$75
1. The almost constant finding of a lung foous when tuberculous mediastinal glands
are present and the close relation of these glands to the ling focus,
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A perusal of the table in which brief details are given of ench of the omson will
suffice to show the truth of this statement in the majority. Those which agres,
therefore, do not call for further ocument in this respect. The exceptions, however,
are by no means negligible in number and must be mentioned,
In the following instances caseous mediastinal glands were present without sexy focus being detected in the lungat Nos 15, 26, 33, 47, 48, 50, 68, 70, 97, 138, 141, 145, 149, 156, 160, 178, 181, 206, 210, 211, 222, 225, 237, 266, 268, 269, 279, 278 and 295. whe figures are those of the Case numbers givm in the table of detailed
findings constituting paper IV of this series.
Of these 29 there are ten which showed strong evidence of being primarily aliment- ary, and as the mediastinal glands night have become involved secondarily to the mesenterio,as was proved to poeur by the experimental results of Calmette,Quérin and Breton (1907). They found that in guinea-pigs dying in two to four weeks after being fed on the bacilli the mesenteric glands (especially the sperior deriving from the mall intestine) were enlarged and inflamed, although no trace of my intestinal lesion could be determined, After 6 - 7 vesica thene glanda vere caseous in greater or less degree and the lungs showed involvement by miliary tubercles with affection of the corresponding tracheo-bronchial glands. Furthermore, these glands, as show in several of the saves detailed in sy series,become caseous more rapidly than the pul-
monary lesions preseding their involvment,
The following, the,will be excluded from the proemit sestien owing to this possib- 111ty: Nos 26, 47, 38, 158, 145, 149, 156, 237, 266 and 268. No 228 may be placed with these on account of the tubersulous condition of the intestine, although there is no obvious reason for the involvmmt of the mediastinal glands on the right side only. No 141 also,since there was a tubareulous absoess of the 6th servical vertebra discharging into the right pleural cavity which might explain the involvement of the
mediastinal glands without a focus in the lung.
Putting all these aside for the moment as not coming fairly within the scope of this subsection, we still have 17 enses which do not conform to the statement relat- ive to the presence of a lung focus when mediastinal glands are found and the rela-
A few words are called for on each of the20. tion of the glands to the focus.
lo 15. A female child of 22 months with extensive miliary infection—lings,livar, spleen, both sides of the diaphragm, and the meninges. No focus could be found in spite of minute and prolonged oxazination. The mediastinal glands on the right side