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Credit: The study of medicine (Volume 2). Source: Wellcome Collection.
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![When the morbid action commences in the abdominal organs, it far more readily passes into those of the chest, than when it commences in the chest, into those of the abdomen ; instances of which have been sufficiently noticed under the complicated species of Parabysma.—(Vol. i., Cl. I., Ord. II., Gen. IV., Spe. 7 ) These, how- ever, are extreme examples ; for, in most cases of tubercular phthisis, the disease has made far less progress at the time of its proving fatal, and is often confined to the seat of the lungs alone, and even to an evolution of tubercles of minute size and uniform simplicity of contents, mostly consisting of a whey-like or cheesy material. A certain but low degree of inflammatory action, however, seems to favour a more rapid forma- tion of fresh tumours, and an enlargement of those already in existence ; and the same may be observed of the accompanying hectic fever. If this be decided and considerable, the disease may run its course in four or five months, and sometimes sooner. If the hectic be undecided and only occasional, the disease may play about the system for some years, and at length prove equally fatal. If the inflammatory action exceed the low degree we have just adverted to, ulcer- ation and suppuration usually follow, and the tu- bercular form passes into, or is united with, the apostematous. M. Louis, like his friend M. Laennec, refers every case of phthisis to a tubercular origin ; and where the predisposition to the formation of such growths is very predominant, he has traced them, in post-obit dissections, to a still wider range than the example furnished by Mr. Langstaff; in various instances, indeed, over al- most every viscus of the abdominal, as well as of the thoracic cavity. In one or two of these, he has even found the tubercular structure to have been far more manifest and elaborated than in the lungs, and especially in the stomach, the mesenteric glands, the ileum or jejunum, but rarely in the duodenum. But he positively as- serts that he has never traced these morbid ap- pearances in other parts, without some kind of manifestation of them in the lungs : and he hence concludes, that a development of tubercles in this last organ is essential to their formation else- where. So far as he has examined, however,— and his field of observation has been very ex- tensive, as well as closely followed up, in the Hopital de la Charite,—phthisis has seldom limited its structural ravages to the region of the lungs. Tubercles, or ulcerations, have usually been detected elsewhere on dissection ; often, indeed, in the trachea, larynx, and epiglottis, and occasionally in the pharynx and oesophagus, as well as in the stomach. And when the hectic has been active, there is scarcely an organ but what he such parts. Transparent cysts are very common in the diseased lungs of pigs, where they even ex- ceed tubercles in number ; and it seems to M. An- dral, that this fact is the chief ground of the opin- ion that tubercles commence in the shape of hy- datids. He also warns us not to mistake the de- position of tubercular matter around hydatids (an instance of which he met with in a rabbit) for Ihe conversion of vesicles into tubercles.—Ed. has found at times entering more or less into the general circle of action ; as the large intestines, the liver, the spleen, the peritoneum, the lym- phatic glands, the aorta, and even the brain. The heart, and the urinaiy organs, have usually escaped with less structural injury than any others.—{Recherches Anatomico-Pathologiqucs sur la Phlhisie, par P. Ch. A. Louis, Paris, 8vo., 1825.) ' With one exception out of 350 dissections, whenever M. Louis found tubercles in the lungs, he always found them in other organs.* In a few instances, however, Laennec found tuber- cles to commence in other parts, especially in the mucous membrane of the intestines, and in the lymphatic glands, their formation in the lungs having been secondary.—{Laennec, op. cit., p. 285.) The occurrence of tubercles in various organs without the presence of any in the lungs, has been noticed by M. Andral more frequently than by M. Louis. Such cases are more com- mon in children than adults. In the former, there is a disposition to tubercles in a larger number of parts at once ; and the organs most frequently affected in them are not the same as in the adult subject. The parts which are most frequently the seat of them in the adults are, first, the lungs, and then the small intestines : in children, first, the bronchial glands ; secondly, the mesenteric glands; thirdly, the spleen ; fourthly, the kidneys ; and fifthly, the intestines, &.c. In children under fifteen, tubercles are least frequent between the first and second years of their age ; and most common from the end of the fourth until the commencement of the fifth. —(Anat. Pathol., torn, i., p. 424.)] Phthisis, as already observed, is a disease of high antiquity, as well as of most alarming fre- quency and fatality. So frequent, indeed, is it, as to carry off prematurely, according to Dr. Young's estimate, and the calculation is by no means overcharged, one fourth part of the in- habitants of Europe (On Consumptive Disea- ses, ch. hi., p. 20) : and so fatal, that M. Bayle will not allow it possible for any one to recover who suffers from it in its genuine form.—(Re- cherches sur la Phlhisie Pulmonaire, Paris, 1810.) I can distinctly aver, however, that I have seen it terminate favourably in one or two instances, where the patient has appeared to be in the last stage of disease, with a pint and a half of pus and purulent mucus expectorated daily, exhausting night-sweats, and anasarca ; but whether from the treatment pursued, or a remedial exertion of nature, I will not undertake * Recherches sur la Phthisie, &c, p. 179. In the 350 post-mortem examinations mentioned in the text, M. Louis found tubercles in various or- gans besides the lungs, in the following propor- tions :— In2-3 of subjects, small intestines ; in l-'l large intestines ; m 1-4, mesenteric glands ■ in 1-10 the cervical glands; in 1-11, the lumbar gla,no«; i 113, the pr0state ; in l'U> the spleen in 1-20, the ovaries ; in 1-40, the kidneys • 1 wi' the womb ; 1-350, the brain; 1-350, the cerehpl lum ; 1-350, the ureter. M. Louis makls nn «»„ Hon of tubercles ,n the testis, which are COmmon. nor does he say any thins about fh~il mon : formation in the bones -Ed occasional](https://iiif.wellcomecollection.org/image/b2112324x_0042.jp2/full/800%2C/0/default.jpg)
