question as to the origin of the tuberculous state of the mediastinal glands is still
unsolved.
66
Ho 285.1 boy,4 years of age. A paratracheal gland on the right was as large zo a
bem and completely cassated; another maller but in a similar osudition present on
the left side, while a hilus gland on the right was enlarged and contained sassous
food. No focus was present in the lungs,merely miliary tubercles and these not En
large numbers, distribuțod evenly through both lungs, but perhaps a little more nuj
erous in the right. Other organs involved were the liver with a very few miliary,
the oplem with considerably more, and the brain. Here there many tubercles at the
bess and over the right hemisphere, and a mass of tubercles focally arranged, the
whole as large as a cobut, just beneath the surface of the right angular gruas.
1
So much for instances in which caseated mediastinal glands were found without a
corresponding foots in the ling. A few words are called for with regard to the sec-
ond point of the statement heading this section: the close relationof these glanda
to the lung foous, Though infection of the glands across from one side to the other is not infrequent,it is not likely that in children, in whom caseation of the media-
stinal glands occurs early and readily, infection should spread to the other and ap- Jarently mise those on the side affected. The following are, therefore, of interest, z as the glands involved did not correspond with the lung focya; that is, that our ex- pectations of locating the lung focus from the gland involved were falsified,
No 44. A fausla child of 5 years. The laft lung contained a focus just below the apex, a small cavity in the lower lobe, and scattered throughout there were millary
and mall caseating tuberoles. The glands in relation to these were congustad only,
while those on the right were cessous, although the lung affection here was not focal but consisted of scattered miliary tuboreles in the middle and lower lobes.
In this case,of course,an explanation might be offered that the infection had pass ad by way of the left glands across to the right, communication between those sets
being at times free.
12. 102. A girl of 6 years. The mediastinal glands on the left side ware enlarged and osseous, but the left lung contained milia only) in the right upper lobe me a
caseated focus the size of a haricot been,
No 122. An infant of 9 months. In the lower lobe of the left lung mo a cavity the size of a filbert, surrounded by gray tubercles, and the parietal pleurs over the cavity showed tuberales also, Nevertheless none of the mediastinal glands on that side were affected,no congestion or enlargement, whersas on the right side they were