but may be found also both in the interior of the air-cells, and in the smaller bronchial tubes. I have seen it in all these situations, both in uninjected and injected specimens; and I have reason to believe that it sometimes occurs within the coats of the blood-vessels themselves.* Either it is variously dispersed throughout the lung's apex, or it is accumulated in some one or more particular lobules, the exact form of which it will occasionally assume. In the more rapid and severe forms of phthisis, any part of the pulmonary structure may become its nidus; this we see well exemplified in those cases, generally connected with a previous attack of pneumonia (of which more will be said hereafter), where the universality of the morbid product has gained for it the term "tubercular infiltration".

The bronchial glands often become the seat of tubercle, not only in early but in more advanced life; indeed, in phthisical children, these organs, far more frequently than the lungs, are found in a tubercular condition. In such instances, it is perhaps difficult to determine whether the glandular affection is secondary or not to the pulmonary one; —that is to say, whether the tubercular substance is first formed in the lungs and afterwards removed, by the process of absorption, to the glands; or whether it is originally deposited in the glands themselves. I believe, however, that the disease

* See the remarks upon Hæmoptysis.

of the glandular structures is rarely the primary one, because we always find that its frequency is in direct proportion to the early age of the patient, or, in other words, to that period of life during which the functions of nutrition and absorption are the most energetic. And it is somewhat confirmatory of such a view of the subject, that tubercle in these organs is less liable to soften than when it occurs in the lungs; as this gives to the whole action the appearance of being a special one, designed to accomplish a salutary object.

CHAP. IV.

THE CURABILITY OF CONSUMPTION.

PRIOR to the appearance of tubercle, phthisis is very frequently within the control of remedial measures; and numerous cases, which, if but for a short time neglected, would pass on to a more obstinate stage, may, under proper treatment, be completely restored.

When tubercles have been once deposited, the prospect of recovery is diminished, although modern medicine has now fully proved that it is very far from being hopeless. Under favourable circumstances, the tubercular deposit may become absorbed, and the health perfectly restored; or, the tubercle may remain latent, and unproductive of any serious inconvenience, for a very considerable time-perhaps even during a long life, the patient being able, under proper care, and by the exercise of discretion, to enter with so much freedom into the duties even of an active life, that, were it not for the chance of some depressing cause subsequently reviving the disease, a cure might be said to have been effected.

The possibility of tubercle becoming absorbed

has been much questioned; but I have witnessed so many instances in which the recovery was complete, and all evidence of pulmonary disease was entirely dissipated, after every general and physical symptom of tubercular deposition had been most unmistakeably manifested, that I cannot for a moment doubt its occasional occurrence,-less often, it is true, than we could desire, but still sufficiently frequent to encourage hope, and to lead to a steady perseverance in those measures which are likely to promote it. We well know that scrofulous enlargements of glandular and other organs sometimes completely disappear, in consequence of their contents becoming absorbed, under the influence of a healthy reaction of the system; and that the morbid secretion rarely softens unless the patient's health is still declining. And we are justified in concluding that, were a similar reaction attainable in phthisis, there would be an equal chance of the like result; the difference in this respect observable in the two forms of the disease, simply depending upon the greater impairment of health which ordinarily attends consumptive cases.

When the amount of tubercle is too great for absorption, or the powers of the patient are unequal to its accomplishment, a cure may still be effected by means of the calcareous transformation already spoken of. In proportion to the completeness of this process, the tubercle

is deprived of its destructive properties, and is either expelled by coughing, or remains impacted in the pulmonary structure, surrounded sometimes by a kind of cyst, and unproductive of subsequent inconvenience, just in the same way that foreign bodies are frequently known to do, in other parts of the system. If, in addition to this, the patient's health can be so restored that no fresh tubercle is deposited, this petrifying process may prove a completely curative one.

That such occasionally happens cannot be questioned, as chalky bodies are sometimes found in the lungs of persons who were not suspected of being phthisical, but who died from other diseases; and I have myself seen cases of perfect recovery, after they had been expectorated. Calcareous transformation is undoubtedly a salutary action, seldom occurring except in conjunction with other favourable symptoms; and although it will too often prove an unsuccessful attempt at cure, the evidence of its existence as afforded by the sputa may be always hailed as a good omen.

The softening of tubercle, and its subsequent expulsion, is yet another mode by which it has been thought that consumption may be cured. I have certainly seen a few cases, in which, after the most unequivocal evidence of tubercular softening, all the active symptoms of pulmonary disease com