ETIOLOGY OF TUBERCULOSIS. 
81 
Plainly the tuberculous process in the bronchial glands had only lately began 
and had spread rapidly. The gland tissue had become very quickly necrotized 
and softened under the influence of the tuberculous bacilli. Somewhere thei e 
must have been a breaking through into a vasalumen (gefasslumen) and so con¬ 
siderable numbers of bacilli have got into the course of the blood to have caused 
the general eruption of miliary tubercles. The location of this breach was, 
however, not to be found in this case. That the same is not always easy to find 
may be seen from the following case. 
4.—A strong man of about thirty years died after a sickness which showed 
typhoid symptoms and had not lasted longer than three weeks. From the dissec¬ 
tion it appeared that there were very many grey little miliary knots in the lungs, 
liver and kidneys, as well as in the greatly enlarged spleen. The bronchial 
glands were swollen, of a marrow-like nature, but not caseous. Also, moreover, 
no older caseous herd could be proved, in spite of the most thorough investiga¬ 
tion, so that one was loth to make a diagnosis of miliary tuberculosis. The in¬ 
testines and mesenterial glands were not changed. 
Microscopic investigation gave the following very noteworthy result: Sec¬ 
tions from the bronchial glands showed wide-spread spots bare of nuclei, and 
which were only filled with black pigment grains, and numerous fragments of 
perished nuclei, together with dense swarms of tuberculous bacilli. These last 
were heaped together in such masses in the immediate neighborhood of little 
arteries that the vasalumen (gefiisslumen) appeared to be surrounded by a blue 
court, even under a slight magnifying power. A greater magnifying 
power showed these blue masses to be composed of bacilli. In single 
places the bacilli forced themselves even into the interior of the vasa, and there 
could be no doubt, therefore, that they found their way into the blood in this 
manner, and were transported in all directions in great quantity. A third method 
was thereby sought by which a general tuberculous infection and the miliary tu¬ 
berculosis conditioned upon it could take place, after Ponfick had succeeded in 
discovering one of these ways in the thoracic duct, and after Weigert had taught 
the second, and to all appearance by far the most frequent, in the breaking 
through of tuberculous masses into the veins. 
The miliary tubercles of the spleen and lungs contained a good many bacilli, 
partly also in the giant cells. 
But this case was of great interest in another way. It appeared, namely, 
that numerous capillaries were filled for short distances with micrococci. Under 
the double coloring treatment, the tuberculous bacilli took, as they always do, 
the blue coloring, the micrococci, on the contrary, the brown color. In many 
places in the same field of vision, and at slight distances from each other, brown 
colored micrococci and blue colored bacilli were to be seen. The capillary mi¬ 
crococci embolism were moreover very numerous in the lungs, and especially in 
the spleen. They had not as yet led to striking changes in their surroundings, 
such as heaping together of nuclei or necrosis, and must therefore have appeared 
not many days before death. The combination of a bacilli and a micrococci in¬ 
vasion as it occurred here, belongs to the mixed infections whose appearance 
seems not to be rare. Such mixed infections can be generated artificially in ani¬ 
mals by simultaneous or closely following inoculation with various infectious 
