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occurrence in the third stage by cicatrization, is the most perfect, that of its occurrence by cretaceous transformation is the most common, and the evidence of its occurrence in the first is the least common,-a circumstance, however, which does not lead us to believe that it is really the less frequent; but, on the contrary, that all trace of the disease is removed in the earliest stage by absorption.

That tubercular matter can be absorbed, we know from the fact that it is often removed in this way, when deposited in glands. Rokitanski believes that miliary tubercles undergo a kind of metamorphosis, which he calls obsolescence, by means of which the tubercle, after it has passed through its condition of crudity, loses its shining appearance, and increases in density, becomes converted into a small hard lump, and then shrinks into a tough amorphous or slightly horny mass -cornification. This forms the basis of a complete destruction or death of the tubercle, and no further metamorphosis can take place.

The chalky and calcareous concretions, which are so often found in the summits of lungs, are invariably, we believe, acknowledged to be the results of the transformation of tubercles. According to Rokitanski, this never occurs in tubercle in its original form, being confined to the dissolving and dissolved blastema; and in connection with this, it is worthy of note, that transformation commences, as softening does, at the centre of tubercles. Dr. Valleix has observed tubercles having a hard calcareous concretion at the centre, round this cretaceous matter, and at the circumference a layer of tubercular matter. Boudet believes that the transformation may take place at all the stages,-grey granulations, crude, or yellow or softened tubercles. Be this as it may, the fact of cures accomplished by this process is established.

So also it is proved that cavities may be healed by cicatrization; by contraction with chalky or calcareous concretion; or by the formation of a thick tough fibro-cellular lining membrane, the cavity remaining persistent.

Nor are these pathological changes unfrequent. Professor J. H. Bennett found concretions and puckerings of the lungs in 28 out of 73 bodies. Rogée states, that of 100 aged persons who died at the Salpêtrière, 31 had concretions and other traces of tubercular disease of the lungs. In five of the cases he found cicatrices of cavities which had healed; and he states, that in the course of a single year he had been able to collect ten or twelve incontrovertible examples of the same kind. Nor is this fortunate issue confined of necessity to cases in which the disease has been of very limited extent; for Dr. Bennett has recorded the case of a man, who, at the age of 22, laboured under all the symptoms of deep decline, but recovered, and died at the age of 50 of an affection of the brain. The apices of both lungs contained cretaceous tubercles, and were puckered, and the cicatrix at the summit of the right lung was from a quarter to three-fourths of an inch in breadth, and three inches in length. When we remember the tendency which all cicatrices have to contract, it will be evident that one of this kind must have resulted from a cavity of very considerable size.

Laennec, one of the earliest writers who enter very fully into the curability of consumption, found, on examining the lungs of many persons who had died of other diseases, appearances such as would result from the healing of ulcers or burns on the surface of the body. He remarks:-" After I was convinced of the possibility of cure in the case of ulceration of the lungs, I examined these remains more closely, and came to the conclusion, that in every case they might be considered as cicatrices." After detailing, at considerable length, the peculiarity of these appearances, he observes:"This fact seems to me to leave no doubt of the nature of these productions, and of the possibility of the healing of ulcers in the lungs. The foregoing observations, I think, prove that tubercles in the lungs are not a necessary and inevitable cause of death, and that cure may take place in two different ways after the formation of an ulcerous excavation; first, by the

cavity becoming lined by a membrane; and secondly, by the obliteration or closing up of the cavity by means of a cicatrix." Dr. Carswell, late Professor of Morbid Anatomy, at University College, observes—

"The important fact of the curability of the disease has, in our opinion, been satisfactorily established by Laennec. All the physical signs of tubercular phthisis have been present—even those which indicate the existence of an excavation—yet the disease has terminated favourably, and its perfect cure has been demonstrated by the presence of a cicatrix in that portion of the lung in which the excavation had formerly existed. Pathological anatomy has, perhaps, never afforded more conclusive evidence in proof of the curability of a disease than it has done in tubercular consumption."-Cyclop. of Pract. Med., Art. Tubercle.


Dr. Swett, one of the physicians of the New York City Hospital, and Professor in the Chair of Medicine in the University Medical College, in his published Treatise on Diseases of the Chest,' considers the curability of consumption, and gives his opinion unhesitatingly in the affirmative. He asks the question—

“Is consumption a curable disease? The general impression in the medical profession, to its disgrace be it spoken, is, that a patient with phthisis is doomed to death. If those cases only are considered in which the disease is so far advanced in its progress that it is easily distinguished, this opinion, on the whole, is well founded; yet, even under these circumstances, unexpected recoveries take place. I shall never despair of the life of a patient with phthisis when I recollect what I once witnessed in this hospital."

Dr. S. then proceeds to detail the particulars of a case which presented all the symptoms of consumption in its most advanced stage. So marked were the indications of a large cavity in the right lung, that he was accustomed to speak of the case as being of an undoubtedly incurable character.

"On one occasion,” he continues," I found the patient, who had been gradually sinking, in such a state of extreme exhaustion that it seemed to me improper to disturb him. He was bolstered up in

bed, with his head resting on his shoulder, breathing with great difficulty, bathed in perspiration, and with a feeble and rapid pulse, He looked like a dying man. The next day my attendance ceased."

On the doctor's return, at the end of two months, he found this dying patient was so far recovered as to be able to walk about, and continued steadily to improve. He then goes on to tell us that


during the past fifteen years he has known many persons who had all the symptoms of consumption in advanced stages, yet finally recovered." And again: "For the past fifteen years I have been in the habit of examining the lungs of all my patients, dying of every form of disease, for traces of phthisis that had been cured. I have been astonished at the number of cases which have presented evidence of this favourable result."

Many examples of cicatrisation of the lungs, after tubercles, are recorded in Andral's 'Clinical Medicine' (book iii. p. 382). These cases are more extraordinary than those given by Laennec, and, together with them, put the fact of the healing of tuberculous excavations beyond all question; or, to use the language of Bonet

"Curatio non est desperanda, etiam jam exorto ulcere."

Thesaurus Medico-Practicus, p. 57.

Such facts surely teach us a lesson of no little importance; they cannot but tell us that despair is unwise, that we may hope even for our consumptive patients; and that hoping we are bound to use all the appliances which our art makes known,—medical, hygienic, climatic,—to bring about what some will call an arrest, what others will designate by the more cheering name of recovery, but what, call it as we may, is in numberless instances a priceless boon.

With this weight of testimony, however, in support of the curability of the disease, we look in vain, through the several works from which I have quoted, for one that can point out the means by which that cure can be effected. Most writers give to nature the credit of accomplishing the recovery when it does really occur. But if Consumption be curable by the

operations of nature, in even a single instance after it has reached its worse stage, when the lungs are broken down into cavities, it must surely be within the reach of art to aid nature so far as materially to increase the frequency of such recoveries.

The RATIONALE of inhalation is exceedingly simple, and it will be at once evident to ANY reader, medical or non-medical, who will give the matter a minute's consideration, that this plan of treatment is based upon strictly scientific and correct principles,—for it requires no professional learning to perceive that, from the relative position of the stomach and lungs, remedies must necessarily be more effective in diseases of the lungs, when introduced into the whole of the aërial cavity of those organs, than when exhibited through the stomach, where they must undergo great and unknown changes, from the process of digestion, &c., and can only reach the seat of disease by means of the circulation.

There is also another advantage which inhaled medicines have over those given in a solid or fluid form, to which allusion has not yet been made: medicines act with greater power and more speedily when minutely divided, just as the solution of any substance takes place most rapidly after the cohesion of its particles has been overcome. The more completely the cohesion, which holds together the active elements of medicinal substances, is overcome before their administration, the more rapid and salutary are found to be their effects. The daily experience of every physician proves this, and its rationale can easily be understood. Before crude medicines can exert any action upon the system, they must be decomposed in the stomach and their active principles eliminated. Until this separation has taken place, they cannot extend their action beyond this organ. Poisons, even of the most deadly character, have been known to lie in the stomach for hours, and afterwards to be washed out, without having exerted any injury upon the system. Others, again, prove fatal within a few moments of the time they are swallowed. The difference in

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