(b) In primary functional disturbances which can be recognized by the temperature curve and the heart action.
(c) In secondary tuberculin hypersensitiveness.
25. Following mild infections the alterations in the vessel walls may retrogress with a suppression [Beseitigung] of the tubercle bacilli. Without exception, however, the hypersensitiveness to tuberculin remains, varying in degree and length of time according to the virulence of the infecting Tb. and to their more or less locally limited action on the vascular system.
26. After a moderately severe infection there is a formation of transparent, submiliary eruptions (nowadays our “gray miliary tubercle”), especially about the smallest vessels of serous membranes. These eruptions are capable of becoming organized. In fact, when they have healed they form a tissue entirely identical with the tissue in which they originated. (Bichat, Lebert, Empis, and many other older investigators.) Aufrecht, Deutsch. Arch. f. klin. Med., Vol. LXXV.
27. The introduction of a tubercular virus so strong as to cause the smallest vessels to become occluded, especially Cohnheim’s terminal arteries of the spleen, lungs, and kidneys, results in the exudation of a coagulable fluid and in necrobiosis of the extra-vascular region supplied by those vessels. (Aufrecht, Arch. f. klin. Med., Vol. LXXV.) Into this dead area tubercle bacilli are dragged by the wandering cells. These bacilli multiply and cause chemical changes which manifest themselves first in a fatty (steatomatous) and then in a cheesy metamorphosis. (Cf. Koch, Volume II of the Mittheilungen aus dem Kaiserlich. Gesundheitsamt, p. 21, and Plate IX, Figs. 45 and 46); my own observations; Aufrecht, 1. c.; compare also the critical reference by Virchow to the works of older authors, such as Vetter, Gendrin, Lobstein, Cruveilhier, Bayle, Baillie, Laënnec, Rilliet and Barthez, Vulpian, Craigie, etc., in “Phymatie, Tuberculose und Granulie,” and in Vol. II of “Die Krankhaften Geschwülste.”
28. We may enumerate as the result of primary tubercular focal disease
(a) Anatomically demonstrable residues.
(b) Functional alterations.
29. Functional alterations may remain without any anatomically demonstrable residues of the primary infectious processes. I divide functional alterations into
(a) Alterations which leave behind them an immunity against living Tb. virus, probably to be sought for in the peculiar condition of the vessel musculature and, in the beginning at least, always associated with hypersensitiveness to the soluble tubercular poisons.