24 
two  different  processes  (which  do  not  exclu¬ 
de  mixed  forms).  The  first  process  tends  to 
hépatisation,  the  second  one  to  destruction 
(caverns). 
The  human  pathological  anatomy  already 
proved  the  exactness  of  this  assertion. 
The  experimentation  confirms  exactly  what 
we  veiified  by  the  observation  of  patients. 
We  produced  the  congestive  process  in  rab¬ 
bits,  monkeys,  rats  and  guinea-pigs.  The  ca¬ 
verns  were  obtained  in  rabbits. 
The  cpngestive process  (the  most  common 
in  experimentation)  results  from  the  extensi¬ 
on  of  the  primary  focus  or  from  the  fusion 
of  some  foci.  Clinical  observation  reveals  the 
appearing  of  other  signs,  not  found  in  the 
first  period  :  the  increase  of  the  vocal  vi¬ 
brations,  verified  by  palpation  and  ausculta¬ 
tion,  larger  extension  and  higher  number  of 
crepitant  stertores.  When  the  conglomeration 
is  situated  at  the  apex,  there  is  often  mur¬ 
mur  and  dullness  at  the  base,  with  abolition 
of  the  vocal  vibrations,  pleuritic  attritus  in 
deep  inhaiation  and  egophonia,  indicating  par¬ 
ticipation  of  the  pleura.  In  the  focus  of  the 
congestive  lesion,  there  is  first  prolongated 
expiration,  which,  later  on,  becomes  granular, 
narsh,  sibilant,  hollow  and  finally  bronchial. 
This  last  is  not  constant,  but  almost  limited 
to  the  3rd  period  of  the  congestive  form. 
In  the  2nd  period  one  may  also  find  the 
so-called  pseudocavitary  breathing,  frequent 
in  the  common  congestive  processes  of  the 
lungs.  These  signs,  in  course  of  evolution,  may 
be  followed  bv  others  of  more  or  less  volu¬ 
minous  effusion  in  the  pleural  cavity.  As  to 
the  general  symptomatology,  there  is  not 
abrupt  change  from  the  1st  into  the  2nd  pe¬ 
riod.  There  may  be  dyspnoea  and  vague  tho¬ 
racic  pains.  There  is  always  more  or  less 
violent  coughing,  abundant  expectoration, 
constant  hemoptoic  sputum  with  the  appea¬ 
rance  observed  in  the  first  period,  yielding 
only  to  iodides. 
In  the  2nd  process  of  thm  period,  which 
is  destructive  and  tends  to  cavern  formation, 
things  pass  in  an  entirely  different  way.  There 
are  clinical  signs  which  make  this  period  a 
true  bacillary  tuberculosis  of  the  lungs  in 
full  secondary  evolution.  Such  was  a  case 
we  first  saw  and  which,  after  excluding  the 
idea  of  tuberculosis  or  syphilis  and  establi¬ 
shing  the  diagnosis  of  mycosis,  was  cured 
by  exclusive,  though  energetic,  treatment 
with  potassium  iodide.  The  foci  of  destruc¬ 
tion  are,  generally,  accompanied  by  a  sequel 
of  ominous  symptoms.  The  expectoration  is 
very  abundant.  The  patient  “is  reduced  to 
sputum.”  These  sputa  are  permanent  and 
hemoptoic.  There  is  coughing  and  fever. 
Anemia  is  pronounced.  The  percentage  of 
red  blood  corpuscles  and  hemoglobin  is  low. 
Adynamia  appears.  Where  crepitant  or 
sub-crepitant  stertores  were  prevailing,  the 
auscultation  now  reveals  mucous  stertores 
“humid  crepitation”.  The  dullness  is  exten¬ 
sive. 
In  some  places  there  may  be  pleura! 
attritus.  The  respiration  is  harsh,  bronchial, 
sometimes  very  loud.  The  auscultation  re¬ 
veals,  sometimes,  small  foci  of  crepitant  ster¬ 
tores,  not  rarely  scattered  over  the  limits 
of  the  dullness.  One  more  step  will  lead 
to  formation  of  cavemae.  Amongst  many 
other  symptoms,  shown  by  the  patient  in 
any  form  of  the  2nd  period,  is  fever.  It  is  ir¬ 
regular,  with  various  remissions,  accompanied 
or  not  by  profuse  sweating,  but  never  reaches 
to  severe  pyrexia.  There  is  also  concomitant 
tachycardia.  ROGER’S  reaction  was  only 
once  positive  in  the  sputa  of  these  patients. 
As  Dr.  MARCELLO  LIBANIO  noted,  the 
diazo-reaction  is  frequent  and  repeated  in 
the  urine  of  these  patients.  The  examination 
of  the  other  systems  reveals  :  spleen  swollen, 
liver  painful,  exceeding  the  right  costal 
border  1  or  2  inches,  gastro-intestinal  tract 
with  little  accentuated  and  easily  cured  dis¬ 
turbances.  Neither  the  central,  nor  the  peri¬ 
pheric  nervous  system  show  any  lesion. 
For  the  patient  now  begins  what  may  be 
called  the  third  period  of  the  chronic  form 
of  the  manifest  disease.  In  the  congestive 
forms,  the  lesions  are  enormous.  One  lung 
is  congested  from  apex  to  base.  The  other 
one  has  still  additional  foci  variously  situa- 
