452 TUBERCULOSIS. 



nodules i. e., prominent formations of a size varying from that 

 of a pin's point to that of a hemp-seed in ganglia which are 

 swelled, softened, and grayish-red. More commonly, however, 

 such nodules are wanting, and the diseased ganglion exhibits a 

 grayish-yellow discoloration, either throughout the transverse 

 section or only in a portion of it, and in the latter case the dis- 

 coloration is sharply marked from the gray-red, vascularized 

 portion of the ganglion. If a discoloration is observed in a sub- 

 miliary spot the size of a pin's prick or of a poppy-seed with- 

 out a protrusion, what reason have we for calling it a " nodule " J ? 

 Would it not be more correct to name such a condition an " infil- 

 tration' 7 ! If we observe whitish-yellow submiliary spots on a 

 grayish-yellow basis, are we authorized in calling only the whitish- 

 yellow parts tubercles? And, lastly, if the whole ganglion has 

 become homogeneous, grayish-yellow, half-dry and friable, where 

 are the tubercles? 



I should say that here, as in every other tissue, a sharp dis- 

 tinction between the tuberculous nodule and the tuberculous infil- 

 tration leads to confusion and error, and I should prefer insisting 

 upon the genetic identity of both these forms, also in the lymph- 

 ganglia. I, however, agree with Schiippel in the view that the 

 tubercle is formed from an inflammatory new formation, and that 

 scrofulosis and tuberculosis are identical. 



If we should place before a person a lymph-ganglion in 

 " cheesy" metamorphosis, without telling him from what part of 

 the body it came and what were the concomitant phenomena, 

 would he be able to decide whether this ganglion was scrof- 

 ulous or tuberculous, or whether it came from the region of 

 typhoid or cancerous disease ? I should certainly think not. The 

 feature common to all is the grayish-yellow infiltration, the 

 u cheese " of Virchow. Later stages of disintegration, softening, 

 suppuration, or calcification are also identical. Nevertheless, 

 Virchow considered it necessary to separate " scrofulosis" from 

 " tuberculosis." 



To what the " cheesy" degeneration is due I will demonstrate 

 later. Here I only wish to maintain that there is no one in- 

 variable anatomical sign which would entitle us to call a given 

 ganglion either scrofulous or tuberculous. Schiippel, however, 

 deserves credit for having demonstrated, by the means of micro- 

 scopic research, that the theory of "hyperplasia" and "hetero- 

 plasia" is not tenable, especially so far as tuberculosis of the 

 lymph-ganglia is concerned. 



