Physical examination showed a markedly emaciated white woman with a high degree of arthritis deformans. Dullness and fine râles were present at the left apex. The temperature was but slightly elevated until three days before death, when it rose to 101°F. and slight dullness developed at the right base with bronchial breathing and fine râles. The white blood count, which on admission had been 9,200 cells per cubic millimeter, rose to 15,000 per cubic millimeter. She died after a seven-weeks’ illness.
At necropsy, with the exception of the joints, little of interest was found outside the thoracic cavity. On the posterior and diaphragmatic surfaces of both lungs fibrous adhesions were present binding the visceral to the parietal pleura. The right lung was moderately voluminous and grey in color over the upper lobe, but had darker red areas over the surface of the lower lobes. Patches of increased consistency were found in the lower part of the upper lobe, in the middle lobe, and at the base. On section there was a slight, red, serous exudate. The surface over the more solid areas was somewhat translucent, grey or light red, and was firm and not friable. The bronchi of the lower lobes were conspicuous, and at the extreme base so dilated as to give almost a honeycombed appearance. From them yellow pus exuded. The left lung was less voluminous and showed some increase in consistency throughout. In the lower lobe this was more uniform, but the upper had a shotty feeling. On section the upper lobe showed many hard or caseous nodules, with occasional patches of grey, gelatinous pneumonia. One small cavity was present about 3 centimeters from the apex. The lower lobe showed no gross evidence of any tuberculous process. Many pseudotubercles projected from the red surface, but from each pus could be expressed exposing the slightly congested wall of a bronchiole. At the extreme base two small cavities filled with yellow pus were present (Fig. L).
Sections from the left upper lobe showed, microscopically, both a chronic and acute tuberculous process. Tubercles with a definite wall were present, but there were also large areas of caseation. The tissue between showed interstitial organization with mononuclear infiltration and occasional groups of leucocytes. The bronchial epithelium exhibited no marked change, but the bronchi were filled with pus cells.