CONTAGIOUS PNEUMONIA. 197 



examination the striation of the fibres is ill-defined, their contour is 

 irregular, and their substance infiltrated with fine granulations. If the 

 endocardium is inflamed the valves are injected and infiltrated ; some- 

 times they show a crop of little yellowish fibrinous deposits, especially 

 near the free border. These changes almost always affect the left 

 heart. Sometimes the pericardium contains a little greyish liquid, is 

 dull, covered with a thin pseudo-membranous layer, or with fine 

 vascular arborescent growths. 



The liver is large, yellowish, friable, and permeated with little 

 haemorrhagic centres. The hepatic cells show fatty degeneration. 

 The spleen is swollen or bosselated, its tissue congested and ecchy- 

 mosed. The kidneys display signs of diffuse nephritis. On section 

 (which reveals numbers of fine ecchymoses) the cortical layer is 

 markedly hypergemic, and apparently more extensive than normal; 

 the medullary layer is reddish in tint. The microscope shows bacterial 

 emboli and degenerative changes in the epithelium. The intestinal 

 mucous membrane is sometimes hardly affected, sometimes greatly 

 congested, infiltrated, and at certain points ecchymosed ; at others its 

 epithelium has undergone desquamation ; the lymph follicles are 

 hypertrophied and may be necrotic. The changes in the nervous 

 centres usuallv consist in more or less intense hypera;mia of the 

 meninges and of the nervous substance. In some cases the meninges 

 contain a sanguinolent exudate, and occasionally fine ecchymoses are 

 found disseminated through the brain and cerebellum, giving the nerve 

 substance a "sandy" appearance. I have seen this condition in 

 several animals ; it has been noted by various authors ; the first two 

 instances were described b\' Laporte. In the patient of which I was 

 just speaking we found two hemorrhagic centres in the medulla, in 

 addition to lesions of the brain proper. 



Certain muscular groups may become acutely inflamed, the micro- 

 scope revealing changes in structure similar to those of the myocardium. 

 The synovial membranes of tendons and joints sometimes show signs 

 of synovitis or of simple arthritis. 



The blood, which carries the agents producing all these lesions, is 

 itself more or less changed in character. Its coagulability seems 

 scarcely diminished, but many of the red blood-corpuscles appear 

 shrunken and in process of destruction, the number of leucocytes is 

 increased, more than one species of microbes may be present, and the 

 serum shows toxic qualities. 



When infectious pneumonia develops regularly and terminates in 

 recovery, the entire process may be complete within a fortnight. As a 



