Matthew Roth wrote:
>2. In lines 615-616, Shade is describing "the exile, the old man / Dying in a motel" and says: >"He suffocates and conjures in two tongues / The nebulae dilating in his lungs."  My >questions: Does "two tongues" refer to languages? Medically speaking, what are nebulae >and how do they dilate in the lungs? What does it mean to "conjure" them?

 

This has pretty much been covered, but there are no nebulae in the lungs - the closest anatomically are alveoli, which do dilate and contract on inspiration and expiration respectively, and the closest phonetically would be nebulisers, which are devices used to administer drugs to the lungs - I'm unsure as to when these entered general use, but my guess would be that they were in common use at the time of writing.

 

The likeliest explanation is, as Matthew has already said, that it's a reference to the radiographic appearance of disease on X-ray. Plain tuberculosis, however, doesn't resemble a nebula on an X-ray film - the classical presentation is cavitating lesions (or nothing!). The only thing that does resemble a nebula is miliary tuberculosis, which gives a pattern of lots of tiny dots in the lung fields which is virtually pathognomic. So we can be actually very specific about the illness in question.

 

On reading this thread, it occurred to me that miliary TB can, like the ordinary form, spread throughout the body (where it has a similar speckled appearance on gross histology at post-mortem, although lacking the black "cosmos" background of the X-ray). About a quarter of those with miliary TB also get tuberculous meningitis - which might link in to the recent lemnisci / tubular sclerosis discussion, and be a possible explanation for Shade's neurological symptoms.

 

Nick.