448 TUBERCULOSIS. 



Beyond this stage no changes are observed, for this form of the 

 disease, as" a rule, terminates fatally, with symptoms similar to 

 those of typhoid fever. This form is the rarest. It differs from 

 nodular tuberculosis, termed subacute, only in the simultaneous 

 appearance of tubercle nodules in different organs and the acute- 

 ness of its course. I can corroborate, from my own careful 

 researches, the statement of Buhl that in ten per cent, of the 

 cases dead of this variety of tuberculosis no trace of cheesy focus 

 can be found. 



Tuberculosis of the Serous and Mucous Membranes. Under this 

 head I shall only take into consideration tuberculosis of the 

 pleura and the peritoneum, as these have supplied me with the 

 most abundant material for observation. 



In the pleura, we find tuberculosis is always combined with 

 the chronic or subacute form of the disease in the lungs, and 

 in the peritoneum also, though here not so constantly, it is found 

 secondary to tuberculosis of other organs. This form of disease 

 has features corresponding with those of chronic tuberculosis of 

 the lungs, and may be considered as chronic tuberculosis of the 

 pleura and the peritoneum. 



The pleura of one pectoral cavity, and the parietal peritoneum 

 in its whole extent, may be considerably thickened, and trans- 

 formed into a white, firm, and dense callosity. I have seen the 

 peritoneum in the pubic region as thick as the width of the little 

 finger. These callosities were either formed by the costal, dia- 

 phragmatic, and the pulmonary pleura, or, as is sometimes the 

 case, mostly by the costal pleura alone. In the abdominal cavity 

 the thickened parietal layer was concreted with the visceral layer 

 by means of thin, pseudo-membraneous cords and plates. In the 

 callosity I found abundant foci, from the size of a hemp-seed to 

 that of a hazel-nut, containing a crumbly mass. In the pleura 

 I met even with cavities, ranging from the size of a Imzel-nut to 

 that of a pigeon's-egg, which were filled with a mixture of pus 

 and cheesy particles. I could trace all transitions in consistence 

 and liquefaction, from cheese to pus. I have several times en- 

 countered such foci between the basis of the lung and the dia- 

 phragma, and also at the anterior border of the lung, with 

 perforations outward, between the third and the fourth rib. I 

 have also observed this condition at the posterior border of the 

 lung, in the niche formed by the union of the vertebrae and ribs, 

 with caries of single ribs. In the peritoneum I have observed 

 such cavities perforating into the abdominal space, with subse- 



