The Consumption Of Textures would here remain inconsiderable, but for the breaking down of fresh tubercle in the proximity of the original ulcer. Inflammation here plays an important part.

(a.) This production of fresh tubercle in the vicinity of that softened, and of the resulting primitive cavity, - at the margin and base of the primitive tubercle-ulcer, upon superficial expansions, - determines the enlargement of the ulcer in all directions, - the textures becoming again and again corroded and necrosed by the fresh softening tubercle. And this takes place with a rapidity proportionate to that of the softening of the secondary tubercle - the product of an exalted cachexia. Another accidental mode of enlargement of the ulcer consists in two or more ulcers, already advanced in the way described beyond the primitive condition, merging in a single one. The result is an ulcer marked by its irregular, indented form, - upon mucous membranes, by serrate, jagged edges, - in muco-membranous canals by its affecting the girdle shape. The manner of its development, and its characteristic form, so different, especially on mucous membranes, from that of the primitive ulcer, fairly entitle it to the appellation of secondary tubercle ulcer.

The destruction of textures involved in this process, as corrosion and necrosis through contact with tubercle-pus, constitutes the tuberculous phthisis of organs. These are either acute or chronic.

(b.) Inflammation enters, as we shall see by and by, into various relations to the phthisical process. What we have here, however, particularly to remark upon is in how far it contributes to the enlargement of the tubercle-ulcer and to the modification of its character. In the first place, it determines, for the most part, yellow tuberculous products, in the form of infiltration, which, conformably with the aggravated dyscrasis, rapidly break up, extensively corroding and destroying the textures involved. In this way inflammatory action occasions an ominous enlargement of the tuberculous ulcer, and the most widely spread tuberculous ulceration in an acute form.

In the second place it engenders organizable, solidifiable, fibrino- or albumino-gelatinous products, which pass into a fibroid callus. Thus arises the callous condensation of the textures encircling the cavity; in the muco-membranous tubercle-ulcer (for example, in the bowel) the hardish elevated brink and the funnel-shape of the primitive; lastly, the jelly-like infiltration and induration at the base and margin of the secondary ulcer.

These products exude, according to circumstances, either pure, or almost pure, or combined together in various proportions. In worn-out individuals, the inflammation, if present at all, furnishes forth thin, albumino-serous products, and the tubercle-ulcer is of a lax and torpid character. In the proximity of cavities seated in the midst of tuberculous infiltration, there is of course no inflammation.

3. Crete/action, as already stated, affects fibrino-croupous tubercle after it has entered into the softening process. It is co-significant with the cretefaction of fluid blastemata, and analogous with the cretefaction of broken-down fibrin in the vegetations and coagula within the vascular system, in croupous exudates upon serous membranes, and in parenchy-mata; and again in the cretefaction of pus.

The basis of this (secondary) metamorphosis is as little to be sought extraneously to tubercle as the softening itself. Nevertheless, the surrounding textures may contribute, by their absorbing agency, to the in-spissation of tubercle-blastema. What cornification is to the gray, cretefaction is to the yellow tubercle, namely a process of involution.