BEPORTS OF CASES. 
213 
Autopsy —The thoracic cavity showed a chronic injected con¬ 
dition of the mediastinal pleura with little hydrothorax. Hydro- 
pericardium. The pericardium distended and thickened, con¬ 
tained one pint of fluid. The cardium was hypertrophied. The 
ectocardium covered with many enlargements, varying in size 
up to a pigeon’s egg. The light ventricle of the heart contained 
an elevated ulcer as large as a five-cent piece; the right auricle 
contained two similar elevated ulcers, but smaller. These ulcers 
were contiguous with the granulomata on the ectocardium, there 
being very little muscle structure at the base of the ulcers. The 
left auricle and ventricle exhibited no lesions, but in the left 
auricle, at the base of one of the mitro-valves, a fibrinous de¬ 
posit as large as a pea was seen which probably caused the 
purring bruits. Half of the lobe of the left lung was indurated. 
The cardiac and bronchial lymph glands were enlarged, likewise 
the inferior cervical lymph glands. The liver was studded with 
numerous distinct spots, dull, light yellow in color, varying in 
size from a pinhead to the circumference of a pea. The liver 
was enlarged to twice its normal size. The kidneys showed 
similar spots. The spleen, pancreas, intestines and other organs 
were normal. A little fluid was found in the abdominal cavity. 
The diagnosis of tuberculosis was established by Dr. Jas. 
Ewing, of the Cornell Medical College, who examined the tissue 
microscopically. A verbatim report of his results follows : 
“ The new tissue involving the heart is composed of diffuse 
granulomatous tissue. It contains polyhedral and spindle cells 
supported by a few fibrils, scanty blood vessels, and is infiltrated 
with numerous lymphocytes. While in most areas these elements 
are arranged diffusely, as in tuberculous tissue, in many foci they 
form miliary tubercles with small giant cells. In some places 
much of the tissue is made up of conglomerate tubercles of this 
sort. 
“ In the liver the very numerous small tubercles are composed 
of polyhedral cells, sometimes forming small giant cells, and 
mingled with many lymphocytes. There is very little necrosis 
in any of the lesions. 
“ The search for tubercle bacilli in the main mass and in the 
liver was not successful. Regarding the possible presence of the 
granular form of the tubercle bacillus it is impossible at present 
to offer a positive opinion. Three guinea pigs inoculated with 
material died three days later from the toxic effects of the 
injection. 
