464 TUBERCULOSIS. 



ally different from tuberculous pus. The course and the 

 termination may be identical with that of an acute abscess after 

 the softened tubercle has become encysted. 



Tuberculous and Scrofulous Diathesis. In conclusion, I wish 

 to make a few remarks on the scrofulous diathesis of the tissues. 

 This, according to Virchow, consists in a " feeble resistance on 

 the part of tissues against disturbances, and a lowered capacity 

 for equalizing disturbances ; in an increased vulnerability of the 

 parts, with a greater persistence of the disturbances." The latter 

 conditions are the consequence of a certain " pathological consti- 

 tution/ 7 which consists in a " weakness of single parts or regions 

 and an especial weakness in their lymphatic organs," and we 

 must understand by this "a certain incompleteness in the arrange- 

 ment of the glands." Here we have the results of exact cellular- 

 pathological research, and these results show what an important 

 advance the cellular theory of tissue diathesis involves, in com- 

 parison with the old humoral theory of the blood krases. 



The swelling of the gland is originally of an irritative, inflam- 

 matory, and hyperplastic nature j but under the influence of a 

 certain " incompleteness in the arrangement of the glands," of a 

 certain "diathesis," it undergoes further regressive metamor- 

 phoses, and among these the " cheesy " is the most common. 

 According to Virchow, the same holds good for the heteroplastic 

 new formation of tubercle proper. 



In opposition to these assertions, it seems to be of advantage 

 not to abandon the ground furnished by the above enumerated 

 facts. 



Let us say : in the inflammatory new formation, which is the 

 substratum, not only of scrofulosis of the lymph-ganglia, but also 

 of tubercle, the old blood-vessels perish in the production of a 

 new tissue, and no new formation of blood-vessels takes place. 

 The succeeding step will be the shrinkage of the living matter, 

 under certain circumstances the softening of the same, etc. 



Let us say, further : certain organisms have not the capacity for 

 producing in a morbid condition, especially in the inflammatory 

 process, abundant living matter, and we have before us the 

 "scrofulous and tuberculous diathesis." But we do not need 

 such a thing as a " diathesis," for we only maintain what direct 

 observation proves. The scanty production of living matter first 

 causes a deficiency in the new formation of blood and blood-ves- 

 sels ; this influences the shrinkage of the inflammatory product ; 

 this in turn causes the disintegration, and finally the softening 



