THE EESPIEAT.OEY TEACT. 721 



and the reestablishment of the circulation, the disease terminates 

 in recovery, manifested by the complete throwing off of the 

 plugs, which are saturated with liquid exudate, and thus 

 loosened. 



Sometimes in persons of a moderately good constitution, in 

 lobar pneumonia exhibiting all features of croupous inflamma- 

 tion, the fibrinous exudation is scanty and the alveoli contain 

 mainly an albuminous mass holding numbers of inflammatory 

 corpuscles. In such cases there is sometimes no reformation 

 of the blood-vessels destroyed in the pneumonic process, and 

 the tissue, then deprived of nutriment, becomes firm and gray- 

 ish yellow, and finally changes into a yellow, cheesy, crumbly 

 mass. This represents the so-called cheesy pneumonia, which 

 is identical with tuberculosis, although originating in larger 

 districts of the lung-tissue and under more marked inflamma- 

 tory symptoms than tuberculous foci in general. In cheesy 

 pneumonia, the existence of which is marked by the continuance 

 of the physical signs of pneumonia with the so-called " hectic " 

 fever, the interstitial tissue is transformed into inflammatory 

 corpuscles the same as in catarrhal pneumonia, and by this pro- 

 cess in turn most of the blood-vessels are destroyed. The alveoli 

 are filled with an inflammatory tissue which had its origin entirely 

 in the alveolar walls. In these the elastic substance resists the 

 inflammatory process in most, but not in all cases, and in more 

 advanced stages of the disease numbers of inflammatory cor- 

 puscles are shriveled, owing to the want of the nourishing blood- 

 vessels, and torn apart or disintegrated, while the elastic frame 

 of the former alveoli is still recognizable. Shriveled inflam- 

 matory corpuscles always exhibit irregular outlines, a fine granu- 

 lation, and pale nuclei, owing to a deficiency of living matter 

 which characterizes the phthisical constitution of the patient. The 

 combination of these appearances produces the cheesy, crumbly 

 or tuberculous mass. A liquefaction of the mass is possible 

 only in localities where the neighboring blood-vessels had, at 

 least for a time, escaped the inflammatory destruction. Fatty 

 degeneration is, as a rule, combined with the cheesy metamor- 

 phosis, as indicated by the presence of crystals of fatty acids. 

 (See Fig. 322.) 



A third and very rare termination of croupous pneumonia 



consists in the brown Jiepatization of a lobe. This condition is 



due to a new formation of interstitial connective tissue, scantily 



supplied with blood-vessels /. ?., hypertrophy of the lung- 



46 



