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January 20, 1900


JAMA. 1900;XXXIV(3):176-177. doi:10.1001/jama.1900.02460030050012

According to Weigert, general miliary tuberculosis depends on a dissemination of tubercle germs in large numbers, due to an invasion in mass through a large vessel—the heart, or the thoracic duct. This theory is supported by the recent investigations of Benda1, who carefully studied seventeen cases with this point in view. The points of invasion of the circulating blood were found by Benda as follows: Through the thoracic duct twelve times, the pulmonary veins four times, the endocardium once—once the mitral valve, and once the aortic—and the thoracic aorta once. In the majority of the cases the vascular foci contained extraordinarily numerous bacilli in heaps. The points of invasion are divisible into two classes: One, which is rare, is due to an erosion of a vessel from without of an extravascular caseous focus, the other, more frequent and present in all of Benda's cases, depends on single or multiple metastases