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The original idea of KocH that such a spread was occasioned by wandering connective tissue cells has been greatly added to. Other channels of infection have been discovered and it is mainly through the prolonged investigation of these by BENDA and others that our ideas have been clarified as to the ways of Tuber- cular infection. The investigations bearing upon the great role played by epithetial channels, the lymphatic apparatus and the vascular system have opened up that complicated question of the distribution of Tuberculosis.
Since my arrival in the Colony, my attention has been directed to this subject, namely, the spread of the Tubercle Bacillus throughout the body. Excellent facilities have been available at the Public Mortuary. where a considerable number of cases of the various forms of Tuberculosis is constantly met with.
Mere mention of the frequent occurrence of Tuberculosis was made in my Annual Report for 1902. My observations at that time were fragmentary and it was considered advisable to withhold my remarks until a larger amount of material was at command.
Considerable fortune has attended my investigation as some excellent material was obtained.
My attention has been directed largely to the examination of the vascular system in all cases of Tuberculosis, because after the masterly presentment given by BENDA of the part played by the circulatory organs in the diffusion of the Bacillus Tuberculosis in the system, it appeared to me, in the presence of such an amount of pathological material that this abstruse question was deserving of further analysis. In addition to this, the other paths of infection have not been lost sight of and several cases, illustrative of these, have come under my notice, which in conjunction with others are worthy of publication.
The following cases, accompanied by remarks, are instructive cases of the. mode of diffusion of the Bacillus Tuberculosis in the body and they shed light upon the clinical and pathological aspect of some of the forms of the disease.
Tubercular Pericarditis.-A Chinese male adult, about 35 years of age. The post-mortem examination was held within 12 hours after death. During life no history of the case was ascertainable. To external appearance the cadaver was that of a well built man whose general nourishment was fair, Post mortem lividity was well marked on dependent parts and rigor mortis was extreme.
The
The pericardial sac contained about 50 c.c. of blood stained fluid. parietal layer of the pericardium was studded with a number of greyish white miliany nodules.
At certain points the right pleura was adherent and in this tissue similar nodules were found. These were larger and irregular and in certain instances caseating. The visceral layer of the pericardium was also the seat of a miliary eruption.
These nodules were variable in size and some of them well in a state of caseation. The nodules extended into the cardiac muscle. A considerable amount of granulation tissue was present. A sheet of fibrin covered the visceral pericardium. The heart, lungs and pleural cavities were normal. The bronchial and mediastinal glands were normal. The glands around the trachea and those situated in the anterior triangle of the neck, were enlarged and caseated. considerable quantity of solt newly formed tissue was found around the trachea. This tissue extended from the neck to the pericardial sac. On section, this granulation tissue was found to contain softened greyish-white nodules, many of which had broken down. The surrounding areas of tissue were normal.
The other body organs were normal.
A
Bacteriological examination showed the presence of Tubercle Bacilli in the newly formed tissue and also in the pericardium.
Four cases of this disease have been met with during the past two years. The mode of infection in these cases has been worked out as carefully as possible, and the following is a brief resumé :-
Full details in regard to the post-mortern appearances of Cases Nos. 2, 3 and 4, have not been given. The lesions present were of a nature very similar to that found in Case No. 1.
In case No. 1, the infection of the pericardium was traced to the tracheal lymphatic glands and those situated in the anterior triangle of the neck.