in a few words the views on the nature of Phthisis, to which I have been led by observation and reflection on the facts and opinions of others as well as my own: but the popular terms decline and consumption are the most significant which I can employ to represent them. I believe Pulmonary Consumption to arise from a decline or deficiency of vitality in the natural bioplasm or germinal matter; and this deficiency manifests its effects not only in a general wasting or atrophy of the whole body, but also in a peculiar degradation, chiefly in the lungs and lymphatic system, of portions of this bioplasm into a sluggish low-lived, yet proliferating, matter, which, instead of maintaining the nutrition and integrity of the tissues (which is the natural office of the bioplasm), clogs them and irritates them with a substance which is more or less prone to decay,

and eventually involves them also in its own disintegration and destruction. This degraded bioplasm, which I will call phthinoplasm (wasting or decaying forming-material), may be thrown out locally, as a result of inflammation; or it may arise more spontaneously in divers points of the bioplasm in its ordinary receptacles, the lymphatic glandular system; and then it commonly appears in the form of miliary tubercles, scattered through the adenoid tissue of the lungs.

I would characterise all consumptive diseases heretofore classed under the terms Tuberculous and Scrofulous, together with the products of low and chronic inflammations, as instances of a lowered vitality of the bioplasm; and I would strongly insist on their being totally distinct, on the one hand, from cancer and other malignant diseases, the characteristic of which is a new kind of vitality, a new growth, perhaps parasitic, with new organic elements, foreign to those of the tissues which they invade and destroy:-and, on the other hand, distinct also from total loss of vitality, death of the bioplasm, which would speedily result in decomposition, gangrene, and putrefaction: to such a result phthinoplasms do occasionally lead, but it is not a part of their common history. That this latter distinction is not sufficiently observed by some German writers is evident from their applying the term necrobiosis to caseation, which, although a process of decay from lowered vitality, does not indicate the absolute death of every living part, as in a slough or gangrene. It will be seen in the chapter on Fatty Degeneration (which thirty years ago was a special object of my study), that I have traced a resemblance to vegetable life in its