ETIOLOGY OF TUBERCULOSIS. 
79 
tubercles, there are often found giant cells of considerable size, which are almost 
isolated or only surrounded by a few epithelioid cells, and are regularly the seat 
of one to three tuberculous bacilli. 
The tubercles of the membrane of the brain were, almost without exception, 
rich in tuberculous bacilli. Frequently the latter are found in the immediate 
neighborhood of small arteries beside which are spindle-formed heaps of epithe¬ 
lioid cells; between the latter the bacilli are strewn in quite uniform numbers. 
But in many places the bacilli are present in such thick masses that their 
presence makes itself known, under a weak magnifying power through the blue 
color of the parts in question. In this case they are principally round cells, 
therefore younger cell formations, among which the bacilli vegetation has its seat. 
Sometimes also I have seen bacilli in the interior of the vasa. 
Of miliary tubercles of the choroidee only one case was at my disposal, and 
that I owe to Prof. Weigert. Here also were formed herds without nuclei, (that 
is to say already developed caseous degeneration), which were surrounded by 
large giant cells, and many epithelioid cells. Partly in the giant cells, but also 
partly outside of them, between the epithelioid cells, a good many tuberculous 
bacilli were present. 
With the exception of one case, comparatively old caseous herds were always 
to be found, especially in the lungs and bronchial glands. Also in these herds, 
which may be considerd the point of departure for miliary tuberculosis, the pres¬ 
ence of bacilli were proved in the cases which were examined with reference to 
them. Often, to be sure, they were only found sparsely in the periphery of the 
herd, but sometimes one discovered nests of dense masses of bacilli. 
It would lead too far if I should here describe particularly all the cases of 
miliary tuberculosis which I have examined, and I select, therefore, only some of 
the most characteristic. 
1.—Workman, thirty-six years old. Strong man, who had not felt unwell un¬ 
til fourteen days before being taken to the hospital, attacked with coughing; 
pains in the chest and moderate fever. The symptoms observed in the hospital 
were only slightly characteristic, and corresponded with those of catarrhal pneu¬ 
monia. Under increase of dyspnoe the patient’s powers sank rapidly and he died 
four days after his reception into the hospital. In the journal of dissection the 
following is worthy of mention. The pleura on both sides occupied by numer¬ 
ous little miliary knots. Both lungs infiltrated, greyish-red, and many little 
miliary grey knots present; the larger knots show caseous degeneration. In the 
conus arteriosus of the heart several sub-miliary grey knots of the endocard. On 
the closing border of the mitralis eruption of firm knots varying from miliary to 
the size of a pea. In the liver not very numerous little knots. Both kidneys 
contain grey little miliary knots in the pithy substance as well as in the outer 
coating in abundance. The hollow of the right kidney dilated, and in the same 
two defecti with indented borders and caseous base whose diameter is about 1£ 
to 2 cm. A caseous deposit of the size of a hazel nut in one papilla. Bladder 
free from tubercles. In the prostata some caseous deposits. In the urethra 
abundant little miliary knots. Caseous degeneration of the accessory testicles, 
partly with caseous softening, drawn in scars on the scrotum. In the testicles 
themselves abundant deposits of little grey miliary knots. The thoracic duct 
