196 CLINICAL vktf:rinarv medicine and sukoerv. 



the exception of a strip as thick as a man's arm occupying the upper 

 border, the entire left lobe was invaded and of a blackish tint. Vertical 

 sections through the lung exhibited varying coloration. In the lower 

 third, where the parenchyma was becoming or had in places become 

 necrotic, the colour was greyish }ellow marbled with darker lines and 

 spots ; in the middle third the tissue was firmer, blackish in colour, 

 and permeated with little grey patches indicating gangrenous tissue ; 

 in the superior third, again, where hepatisation was recent, the appear- 

 ance of the pulmonary tissue recalled that of peripneumonia (con- 

 tagious pleuro-pneumonia) of the ox, exhibiting greyish tracts of 

 irregular thickness, surrounding pulmonary areas of a pale brown, 

 deep red, or even blackish tint. 



Microscopic examination of the pulmonary parenchyma reveals 

 more complex lesions than in simple pneumonia. We note first of all 

 marked changes in the intra-lobular spaces, more intense hypergemia, 

 more abundant diapedesis of leucocytes, which have accumulated in the 

 alveoli and around their walls ; finall}-, considerable haemorrhages at 

 many of the points examined — haemorrhages which result in entire 

 groups of lobules being surrounded with red blood-corpuscles, and 

 which b}' extending in all directions through the intra-lobular spaces 

 produce a kind of dissecting effect. 



The pleura, which is always attacked secondarily, appears affected 

 with acute diffuse pseudo-membranous, exudative, or purulent in- 

 flammation. Two patients with this complication died. One showed 

 lesions of exudative pleurisy, the other of empyema. At the 

 post-mortciii of the first we found in the pleural cavity about se^•en- 

 teen quarts of a yellowish-grey liquid holding in suspension fine 

 fibrinous flocculi. In its lower parts, but especially over its \-isceral 

 layer, the pleura was covered with a layer of fibrin, on removing 

 which the serous membrane appeared dull, infiltrated, injected, and 

 closely dotted over with fine granulations. In the other the exudate 

 was reddish, unmistakably purulent, and rich in staph}lococci. Sown 

 on gelatine it produced white and yellow cultures, liquefying the 

 medium. 



Other changes are inconstant, and result from diffusion by the 

 blood-stream of infectious organisms or their toxins. These changes 

 can be found in most of the \-iscera and tissues. I shall only refer to 

 the principal. 



The heart is often affected. In certain cases the myocardium 

 shows granular degeneration, is more or less swollen and softened, 

 ecchymosed in places, its surface marked with greyish or }ellowish 

 patches, which also appear on the surface of sections ; on microscopic 



