7
!
MATA
v
71
the following four cases,Nos 2,35,59 and 61. In each of these a focus was preacht
and the corresponding glands were swollen to some extent and congested, though net
obviously tuberculous. Microscopical examination in two of them, however, revealed
giant cells and a few bacilli, In two others (Nos 55 and 39) one cannot explain the
absence of obvious gland involvment by tender age and early death, for in the former
there was a condition of typical phthisis--tuberculous broncho-pneumonia with ulcer-
ation to mall cavity formation--and in the latter the disease had been in existence
long enough to have produced caries of three vertebrae in addition to the condition
of caseating tubercles and a focus in the lung.
3
4. The almost constant absence of a lung focus when the portal of entry appeared
to be elsewhere.
This is a more difficult matter on which to pass an opinion out here where the
chances of infection by a double route, respiratory and alimentary, are so great. In
the discussion of cases in which the primary portal was uncertain several of such
were dealt with. To take these,e.g. Hos 27,35,39,50,116, and so on,as instances for consideration as to the verity of the dietim of this section would be to beg the
question. The statement would apply rather to places where one sees either respårat- ory or alimentary cases, or at least cases in which the primary portal is undoubted- ly one or the other,not those in which the dual route is not only possible, but, as
in many here,highly probable.
Disregarding any of these,therefore, there still remain a few in which a lung focus
respiratory was found although the primary portal of entry was probably not viå the at
tract.
I_52. A girl,4 years of age, who had caries of the spine involving the last two dorsal and the first lumbar vertebrae, and also marked alimentary infection, there being several tuberculous ulcers in the mall intestine, while the mesenteric glands were enlarged and adherent in cassous masses. The lunge,inaddition to miliary in- festion, showed a definite focus altunted just below the apex of the right lower lobe,as large as a polnut. That the alimentary and spinal conditions proseded that of the lưng is supported by the fact that the mediastinal glands revealed practical- ly no involvement,merely a slight swelling, whereas the mesenteric,as stated, were in
caseated, aggregated massos,
No 6a,An infant of 8 months. In this case the mesenterio glands were enlarged and aggregated in caseous masses, These appeared to be of older standing than the media-
etinal gland affection, where the hilus and superior tracheo-bronchial on the right