254 DISEASES OF THE PARENCHYMA OF THE LUNG. 



caseous deposit, contradicts this plausible hypothesis. We must, 

 therefore, content ourselves by stating that, in most cases, acute 

 miliary tuberculosis is a secondary disease, arising, in some manner 

 as yet unknown to us, from the pernicious effect of the cheesy deposit, 

 but that may also proceed from other causes, of whose nature we are 

 equally ignorant. 



ANATOMICAL APPEARANCES. If we find, upon dissection, that the 

 lungs are studded uniformly from top to bottom with miliary tubercles, 

 if the miliary nodules present that gray, translucent appearance of 

 fresh tubercle, if the surfaces of the pleura be also strewed with 

 miliary tubercles, we may decide with positive certainty that the 

 patient has had acute miliary tuberculosis, even though we know 

 nothing of what the course of the disease has been. In chronic tuber- 

 culosis this uniform dissemination of the tubercle is never found, and 

 yellow, caseous granulations always coexist with the new gray tuber- 

 cles, showing that the deposit has been a gradual one. In most cases 

 of the acute disease, the peritonaeum, the liver, the spleen, the kidneys 

 are covered by miliary tubercles. Finally, especially in young per- 

 sons, numerous granulations are often found in the pia mater, particu- 

 larly at the base of the brain, about the pons, and the chiasm of the 

 optic nerves, together with acute hydrocephalus of the ventricles. 



The parenchyma looks injected and more or less infiltrated with 

 serum, otherwise it is generally free from inflammatory or other nutri- 

 tive disturbance, with the exception of the traces of former disease 

 which may be there. The corpse of a person who has died of acute 

 miliary tuberculosis resembles that of one who has died of an acute 

 febrile disease, the resemblance commencing during life and con- 

 tinuing after death. The blood is dark and liquid, and settles to the 

 most dependent points, giving rise to extensive pulmonary hypostasis. 

 The muscles are red, and even the spleen is often somewhat swollen 

 and softened. 



SYMPTOMS AND COURSE. When an acute miliary tuberculosis de- 

 velops at an advanced stage of consumption, complicated with hectic 

 and night-sweats, it is very difficult of recognition, inasmuch as it can 

 hardly be decided whether the fever and the rapid decline of the pa- 

 tient are due to the original complaint or to the complication. Physical 

 examination of the chest gives negative information as to the new 

 deposit of miliary tubercles ; as the innumerable little granules, being 

 everywhere enclosed in tissue containing air, do not modify either the 

 sound upon percussion or the respiratory murmur, although the dis- 

 proportion between the intense dyspnoea and the trifling extension of 

 some old point of induration perhaps may aid the diagnosis. 



The disease assumes a different guise when it attacks persons ic 



