210 
ft. ftOCH. 
A third possibility is suggested in the case described in the earlier pages 
of this paper, in which the bacilli grew into the lumen of an artery. In all 
these cases the bacilli were rapidly swept away by the blood-stream, scattered 
into the most various organs of the body and there established. If very many 
bacilli at one time got into the blood, then the conditions are exactly the same 
as in the experiment with the rabbit into whose ear-veins considerable quan¬ 
tities of tuberculous bacilli from a pure culture were injected. As well in the 
artificial as in the natural experiment, and in the same manner, tuberculous 
knots arise in great numbers, and moreover epecially in the lungs, spleen and 
liver. Why these organs are so specially favored demands explanation. The 
connection between the localized tuberculous processes and the acute miliary 
tuberculosis which formerly appeared so enigmatical, and on that account has 
been characterized by many as impossible, has been made clear with unques¬ 
tionable certainty by the discoveries of Ponfick and Weigert. This example 
of the manifold forms of a disease warns us forcibly against considering patho¬ 
logical changes, and especially infectious diseases.only from an anatomical point 
of view unless forced to do so, but first of all to consider the setiological relations 
as authoritative. 
A considerable number of tuberculous bacilli do not always force them¬ 
selves at once into the blood-passages. It can also occur that only compara¬ 
tively a few bacilli are carried along by the blood-stream. Then there arise cor¬ 
respondingly fewer tuberculous herds, but which reach greater dimensions 
because in this case life is longer preserved, than when an immense eruption of 
tuberculous knots cause rapid death. Also in this matter the infection taking 
place in the natural way conducts itself just like that artificially generated. 
Sometimes only a very few bacilli get into the blood and only individual tuber¬ 
cles are formed, which then in course of time grow to considerable dimensions. 
This proceeding, which can repeat itself with intervening pauses, has been char¬ 
acterized by Weigert very fittingly as chronic miliary tuberculosis, in contrast to 
the acute, which, owing to the immense production of tubercles is quickly 
fatal. 
To these last mentioned forms of miliary tuberculosis are joined those 
processes where, in certain places of the body, which are not easily suceptible 
to an invasion from without and apparently without a herd causing the infec¬ 
tion, a tuberculosis confined to the spot is developed. This sort of process, among 
which the fungous carious infections are to be reckoned, arise strictly localized. 
One can scarcely explain their occurrence otherwise than that a single infec¬ 
tious germ, therefore a single bacillus, was deposited by the blood on the spot 
in question. But how is a single bacillus to get into the blood ? Could it after 
being inhaled into the lungs get into the lung capillaries without previously 
causing in the lung itself a tuberculous herd ? Such a supposition has to me 
little probability. The almost regular appearance of caseous or calcareous 
bronchial glands in the diseased conditions mentioned rather makes the sup¬ 
position probable, that the lymph-glands are not always an unconquerable 
hindrance to the further progress of the bacilli, and that individual bacilli just 
as they are carried along by the wandering cells and the lymph-stream, can 
also by help of the wandering cells leave the lymph-glands in centripetal di- 
