X34 1 H - F. Formad, 



latter and the removal of the cells obliterating these important channels. 

 Then, the dangerous obstacles to the reabsorption of any inflamma- 

 tory exudate that might occur being removed, the passage of serum 

 between lymphatics and blood-vessels goes on unimpeded, lubricating 

 and distending the formerly dry and occluded lymph-spaces. 



The second exceptional point in the etiology of tuberculosis is 

 the occurrence of miliary tuberculosis secondary to simple inflammation 

 of serous membranes in normal non-scrofulous beings. Experiments, 

 clinical observations, and autopsies sustain this fact. At the same 

 time, it appears that inflammatory processes affecting parts of the 

 body other than serous surfaces do not lead to tuberculosis in non- 

 scrofulous subjects. I will recall here that the anterior chamber of 

 the eye, which is occassionally used as a point for inoculation with 

 tubercular virus, is also a serous sac. Of the same character are the 

 synovial membranes and the choroid coat, of which ophthalmoscopic 

 examination reveals tubercles so beautifully in cases of miliary tuber- 

 culosis l ). 



There are cases on record of traumatic injuries of joints and of 

 the eyeball in non-scrofulous persons, in which general miliary tuber- 

 culosis was a consequence. 



It is possible, also, that croupous pneumonia may lead to pul- 

 monary phthisis in the non -scrofulous, on the ground that the epi- 

 thelium lining the air-vesicles approaches very closely in histological 

 character the lining of the serous membranes, — in fact, is considered 

 by some to be endothelial. The inflammatory exudate of croupous 

 pneumonia is fibrinous, as it is in inflammation of serous membranes. 

 This peculiarity may also explain Tappeiner's alleged success in pro- 

 ducing pulmonary tuberculosis in dogs (animals not predisposed to 

 it) by making them inhale phthisical sputa distributed by a spray- 

 producer. 



First Litten a ), clinician to the Charité in Berlin, and subsequently 



*) I doubt if practitioners avail themselves sufficiently of the ophthalmoscope in 

 the physical diagnosis of tuberculosis. 



2 ) M. Litten, Sammlung Klin. Vorträg-, No. 119. Ueber acute Miliartubercu- 

 lose, 1877. For further references see Wiener Med. Presse, No. 36, 1882; Charité 



