AUTOPSIES AT THE PHILIPPINE MEDICAL SCHOOL. 213 



condition was found to a greater or less degree twenty-seven times, or in 

 about 90 per cent of the cases of pulmonary involvement. 



Histologically, the irregular, ragged walls of these cavities were in 

 the majority of instances not definitely limited by any marked reaction 

 on the part of the surrounding lung tissue. A definite formation of new 

 fibrous tissue was found in but one-third of the eases and this zone was 

 nearly always lined with a layer of newly formed tuberculous tissue. 



Extensive areas of consolidation were frequently found associated with 

 the cavity formation, and in a contiguous portion or adjoining lobe 

 great showers of miliary and conglomerate tubercles were encountered. 



The pleura was involved in all cases, the involvement consisting in 

 a chronic, fibrous thickening and obliteration of the cavity which varied 

 from a localized area to complete union of the surfaces. In addition 

 to the cases of tuberculosis, pleural lesions were found very frequently, 

 50 per cent of the cases included in this report showing some pleural 

 involvement. 



Tuberculous peritonitis was the cause of death in four cases. One 

 of these showed a small, active focus of the disease in the lungs, one 

 an apparently healed apical lesion, and after a prolonged search the 

 other two revealed no pulmonary involvement. Tuberculosis of the 

 vertebras occurred but once and of the bladder three times; psoas abscess 

 was also present once. Latent tubercular lesions were found in the 

 lungs in but 2 of the 100 cases, and healed foci occurred in but 6. 



In connection with this evidence of the virulence of the tubercle 

 bacillus, it is interesting to note that cultures of the organism obtained 

 by subcutaneous inoculation of guinea pigs and subsequent transference 

 from their glands, to suitable media, were kept alive with considerable 

 difficulty and soon died out after a very sparse growth. 



pneumonia. ' 



Pneumonia was the cause of, death in 27 cases, 11 of these being 

 croupous or lobar, and 16 broncho-pneumonia, the majority of the 

 cases occurring in j r oung adults and three-fourths coming from the city 

 proper. A summary of the cases of lobar pneumonia shows that all 

 lobes of both lungs were involved in 1 ease, the entire right lung in 

 1, the left lower lobe in 5, the remaining 4 cases showing involvement 

 of but one lobe. All were accompanied by an exudation of a fibrinous 

 nature upon the pleural surface of the involved lung. 



Death in this series of 11 cases occurred early in the disease in 

 four instances, and during the stage of red hepatization in two instances. 

 In the former, the tissue involved was in an early stage of engorgement 

 with greatly distended capillaries and swollen epithelium surrounding 

 but a small arumber of red corpuscles. The remaining five cases showed 

 typical, gray hepatization. 



