446 TUBEBCULOSIS. 



initial stages of the disease the infiltrations are not sharply 

 marked from the surrounding hepatized lung-tissue. Sometimes 

 they have the appearance of being composed of numerous con- 

 glomerated particles the size of a pin's point. 



At other times we find a lobe, or the larger portion of a 

 wing, in the condition of lobar pneumonia, consequently en- 

 larged, heavy, dense, rigid; and without air i. e. f in a grayish- 

 red or gray hepatization ; and if the inflammation has invaded a 

 pigmented lung, it has the aspect of granite. 



In genuine croupous pneumonia the section looks finely gran- 

 ular, owing to the filling of the alveoli j if the inflammation has 

 attacked a coarsely spaced, atrophic lung, it is filled with coarser, 

 yellow exudation plugs. In tuberculous pneumonia, on the con- 

 trary, we find, usually, in the vicinity of the finer bronchi, groups 

 of moderately firm, grayish-yellow nodules, in varying numbers, 

 imbedded in the hepatized tissue. I have observed this form 

 several times, generally in the lower lobes, after capital opera- 

 tions f. i., amputations in individuals who, by previous sup- 

 purative processes, had become broken down. 



In a third instance we find the whole wing in brown-red 

 hepatization, its tissue without air, firmly indurated with a slight 

 serous infiltration, and pervaded by numerous nodules the size of 

 hemp-seed, or nodes from the sizes of a lentil to that of a hazel- 

 nut ; these are mostly softened. Such a lung exhibits an aspect 

 similar to that of porphyry. If the indurated tissue of the wing 

 is profusely pigmented, the pigmentary induration, therefore, has 

 invaded the whole wing, we find in it scattered nodules, usually 

 of a size not exceeding that of a millet- or hemp-seed, which may 

 be both obsolete and calcareous, or gray, grayish-yellow, and soft. 

 Here, too, the characteristics of pneumonia are marked and have 

 led to a condensation, hypertrophy, callosity, and pigmentary 

 induration. Still the nature of the process is sufficiently apparent 

 by the presence of the nodules and infiltrations. 



Finally, we find in the indurated tissue of red- brown hepatiza- 

 tion of which only little is left, firm, grayish-yellow, half -dry 

 infiltrations, partly softened, about the size of a pea, hazel-nut, or 

 perhaps as large as a walnut, which are closely packed together 

 or confluent. An entire lobe, or wing, with the exception of 

 scanty remains of red-brown, hepatized lung-tissue, may be per- 

 vaded by this " cheesy" infiltration, which on being scraped 

 yields only a small amount of a cloudy liquid. Such an infiltra- 

 tion renders the diseased tissue friable and brittle. Only the 



