MILIARY TUBERCLES. 203 



other than that due to the fusion together of several of 

 these minute foci can be detected by the naked eye. 



The miliary tubercles are of a pale gray color, with a 

 white centre, are slightly elevated above the surface of 

 the tissue in which they exist, and, as stated, vary con- 

 siderably in dimensions, usually appearing as poiots 

 which range in size from that of a pin-point to that of a 

 pin-head. They are not only located upon the surface of 

 the organs, but are distributed through the depths of 

 the tissues. To the touch they sometimes present nothing 

 characteristic, but may frequently, when closely packed 

 together in large numbers, give a mealy or sandy sensa- 

 tion to the fingers. Stained sections of these miliary 

 tubercles present an entirely characteristic appearance, 

 and the disease may be diagnosticated by these histologi- 

 cal changes alone, though the crucial test in the diagnosis 

 is the finding of tubercle bacilli in these nodules. 



Microscopic Appearance of Miliary Tuber- 

 cles. — The simple miliary tubercles under the low mag- 

 nifying power of the microscope preseijt somewhat the fol- 

 lowing appearance : There is a central pale area, evidently 

 composed of necrotic tissue because of its incapacity for 

 taking up the staining employed. Scattered here and 

 there through this necrotic area may be seen granular 

 masses irregular in size and shape. They take up the 

 stains employed and are evidently the fragments of cell- 

 nuclei in the course of destruction. Through the 

 necrotic area may here and there be seen irregular lines, 

 bands, or ridges, the remains of tissues not yet com- 

 pletely destroyed by the necrotic process. Around 

 the periphery of this area may sometimes be noticed 

 large multi-nucleated cells, the nuclei of which are 

 arranged about the periphery of the cell or grouped 



