TUBERCULOSIS. 447 



pigment indicates the otherwise unrecognizable lung-tissue 

 (Rokitansky). 



One of the cases which I observed deserves mentioning, because it will 

 be of value in supporting the theory of tuberculosis, to be dwelt upon later. 

 A strong boy, eet. 15, was taken to the hospital with the symptoms of typhoid 

 fever. Soon pneumonia of the right lung was diagnosticated. Two months 

 afterward the patient died, with symptoms of a clinically diagnosticated tuber- 

 culous pneumonia. In autopsy I found the right wing pervaded by " cheesy" 

 infiltrations to such a degree that the tissue was atelectatic and firm ; the left 

 lung at its apex contained an infiltration the size of a child's fist. The infiltra- 

 tions in both apices were softened, and in the right apex showed a number of 

 cavities of different sizes, but not very large. No traces of any previous 

 chronic tuberculosis could be discovered. The spleen, the small intestines, and 

 the mesenteric lymph-ganglia had the same appearance as seen in typhoid fever 

 after the healing process had been going on for a few weeks. Here, therefore, 

 under the influence of marasmus after typhoid fever, an original, clinically 

 well-marked genuine pneumonia was changed into a tuberculous pneumonia. 



The nodules and infiltrations, through their peculiarities, may be 

 at once recognized as tuberculous, because they are markedly different 

 from analogous nodular infiltrations of the lungs, as observed in 

 carcinomatosis and pycemia. The distinguishing features are: the 

 white color, the scanty vascularization, the wreath-like arrange- 

 ment around the pulmonary vessels in carcinomatosis j the yellow 

 color, the softness, the partial disintegration to pus or ichor, the 

 purple color, and sometimes the dark red hepatization of the 

 neighboring parts in pyaemic infarctions. 



A fourth form of tuberculosis of the lungs is known by the 

 name of the acute or miliary tuberculosis (Bayle). Here we find 

 both lungs diseased nearly simultaneously, and to nearly the same 

 extent. They are enlarged, heavy, profusely supplied with blood, 

 and saturated with a viscid, cloudy exudate. In the apices we 

 encounter chronic and sometimes even healed tuberculosis 5 in 

 other cases, no trace of this condition. The whole hyperasmic 

 lung-tissue is pervaded in nearly uniform distribution by more or 

 less densely arranged gray, or grayish-yellow, soft, translucent, 

 opaque nodules, the size of poppy-, millet-, or hemp-seed. In 

 several cases, the largest and most numerous of these nodules 

 were found in the upper lobes ; comparatively few nodules of the 

 millet-seed size in the right middle lobe, and but very few gray 

 nodules the size of a poppy-seed (submiliary) in the lower lobes. 

 All cases of this variety exhibited in the meninges, the liver, the 

 spleen, the kidneys, and the peritoneum the same morbid condi- 

 tions in different combinations. 



