The Mucous Membrane Of The Alimentary Tract, especially of the stomach and large intestines, is also in a state of more or less developed blennorrhoea; and, towards the end of phthisis, an acute softening of the mucous membrane of the great cul de sac of the stomach is not of uncommon occurrence.

The liver is very frequently affected; the condition known as nutmeg liver, and depending on a morbid separation of the yellow and reddish-brown substances, with a preponderance, and more or less fatty degeneration of the former, is extremely common, and so, also, is the true fatty liver. These changes in this organ are not peculiar to phthisis, - that is to say, to the softening of the tubercles and the tuberculous ulceration of the pulmonary tissue, - but are associated with tuberculous disease generally.

The spleen exhibits no constant change which stands in any essential connection with tuberculous ulceration of the lungs.

The right side of the heart appears sometimes to be dilated, in consequence of the impermeability of the lungs, induced by tubercle and its consecutive diseases; it is, however, much more frequently remarkably small, pale, and devoid of fat, in consequence of the anaemia which accompanies phthisis in its progress. In the former case we find stasis and accumulation of blood in the right side of the heart, and from thence, in the whole venous system; in the latter, there is a general deficiency of blood, and a contracted aortic system.

The central organs of the nervous system exhibit no essential anomaly, although, as a consequence of acute phthisis, we not unfrequently observe hyperemia of the brain and its membranes, and recent serous effusions into the ventricles, associated with white (hydrocephalic) softening of the cerebral substance.

The muscles are all emaciated in an extreme degree; the fat is, in most cases, almost entirely consumed, and the cellular tissue, especially on the extremities, is very often in an infiltrated condition.

Tuberculous pulmonary consumption is unquestionably curable, as we may infer from the appearances not unfrequently observed in the dead bodies of persons who formerly had more or less suspicious thoracic affections, and subsequently recovered. It is only by the investigation of the conditions under which these natural cures take place, that we can hope to arrive at a truly rational mode of treatment, and the results will be the more beneficial when directed against the tuberculosis generally, and not merely against the pulmonary abscesses. Pulmonary phthisis, or tuberculous ulceration of the lungs, can only be healed when the general disease, and consequently the local process on which the ulceration depends, is eradicated. There are incontrovertible facts to show that, under these conditions, pulmonary abscesses may actually heal in various, ways.

a. The reactive inflammation of the interstitial tissue in the vicinity of the caverns gives rise, as has been already mentioned, to a gelatinous infiltration which causes an obliteration of the air-cells. By this means the whole of the adjacent parenchyma is converted into a dense, fibro-cellular layer of varying thickness. While this is taking place, the exudation, which is deposited by the same inflammatory process on the walls of the cavern, becomes organized from this fibro-cellular tissue into a smooth serous membrane. The whole cavern is now converted into a cellulo-serous cavity, whose inner surface secretes a serous, viscid fluid resembling synovia. The bronchial tubes, which open into these cavities, present a peculiar character, for the serous membrane lining the cavern, and the subjacent fibro-cellular tissue project beyond the outer stratum of the bronchial tubes at their openings, and their mucous coat hangs forward with a wrinkled, somewhat inverted free edge into the cavity.

More commonly, however, we find the caverns lined with a villous, cellulo-vascular, more or less deep red layer resembling mucous membrane, which is intimately connected with the subjacent tissues. It appears in a constant state of irritation; and, as we generally find in caverns with which large bronchial tubes communicate, its conversion into a smooth serous membrane appears to be impeded by the irritation induced by the constant entrance of atmospheric air. An already formed serous investment may doubtless be again reduced to this cel-lulo-vascular mucous membrane-like state, in consequence of this continuous influence. It secretes a torpid, muco-serous fluid, and it is not unfrequently observed to be covered with fresh exudations in consequence of higher degrees of irritation. It is extremely probable that these processes of irritation, associated with other causes presently to be described, effect the gradual diminution and finally the closure of the caverns. In cavities of this sort, the form of the bronchial openings is somewhat different from that which has been already described; for the bronchial mucous membrane coalesces with the lining'texture of the cavern, which is analogous to its own tissue, and they merge into one another without any apparent line of demarcation.