CO129-468 - Governor Sir Stubbs - 1921 [6-8] — Page 61

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animals of the same species and as nearly as possible of the same weight, that in

10 days the adjacent gland was involved; in 10 to 20 days the left superficial and

deep inguinal and the sacro-lumbar glands, and also,perhaps, the spleen and the retro-

hepatic glands. In another 10 to 15 days the liver, the lungs, the bronchial, supra-

seapular and cervical glands on both sides showed involvement (Delépine), 60

since in my series the respiratory portal of entry was that most frequently mooun-

tered these cases will be first dealt with.

Albrecht, Chan, and others hold that there is a special form of tuberculosis in

children consisting of a primary lung foous and resulting from the entrance of the

bacilli by inhalation. This focus, they stated,was usually the size of a pea,but might be quite mall and was rarely larger than a cherry. In nearly three-fourths of the cases the focus was single. The focus is believed to arise "in aggregations of lymphoid tissue in the neighbourhood of mail bronchi." Around this focus mall tubercles are seen and perhaps reactionary fibrous tissus. In the case of larger

fool hard dry casastion is usual and occasionally there is actual cavitation.

As regards the situation of the focus the order of frequency wasi right upper, left upper right lower,left lower,right middle, the first named site being four

times as common as the last.

An examination of the mediastinal glands showing involvement will in many cases enable one to predict the situation of the lung focus. The lymphatics,deep and super ficial, discharge into the broncho-pulmonary glands situated between the branches of the main bronchi and at the hilus; those from the middle and lower portions of the lung into the inferior tracheo-bronchial at the bifurcation of the trachea; those from the upper to the superior tracheo-bronchial in the angle between the traches. and bronchus, There is also a chain of glands each side of the traches, the para- tracheal glands. Infection seross from one side to the other is frequently met with. The original focus may open into a bronchus and thus by inhalation a tuberculous broncho-pneumonia is set up; a like result would,of course,follow the perforation of a bronchus by an adherent gland, Again,there may be direct extension from a gland adherent to the pulmonary ŝissue, while,lastly,by communicating with a blood-vessel,

millary tuberculosis may emme.

It used to be held that gland infection was primary and the lung sondition second- ary to it, but this would leave unexplained the fact of apparently arbitrary selso- tion of a site remote from the primary gland infestion, while the intemediate tåsatte

remained free from disease,