80 
R. KOCH. 
dilated, on several spots on its wall caseous thickening, and on the inner surface 
of the same some defecti provided with caseous base. 
Here we had a case of chronic tuberculosis of the uro-genital organs. The 
tuberculosis of the thoracic duct connected itself with this and had as a conse¬ 
quence, the breaking out of the general miliary tuberculosis. This case according 
to its origin belongs to the form of miliary tuberculosis described by Ponfick and 
forms a typical example of the same. The microscopic returns corresponded ex¬ 
actly with the description of the action of the bacilli as previously sketched. 
The tubercles in the lung tissue showed themselves comparatively small, and for 
the most part contained bacilli in abundance. Some contained so many that 
under a weak magnifying power a bluish color showed itself in the middle. 
Many gigantic cells were also found in the tubercles of the liver and spleen, 
which for the most part were supplied with bacilli. Very numerous bacilli were 
present on the edge and in the surroundings of the herd in the papilla of the kid¬ 
neys. At single points in the surroundings of this herd, the bacilli had collected 
in groups in the urethra, and the peculiar grouping here manifest suggested the 
figures which they take in blood serum culturen, and which are to be mentioned 
later. Whether the bacilli in this case reached the urethra via the course of the 
blood or whether they spread from the neighboring tissue, could not be decided. 
In another tuberculous kidney which I received from Prof. Weigert, numerous 
glomeruli and the neighboring urethra were covered with masses of bacilli, which 
leads us to conclude that the bacilli can make their way from the course of the 
blood into the urethra and from there perhaps into the urine. 
2. —A second case of tuberculosis of the thoracic duct in a man forty-eight 
years old shows an analogous behavior. The tuberculous process had been here 
spread from the caseous mediastinal glands to the thoracic duct, and has brought 
about miliary tuberculosis of the lungs, liver, spleen and kidneys. Death fol¬ 
lowed later than in the first case; the tuberculous eruption was not so abundant, 
the single knots reached a greater size, were more caseous and contained a cor¬ 
respondingly smaller number of bacilli. 
3. —Nine year old boy. Said to have been taken sick only a few days before 
his admission into the hospital. At his entrance into the hospital diseased senso- 
rium, great restlessness and delirium with high fever. In the following days 
bronchial phenomena showed themselves, death ten days later. Dissection 
showed : caseous swelling of the bronchial glands; broncho-pneumonia herds in 
both lower lobes of the lung. Besides these, numerous grey miliary and sub- 
miliary tubercles in the lungs, in the enlarged spleen, in the liver and in the kid¬ 
neys. At the base of the brain, and in the surrounding of the vessels a slight 
muddiness (triibung) and a great number of little grey knots. 
In the tubercles of the lungs, liver and kidneys and spleen, bacilli were found 
in varying abundance. The tubercles of the pia mater were very abundantly 
supplied with them. 
In the caseous bronchial glands belonging to this case, large quantities of 
bacilli were found, and not only on the borders of the caseous herd, but forcing 
themselves far into it. The parts of the gland tissue which were not yet necro¬ 
tized contained numerous gigantic cells which were noticeable for the multitude 
of enclosed tuberculous bacilli, and for the radiate arrangement of the same. 
