The lesions of surgical tuberculosis, except those already spoken of as constituting cold abscess, are so essentially connected with the presence of granulation tissue, just described, or of this form of the infectious granulomas, that no student can appreciate the subject until he is familiar with this tissue in its various phases and in various locations. Of such great importance is it that this be realized that some of the local manifestations of this new tissue must here be considered, although they may be rehearsed in other form in succeeding chapters. _In the skin and subcutaneous tissues_ and _in and under mucous membranes_ this granulation tissue may be studied at places where it is free from most mechanical restraints to growth, and where, in other respects, its appearances are typical. The most characteristic manifestations in the skin occur as _lupus_, a disease considered cancerous or of uncertain etiology. Lupus is always a cutaneous manifestation of this protean disease. (See Plate VII.) In its incipient stages lupus consists of multiple minute nodules of granulation tissue just beneath the surface, containing all the elements of true miliary tubercle, with infiltration of the surrounding skin, even into the subcutaneous fat. The most common location of these lesions is on exposed surfaces. Bacilli are not numerous in them, yet may be demonstrated. The tendency is more or less rapidly to break down, the result being a tuberculous ulcer, which, as it extends, manifests usually a disposition to cicatrize in the centre while enlarging around its periphery. The dermatologists describe several different forms of lupus under the names _hypertrophicus_, _vulgaris_, _maculosus_, etc., all of which are essentially the same in character, the differences being largely constituted by the rapidity or slowness with which the granuloma of the skin breaks down. From the surface these growths may extend and involve parts at considerable depth, even the periosteum. This name should also include the lesions described as _scrofuloderma_ or scrofulous ulcers of the skin, they being all of the same character. A variety known as _anatomical tubercle_ has been described by some writers, found especially upon the hands of those who frequent dissecting-rooms or handle dead bodies, and is supposed to be the result of local inoculation. It appears usually as a warty growth, which ulcerates and becomes covered with a scab--is usually indolent in character, but is followed by lymphatic involvement, and in rare instances by death from tuberculous disease. [Illustration: FIG. 20 Tuberculosis of cervical lymph nodes.]