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right lung, or there may have been hamatogmous infection resulting in the general
distribution in both lunga; the blood-stream route is favoured by the fact of the
involvment of the spleen and meninges.
76
Passing on to the question of abdominal and alimentary tuberculosis there is not
much to be said in this section dealing with the aspect of the morbid anetony, As
already stated, cases of isolated primary tuberculosis of the intestines,not uncommon
at home, are comparatively rarely met with here. In only four instances was the đâs -
ease confined to the abdomen, namely,Nos 7,8,81 and 112. From the intestines with,or
more often without, any local lesion the basilli are arrested for a time in the ser-
enteric glands and thenes spread either by way of the lạmphatics to the blood sid
so to the lungs (of this method several instances have occurred in this series and
have already received sufficient mention), or else by the portal blood to the liver.
This has been very rare in these cases. In fact, cases in which the liver was exten-
sively involved have been few. The spleen in nearly every case vas more affected
then the liver, and in two only,Hos 10 and 201,was the liver infected and not the spleen, Then tubercles were found in the liver, in the farge majority of instances they were mall,niliary to piníîhead, and confined to the surface, the rarer forms of
intestinal tuberaulosis where the disonse is localised to the resion of the il-
caecal valve to produce a mass of tuberculous ecicatricial tissue constricting the
lumen I have met with once among these cases,No 92.
No 86 is worthy of mention while dealing with alimentary forms. This was a child of two years; there were tuberculous ulcers in the mall intestine and the meachter-
io glands were alarged and saseated, å tuberculous meningitis was the only other
lesion detected; there were mmerous pin-head tubereles at the base and a few on
the vertex. The mode of extension in this case is obscure; one only evades the
question by saying that it was probably metastatic by way of the blood-stream,sna- logous possibly to cerebral abscess in cases of hamorrhoids and in liver condition,
The meninges and brain were found involved in a considerable number of cases, par- ticularly the femer, and usually as miliary tuberculosis affecting mostly the base and the Sylvian fissures, Definite focal masses in the brain or cerebellum VOTO
comparatively rare.
As examples of onses in which the lungs and meninges were the only parts in which tubercles were found the following may be sited: Mos 4,155,170 and 187; in seven others the meninges and one lung only were affected,vis,,Boa 2,37,46,49,98 and 205
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