LOCAL OR GENERAL TUBERCULOSIS. 331 



found in the laboratory, presents, in the main, changes 

 that are characterized by coagulation-necrosis and case- 

 ation. This is particularly the case when the infec- 

 tion is general — i. e., when the process is of the acute 

 miliary type ; then the tissues of the liver and spleen 

 present the most favorable field for the study of this 

 pathological-anatomical alteration. 



In general, the tubercular lesions can be divided into 

 those of strictly focal character — i. e., the miliary and 

 the conglomerate tubercles — and those which are more 

 diffuse. The latter lesions, although fundamentally 

 of the same nature as the miliary tubercles, are much 

 greater in extent and not so sharply circumscribed. 

 These latter lesions play a more conspicuous rSle in the 

 pathology of the disease than do the miliary nodules, 

 although it is to the presence of the miliary nodules that 

 the disease owes its name. 



At autopsy the pathological manifestations of the dis- 

 ease are not infrequently seen to be confined to the seat 

 of inoculation and to tlie neighboring lymphatic glands. 

 These tissues then present all the characteristics of the 

 tuberculous process in the stage of cheesy degeneration. 

 ^yhen the disease is more general the degree of its exten- 

 sion varies. Sometimes the small gray nodules — mili- 

 ary tubercles — are only to be seen with the naked eye in 

 the tissues of the liver and spleen. Again, they may in- 

 vade the lung, and frequently they are distributed over 

 the serous membranes of the intestines, the lungs, the 

 heart, and the brain. These gray nodules, as seen by 

 the naked eye, vary in size from that of a pin-point to 

 that of a hempseed, and, as a rule, are, in this stage, the 

 result of the fusion of two or more smaller miliary foci. 

 Though the two terms " miliary " and " conglomerate " 



