274
ENDOCARDITIS,—Continued.
No. SEX. AGE. SEAT OF DISEASE.
BACTERIOLOGY.
REMARKS.
The other organs especially the spleen and kidney were
deeply congested.
So far as the genital apparatus is concerned, the vagina was thickened and hard and its squamous surface rough and covered with patches of papillary thickenings of connective tissue. There was papillary erosion of the cervix uteri with the presence of a thin pyoid secretion. The endometrium was thickened and warty and the cavity practically in a condition of pyometra.
The micrococcus was recovered from the cardiac valves.
It was not definitely found in the genital apparatus but its pathological condition was diagnostic of the effects of gonorrhoea.
The woman was a Chinese prostitute.
Pathological appearances similar to Case No. 3.
5
M. 23 !
Mitral valve.
F.
years.
50 Mitral valve with years. extension of
opaque areas over the auricle.
Streptococcus pyogenes.
Do.
Same as Case No. 5.
Tuberculosis.
Although an enormous amount of research has been prosecuted in regard to the interpretation of the lesions caused by the Tubercle Bacillus, it may be said that as yet the majority of the tissue manifestations of tubercular disease are wrapt in mystery. Speculation is rife as to the modes of infection, the proclivity of certain animal tissues to the disease, the apparent immunity of others and the apparent erratic spread of the infective process
It would appear from an examination of the most recent researches, however, that at last some light is to be thrown upon that most difficult problem, namely, the diffusion of the Tubercle Bacillus in the system.
With the advent of more perfect tinctorial methods, elaborated by WEIGERT SO long ago as 1877 and extended by EHRLICH, WECHSBERG and others, recent research has furnished us with a considerable literature in regard to this question, and fur- ther has opened up to us entirely fresh fields of investigation regarding the pro- bable avenues of general infection in Tuberculosis.
The portals by which the Bacillus Tuberculosis enters the body still remain a subject for the most varied discussion. Tonsillar infection, intestinal infection, respiratory infection, genital and urinary infection, as well as others, have all been advanced. The part played by each of these modes or others is difficult to gauge in the enormous field of tubercular pathology. As HABERSHON stated in the Con- gress on Tuberculosis in London in 1901, the forms of Tuberculosis and its man- ifestations in the body probably depend-first, upon the mode of entrance; second, upon the character of the invasion; and thirdly, upon the resisting power of the individual. These general principles as regards Tuberculosis are most important and to a certain extent are responsible for the peculiarity of the lesions subsequently produced. At the same time, it must be borne in mind that the lesions produced in the individual affected are influenced by three important factors relating to the causal agent itself, namely, the slow growth of the Tubercle Bacillus, its absence of the power of movement, and the severe effects which it produces at the seat of its colonization. Examples of this are numerous in tubercular pathology, e.g., the occurrence of localised nodular tubercles in the majority of organs and glands of the body. Such localised productions of tubercle, however, are unfortunately in the minority. What we have to explain is the occurrence of widespread Tuberculosis and that, given the infection, what are the avenues through which the Bacillus Tuber- culosis is enabled to call forth such ravages throughout the whole animal organism.