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These were situated on the auricular surface. They were mostly discrete, but in some instances several had apparently run together forming larger masses. They were perfectly opaque. To touch they varied extremely; some were hard and nodular, while others were distinctly soft. In their immediate surrounding there were small points of superficial ulceration, and spreading from and under tlie dis- eased: process was found considerable thickening due to hard; dense, connective tissue. On cutting these nodules, some were solid and fibrous but the majority were cheesy. Microscopic examination of these nodules was carried out and large num- bers of tubercle bacilli found. The auricles and ventricles appeared to be perfectly healthy. The heart muscle was pale and the organ generally anæmic. The organ weighed about 101⁄2 ounces. The coronary arteries were slit up but no trace of disease could be detected. The pulmonary arteries and veins were opened and showed the presence of ulceration and in some cases thrombosis. Tubercle bacilli were found in many of these foci. In both lungs there was old caseous tubercular pneumonia, with the development of a considerable amount of fibrous tissue. The disease in the lungs bad certainly lasted for some consitierable time. In addition to the old caseous fuci, there was an eruption of recent miliary tubercles scattered throughout both lungs a typical acute iniliary tubercle of the lung. Extension of the old tubercular pneumonia along the lymphatics was also present. The lymphatics could be seen radiating from the caseous focus and were studded with minute grey nodules. These were so marked that they could be easily distinguished from the definite eruption of miliary tubercles throughout the pulmonary tissue. Several of the bronchial glands were caseous, others showed the presence of small tubercles commencing to break down centrally, Many of the other mediastinal glands contained miliary tubercles with caseation. The gastro-intestinal tract was normal to the naked eye. The mesenteric glands were enlarged and indurated. A few slowed the presence of calcareous deposit in their interior. The liver was enlarged and weighed about 4 pounds. Its surface was smooth and anæmic and shining through the capsule, more particularly on its upper surface, could be seen numerous small, round, greyish yellow nodules varying in size from a pin's head to a peu. These were incised. They showed Caseation. On section, the organ was anamic and throughout the parenchyma was an eruption of acute miliary tubercle. In other respects the organ presented the appearances usually met with in amyloid disease. The spleen weighed 10 ounces. Its capsule was thickened and contained miliary nodules in which tubercle bacilli were found. On section, the organ was fibrous and pigmented and tubercles of varying size were scattered throughout its surface. Sinear preparations of this organ showed tubercle bacilli and malarial pigment. The kidneys were slightly increased in size and weight. Fibrous tissue was in excess throughout both organs and in addition several tubercles containing tubercle bacilli were found scattered throughout the parenchyma, more particularly in the medul Jary portion. Both the spleen and tlie kidneys were waxy, nodules of a tubercular nature were also found in the adrenals. The pancreas was cirrhotic but no tuber: cles were found. The genital organs were apparently normal. The brain with the exception of a tubercular nodule in the pons was normal to the naked eye: Careful examination was made of the vessels in order to determine the presence of tubercular disease. The aorta with the exception of atheroma and partial throm- bosis was normal.. As already mentioned the pulmonary vessels showed the presence of tubercular disease.

This case was interpreted as follows:-

There was a well marked caseous tubercular pneumonia with the formation of a considerable amount of reparitive tissue. At one particular period during the course of the disease, the tubercle bacilli had set up tubercular disease of the vessels, e.g., the pulmonary, and the heart with affection of the mitral valve. This extension of the process had led to the large numbers of tubercle bacilli in the blood stream, with the result that secondary to the chronic tubercle in the lung there were established throughout the body a superimposed tubercular infection in the shape of acute general miliary tuberculosis. This case which i have outlined is a splendid instance of the course of tubercular disease, and its method of extension. The condition of tuber- cular endocarditis and endarteriitis will, if carefully looked for, be found to be a not infrequent complication in tuberculosis. There is much need, however, for further research in this direction. Few cases have as yet been reported and illustrations of the ways and means through which the tubercle bacillus finds its way into the innermost recesses of the animal body are urgently required.