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In cases Nos. 2 and 3, the infection was trace to the bronchial gland, and in the lungs evidences of tuberculosis were present.
In case No. 4 the lymphatic glands lying at the bifurcation of the trachea showed the presence of Tuberculosis.
These cases are interesting in the following respects. They show that by the careful dissection of the affected parts, some previous infection will be found and that tubercular Pericarditis as a spontaneous infection is of doubtfu! occurrence. ZENKER, BAUMLAR and SCHOTTELIUS and KAST have pointel out the relation existing between diseased cervical, mediastinal or bronchial lymphatic glands and the Pericarditis.
The lymphatic glands become affected with Tuberculosis in the first place ; then by a process of extension the pericardium falls a prey tothe disease.
Tubercular Endocarditis. For many years, tubercular disease of the heart remained as a pathological entity. The existence of the condition has up until a few years ago been considered of the rarest possible occurrence. It was the discovery by WEIGERT in 1877 of such a condition in the heart that gave pathologists the famous clue to the question of general infection in tuberculosis. Since then the advent of more perfect staining methods ought to furnish a greater number of cases of tuberculosis of the heart in future.
There is no doubt that the vascular system forms one of the most important channels through which the general system becomes tubercular infected. Through the researches of RIEDER, PONFICK, LETULLE, PETIT, HANOT, BENDA, and others, tuber- culosis of the vascular systein in all cases tubercular disease has been firmly established and in order to amplify their investigations, particular attention ought in a great measure to be directed to the careful study of vascular tuberculosis, the extent and method of spread of such a process and the interpretation of the results obtained. That general infection in tuberbulosis is not occasioned by the smaller blood vessels, as propounded by RIBBERT, has been almost settled by the elaborate researches of BENDA.
In tuberculosis, one of the most constant features of the disease during its development is the absolute obliteration of the blood vessels of a certain calibre in the neighbourhood of the diseased focus, tubercle bacilli are few in number in these situations. It is obvious then that these vessels are unable to occasion the spread of the pathogenic agent.
It is only when we come to the larger vessels that opportunity is given for the extensive spread of the disease, in vessels of a calibre which do not allow of complete obliteration in the presence of a tubercular focus.
TO WEIGERT belongs the discovery of the presence of tubercular foci in the large vessels, a fact which gives us a most thorough explanation of the extra- ordinary widespread nature of tuberculosis throughout the whole body of the organism. The process here at work is the gradual extension of a tubercular nodule through the blood vessel wall and its subsequent discharge of the infective agent into the general blood stream. This result has been recently studied by BENDA who has shown that although this method of generalisation is common, yet it is not the one and only way. What he has demonstrated to perfection is that apart from the solution of continuity in the wall of the blood vessel (WEIGERT), it is possible to have an eruption of miliary tubercles in the blood vessel wall, i.e., in the tunica intima. The knowledge of the occurrence of such constitutes at present one of the most important advances in regard to the mode of spread of the B. Tuberculosis throughout the body. The occurrence of this condition in tuber- culosis would appear to be cominon enough but so far scarcely any confirmation of this has appeared.
The following is interesting:
A Chinese male ailult, aged about 20, was examined post-mortem. No history of the case could be ascertained. The body had been " "dumped". The external appearances of the cadaver were that of a well-developed man whose general con- dition of nutrition was poor. Post-mortem lividity and Vigor mortis were slightly marked. The pericardial sac contained a few onnces of yellowish and clear fluid. The walls of the sac were normal. The heart on being opened showed the pre- sence of endocarditis of the mitral valve. The other valves were normal. The diseased mitral valve showed numerous small vegetations about the size of a pin.