l68 PATHOLOGY 



tuberculous milk), direct inoculation through wounds of 

 the skin, or through the genital tract. Direct transmis- 

 sion to the fetus in utero occurs, but is rare. The trans- 

 mission from one member of a family to another is fre- 

 quent. 



Morbid Anatomy. No organ of the body is free from 

 the manifestations of this disease. The order of fre- 

 quency in which the organs are affected in this disease 

 are as follows: lungs, lymph-glands, bones and joints, 

 intestines, peritoneum, kidneys, brain, spleen, liver, and 

 generative organs. Wherever the infection is located 

 it is characterized by the formation of tubercles. The 

 evolution of a tubercle is thus described by Baumgarten: 



(1) There is a rapid multiplication of the tubercle 

 bacilli, which is accompanied by their dissemination in 

 the surrounding tissues, partly by growth and partly 

 by the lymph-current. 



(2) Multiplication of the fixed cells, especially those 

 of the connective tissue and the endothelium of the 

 capillaries, and the gradual production from them of 

 rounded cuboid or polygonal bodies with vesicular 

 nuclei, the epithelioid cells, inside some of which bacilli 

 are seen. 



(3) From the vessels of the infected focus leukocytes 

 (chiefly polynuclear) migrate in numbers and accumulate 

 about the focus of infection. They do not long survive, 

 however, and many undergo destruction. Later, as 

 the little tubercles grow, the leukocytes found are of 



