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not the less instructive, since they serve faithfully to exhibit all the facts under observation, and thus to counteract any tendency to hasty generalization.

I may mention that one of these patients, J. L., originally entered as having phthisis in the third stage on one side only, but yet with unmixed purulent expectoration, has been carefully examined with a view to the question just proposed, namely, the cause of the admixture of frothy with purulent expectoration. The result of the examination is instructive. The entry was incorrect. There is not only gurgling rhonchus in the left subclavicular region, but cavernous metallic cough in the right interscapular region.

Phthisis, therefore, exists in its third stage on both sides. The patient to whom I refer coughs up the porraceous expectoration of peculiar tint, which I now show you, and which is of the kind usually occurring within two or three weeks, sometimes only a few days, of death. He is rapidly losing strength, and I fear the issue will soon determine the correctness of the indication.*

* This patient died sixteen days afterwards.

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* The figure 1 represents the stage of phthisis preceding softening; 2, that of softening; and 3, that in which vomica is detected.

Let me take this opportunity of calling your attention to two preparations, on the table, of fibrinous. moulds, resembling in form the roots of plants, which have been coughed up from the bronchial tubes. One of them is from a middle-aged woman residing in the country, usually enjoying good health, and not presenting any physical signs of pulmonary disease; who, without any preliminary symptoms excepting a sensation of coldness in the chest, has, during the last four years, repeatedly expectorated these branched concretions. I cannot learn that she ever had hæmoptysis. I know little of the history of the other case, but believe that both patients are at present in tolerable health. Examples of this complaint are rather rare, but you will find descriptions of these "bronchial polypi," as they are termed, given by Dr. Warren,* and by Mr. North. They are also figured by Dr. Carswell. Spitting of blood, although not constant in these cases, occurred in the two recorded by Dr. Watson.† Those two patients are stated by Dr. Watson to have occupied chambers warmed by Arnott stoves; but no such stove is used by the countrywoman whose case I have described. I do not think that these bronchial concretions have any relation to phthisis, or that hæmoptysis is a necessary element.

In one of the cases above noticed, Dr. Todd suggested, as a probable explanation, that a chronic and limited inflammation of certain of the bronchial tubes first occurred, not disclosing itself by any marked symptoms,

* Medical Transactions, Vol. I.

+ Lectures on the Principles and Practice of Physic. 3rd Ed., Vol. II., p. 58.

but leading to the formation of tubular membranes ; that after a while these membranes began to be detached; that hæmorrhage resulted and continued till the separation was complete; and that at the same time. some of the extravasated blood coagulated in the airtubes, took their shape, and was afterwards expectorated. There is some difficulty in applying this explanation to all the instances in question. Opportunity may occur to me for the further prosecution of this subject; at present I will only propose the inquiry, whether the cause may not be a condition of blood requiring the elimination of fibrine, the direction to the bronchial tubes being sometimes a result of some accidental circumstance, rather than of inflammatory action, the proof of which was certainly wanting in the countrywoman, from whom one of the preparations before you was obtained.

In the course of this lecture I have referred to the microscopical examination of the expectorated matter. Some months since I attended a patient in whom the principal symptom was dull sound on percussion, attended with increased vocal thrill as communicated to the hand, over the greater part of the right side of the chest, but without any accompanying symptom adequate to determine the question whether the pulmonary consolidation was the result of inflammation, or of tubercular deposition. Some of the expectoration which presented a flocculent aspect, having been placed under the microscope, exhibited the peculiar granular character distinctive of tubercle, as is well represented in the drawing.* In this patient there is no evidence of

* Plate I.

you

the existence of vomica, and the tubercular affection has not made progress. It is therefore reasonable to conclude that the tubercular material is chiefly eliminated on the bronchial surface. Such an instance, however, of information thus derived in the first stage of phthisis is probably rare. In the way of diagnosis, as derived from the sputa, I fear you will not find the microscope aid much. Now and then the presence in the expectoration of fragments of bronchial tube, or of pulmonary structure may furnish evidence of disorganising disease. I could indeed give you an instance in which the existence of advanced phthisis was thus detected on the examination of a drop of expectoration sent from a distance, and microscopically examined; but, at this advanced stage of disease, other conclusive signs are usually present, and yet the microscopical testimony may prove insufficient. At any period, unless much practised in such investigations, you may be embarrassed by the great variety of substances combined in the expectorated matter. In a specimen now under the microscope you will find, in addition to pus and mucus globules, chloride of sodium, epithelium from the mouth, muscular fibre, vegetable fibre, and also tartar from the teeth,-the materials of a meal having remained entangled for a considerable time afterwards. Nevertheless the investigation, although limited in its practical utility, opens views of no common interest.

I have already mentioned that, on examining microscopically the expectoration of W. J., I observed a peculiar object resembling a conferva, such as I had never before seen, but not much unlike the torula of yeast. A reference to the paper of Dr. Hughes Bennett

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