(b) Scrofulous diathesis, consisting in such changes in the vascular system and the lymphatic apparatus that a renewed Tb. infection very readily causes cheesy tubercular lesions.
30. As scrofulous infectious processes, I regard
(a) Lupus, which I interpret as a cutaneous additional effect of a tubercular infection.
(b) Gland scrofula,[6] inclusive of tuberculosis of the mediastinal, bronchial, and mesenteric glands.
(c) Bone scrofula and joint scrofula.
(d) Scrofula in the domain of the external body covering, of the mucous membranes, and of the lymph-channels.
(e) Cheesy metamorphosis in internal organs, inclusive of the organs of sense, and the vessel intima.
31. The acute miliary tuberculosis in man, which can be clinically diagnosticated, is to be regarded as a provocative secondary infection, resulting from scrofula of the blood-vessels’ intima when, on the disintegration of cheesy intima tubercles, a great many tubercle bacilli are thrown into the circulation at once. (Weigert-Ponfick.)
32. Disease of the lung apices occurring in the virile period of infection and, because of its important bearing on the origin of consumption, considered separately, is preceded by the consequences of an infantile infection. Foremost among these is the secondary hypoplasia of the smooth muscle tissue (of vessels, bronchi, and intestinal wall); next in order come wasting [Veröding] of the lymphatic apparatus (quantitative and qualitative reduction of the follicular receptive apparatus of the tubus alimentarius); destruction of lymph-glands; and the secondary hypoplasia of other primary points of attack for Tb. action (in the spleen, bone-marrow cavities, on serous surfaces of the large body cavities, and of the joints). The predilection of the thoracic dome for immobilizing changes can probably be ascribed to its exposure to the Tb. infection in connection with precedent mediastinal-gland scrofula; while the predilection of the lung apices for caseating lesions can again be brought into causal relation with secondary ossifying processes, of scrofulous origin, in the joint structures of the thoracic dome (cf. Aufrecht, 1. c.).
33. In my experiments on tubercular cattle I succeeded in producing eruptions of gray, non-caseating tubercles, running an acute course, by means of injections of tuberculin. At the same time it was noticed that not infrequently after the intercurrent exacerbation had subsided, the old infectious process had been favorably influenced.