the expectoration of tubercular matter never ceases until death.

THE ARREST OF TUBERCULISATION IN THE LUNG.

It has been often remarked that tubercular masses have been found in lungs after death when there was no previous suspicion of their existence, and such prove that the deposition, which had been very restricted, had ceased, and that the tubercular matter (always assuming such masses to be tubercular) had undergone some secondary changes. We do not stay to remark upon the fact of the fewness of such cases in proportion to those in which the disease progresses (so that we must not infer that the condition is common), nor upon the further fact, that as in such cases no careful examination had been made for their detection, we are not entitled to affirm that such conditions could not have been diagnosed, since these questions have been treated of elsewhere, but we take them as simple evidences of the occurrence of one form of cure of tubercle.

OBSOLESCENCE, OR ARREST, OF TUBERCLE.

In this form of arrest of tuberculisation we find that a few or many cells have been lost to the lung, and have become filled with, and closed up by, material, whilst the tissues immediately adjoining remain pervious and useful. The tubercle itself has commonly become quite opaque, dry, and calcareous, and the cell walls in which it is inclosed have become dry

and detached. In such cases the tubercle, as an irregular nodular mass, may commonly be turned out of the lung, leaving behind it a small irregular cavity.

How far such a condition is due to a diseased action localised to these few cells at the time of the deposition, cannot be determined; but since whatever disorder may affect the whole, may likewise affect a part of the lung, and since such masses are found commonly in the centre of the apex, or at the part of the least mobility of the lung, it is possible that such a localised action may occur. It is, however, more likely, we think, that at the period of deposition of the tubercle in those particular cells, there was a tendency to its deposition in the adjoining cells also, but that the action was thus arrested by the removal of the conditions to which it was owing. It is in this way that we believe the beneficial action of voluntary inspiration proceeds, for whether we consider with M. Piorry that this remedy facilitates the absorption of deposited matter or not, we can have no doubt that its power to maintain the patency and increase the physical and vital action of the cells would tend, at this period, to prevent the extension of the disease, and to give bounds to that then existing. In this state the material may remain without change, or without inducing change, for an indefinite period.

The expectoration of cretaceous tubercle results from such an accumulation of matter, associated with destruction of tissue and the formation of a communication with a tolerably large bronchial tube, and before its expectoration: it becomes again partially softened

by the introduction of fluid, so that portions become detached, and are spat up in sizes of from a pin's head to a half a grain of wheat, accompanied usually with an imperfect emulsion of the same material, looking like chalk and water. In such expectoration there will be necessarily the débris of the yellow elastic and other tissues; but as the process commenced at a distant period, and the tissues have been long shrivelled, their character is far less evident than is observed in recent softening. Yet it may be that recent softening is proceeding in an adjoining part, and the expectorated matter may contain both products.

Tubercle is also subject to other transformations, as, for example, fatty transformation and the production of cholestrine, but these conditions either precede the cretaceous formation, or they are found in such tubercle as tends to softening and destruction of the tissues.

ABSORPTION OF TUBERCLE.

We have just referred to the opinion of so eminent an authority as Piorry, in reference to the promotion of absorption by a particular mode of treatment; to this we may add the well-ascertained fact of the absorption of inflammatory exudations, although it occurs slowly and seldom quite perfectly, as presumptive evidence of the absorption of tubercular matter; but it must be recollected that commonly, perhaps, the exudation in inflammation occurs rather between the cell walls than in the cells themselves, that is to say, in the parenchyma of the lung, where it cannot be doubted the

more direct vascular actions occur.

Yet there is strong evidence in favour of the absorption of tubercular matter from the air-cells themselves, in the fact that degenerated epithelium in closed cavities must in health be removed by absorption; and also that under our observation the evidences of the deposition distinctly disappear in a stage so early, that the matter, if removed by expectoration at all, must have passed out, not by a cavity and large bronchus, but by the minute opening of the ordinary bronchial tube.

PART III.

TREATMENT.

CHAPTER XXV.

RESTORE THE BULK OF THE BODY BY LESSENING
ELIMINATION.

THE SKIN.

IN discussing the methods of treatment which are adapted to this disease, we purpose first to consider the indications for treatment, and the best method of fulfilling them, and then to give, in an empirical and categorical manner, a detailed statement of the whole plan which we recommend. It will also be necessary to subdivide the former into those conditions which apply to the system as a whole, including the lungs, and those which refer to the lungs and other organs, &c., as local affections. To these we shall also add chapters upon certain questions which could not be fully treated of under those heads.

We have already shown that we have to do with a disease in which there is commonly diminution of the appetite, flesh, and strength, and increased elimination of fluid and loss of heat; and that these conditions