Tuberculosis. 



305 



miliary nodules alone, all of the same age, that is of uniform size, 

 it is said to be involved by acute miliary tuberculosis. With local 

 multiplication of the tubercle bacilli, the nodules enlarge to the size 

 of a lentil, pea or nut, these larger forms usually showing their 

 origin from fusion or conglomeration of smaller miliary tubercles. 

 This condition constitutes what is known as chronic miliary tubercu- 

 losis. On serous surfaces the formation of nodular masses gives 

 rise to the so-called pearl disease. 



The tuberculous fungous granuloma is the result of a progres- 

 sive formation of cellular nodules and their profuse growth on free 



surfaces; it is chiefly met with in . — _^ 



the thoracic serous membranes and 

 peritoneum and sometimes, too, in 

 the intestinal nmcous membrane. By 

 the synchronous development of the 

 nodules and of a vascular connective 

 tissue growth, there may be produced 

 ofravish-white, gravish-red and yellow- 

 ish-red tumor-like masses from the size 

 of an egg to that of a fist, which are 

 piled up about and over each other as 

 large excrescences, covering consider- 

 able surface areas and reaching per- 

 haps a weight of from twenty to forty 

 kilogrammes. Caseation of these tu- 

 berculomata, which also occasion adhe- 

 sions of the serous surfaces, at first 

 appears in punctiform foci and in 

 small spots in the granulation tissue, 

 as yellow or light yellow opacities, and 

 can advance to complete transforma- 

 tion of the whole bunch of nodules into 

 a mass which on section looks like corn-bread, yellow, hard, gritty 

 and partly calcified. 



Tuberculous ulcers, especially in the bowel, larynx and bron- 

 chial tree, result from the maceration and disintegration of the 

 caseated parts as well as from a purulent softening of the tuber- 

 cles developing in the mucous surfaces (lymph follicles). These 

 areas of tissue destruction are circular or oblong, shallow or some- 

 times a millimeter in depth, as large as a lentil to a little over a 

 centimeter in diameter, or in the bowel reaching perhaps the length 

 of a finger and two fingers in breadth. The base of the eroded spot 



Figr. 68. 



Ulcerative tuberculosis of intes- 

 tine of cow. (Mucous sur- 

 face of small intestine.) 



