114 
R. KOCH. 
joined directly to the caseous herd present, and formed the immediate surround¬ 
ing of the same. Only in glands which possessed a tuberculous structure of 
this sort could tuberculous bacilli be proved. In a number of cases, on the 
contrary, in which the glands were enlarged, partly also softened, and thor¬ 
oughly inpregnated with herds of pus, but in which epithelioid and giant cells 
as well as the characteristic necrosis of the tissue were wanting, no bacilli were 
found. 
The tuberculous or scrofulous glands examined belonged to twenty-one 
different patients. Of these eleven were between the ages of ten and twenty 
years, seven between the ages of twenty and thirty, one each thirty-seven, 
thirty-nine, and three. The glands had been situated fifteen times on the neck 
and in the submaxillary region, three times in the back of the neck, twice in 
the axilla, and once in the region of the cubitus. In the last case, that of a 
three-year-old boy, there existed at the same time caries of the wrist on the 
same side. In three cases there had been a relapse after the first operation, 
and this had caused a second excision of the glands. In several cases it was 
stated that phthisis was hereditary in each family. 
In general the tuberculous glands in reference to their contents of tuber¬ 
culous bacilli were very uniform. In the interior of the caseous herd I have 
found the bacilli only in two cases, and even here only individual specimens. 
The bacilli appeared only exceptionally and individually between the epitheli¬ 
oid cells. On the contrary, among the giant cells there were always some, oc¬ 
casionally many, which contained one or two tuberculous bacilli. Giant cells 
with a larger number of bacilli, as one so often finds them in bronchial and mes- 
entric glands, I have never been able to find in scrofulous glands. 
In the three cases in which after a time a second gland extirpation took 
place, the glands twice showed themselves to have the same constitution as in 
the first examination. The third of these cases which is noteworthy in other 
respects, was as follows : strongly built man of thirty-four years. A year 
before large gland tumors had grown on the neck and in both axillae, and at 
the same time a high degree of anaemia had developed. In the lungs no tu¬ 
bercles could be shown. The tumors which had been excised had the figure 
and size of potatoes, were of a soft, almost marrow-like constitution,and with¬ 
out caseous changes in the interior. The microscopic investigation showed 
that in the swelled mass numberless little herds of epithelioid cells were im¬ 
bedded, which contained in their midst one or more giant cells. In many of 
these giant cells one or at most two tuberculous bacilli were found. Very rarely 
it occurred that one bacillus was situated in the interior of an epithelioid cell, 
close beside the nucleus of the same. Scarcely a year after the removal of these 
glands, almost equally large tumors have developed themselves anew on the 
same spots. These were extirpated again and showed the same microscopic 
conduct, only with the exception that the number of bacilli-bearing giant cells 
had decidedly increased in comparison with the previous tumors. 
5—Tubeeculosis of the Joints and Bones. 
There were examined by me thirteen tuberculous joints, three hip joints, 
five knee joints, three elbow joints, one foot joint, and one finger joint; further, 
