The Bacillus tuberculosis. 135 



other clinicians and pathologists, called attention to the importan 

 fact that true miliary tuberculosis may be caused directly by acute 

 pleurisy and peritonitis in persons not predisposed to phthisis, and 

 without any cheesy masses being found in any part of the body. This 

 is alleged to be the case especially when there is a rapid reabsorption 

 of the exudates formed in this lesion. Again, it is a wellknown fact 

 — any text -book of pathological anatomy gives it — that inflamma- 

 tory products in serous membranes give rise occasionally to peculiar 

 nodular formations, the so-called pseudo-tubercles. The distinction of 

 these from true tubercle is not as easily made as some allege, and 

 it is certain that to do it, in addition to a profound knowledge of 

 mycology, such as Koch unquestionably possesses, requires a consi- 

 derable experience in pathological histology. Moreover, it is also well 

 established that primary true tubercle occurs in the organized in- 

 flammatory products of serous membranes. 



This is eminently correct. I have been fortunate enough to 

 examine on the autopsy-table, *and to submit to thorough microscopic 

 examination, several cases in which primary tuberculosis was found 

 profusely in all the serous membranes and in the organized products, 

 adhesive bands, etc., formed upon them. There was perfect absence 

 of pulmonary phthisis or any cheesy matter elsewhere ; the lymphatic 

 glands were also normal. In two other cases I observed general mi- 

 liary tuberculosis, including the lungs, beyond all doubt secondary to 

 tubercular peritonitis, and with no cheesy matter anywhere. There 

 was no phthisical history in either case. The tubercles met with in 

 these cases were in microscopic appearance identical with those of 

 ordinary scrofulous cases, only fibroid change was more common in 

 them than in tubercles originating in scrofulous persons. I will detail 

 these cases upon another occasion. 



Some interesting thoughts suggest themselves as to how the tu- 

 bercular disease here originates. Litten (loc. cit.) lays stress upon the 

 rapid reabsorption of the exudate, and suggests the carrying of in- 

 fecting particles from the latter into the blood, as a probable cause. 



Annalen, Vol. VII., Berlin ; Krankheiten der Respirations-Organe, in Virchow's Handb. 

 der Spec. Path, und Therap., Vol. I.; Virchow, Geschwülste, Vol. II, p. 725 etc. 



