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“ག་པ་པ
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the intestinal, though perhaps more advanced, arose from the swallowing of infected
sputum. In this way we may account for cases mish as the following, the respiratory
route giving rise to the lung focus primarily, the intestine being infected secondar- ily, and the lung being again involved by miliary tubercles spreading via the lymph-
ation to the thoracic dust and so to the pulmonary circulation, & considerable num-
ber in this series may find explanation in this way, Several of them have already
been mentioned in the previous paper; to avoid repetition and quoting them all, the following will serve as exemples: Nos 42,96,240,274,294,but on perusal of the paper
giving details of oases several others will be seen,
In connection, however,with these points--the "almost constant absence of a lung focus when the portal of entry appears to be elsewhere" and the corollary of tháo,
the "almost constant abemse of evidence that the portal of entry might be elsewhere when a lưng focus was present--the following must be accorded brief mention. There is no necessity to go much into detail because some of then have already been refer- red to in the section dealing with "theertain prinary portal of entry,"
No 27. A female child, one year old, showing two distinct feel in the lower lobe of the right lung. There were tuberculous ulcers in the intestine and the zezetari.c glands were in large sassous massés. The presence of fooi in the lung nhỏ the cor- responding mediastinal gland involvement are in favour of a respiratory origin, but the intestinal condition, and, still more, the advanced tuberculous state of the mes- enterie glands rather silitate against these being secondary to the lưng, On the other hand, had the spread occurred from the intestine viä the lymphatic system to the lungs by the pulmonary circulation,ene would expect both lunge to be affected.
As has been already stated there is always a danger in estimating the relative agen of two tuberculous conditions by the actual state of things present in each; never- theless, we have in this case a lung focus,in fact two foci,when the portal of entry
may have been, and very likely was,by the alimentary route.
No 38, a boy of 6 years. The caseated and adherent mesenteric glands, together with the mafting of the intestines and extensive affection of the peritonem are strongly in favour of the alimentary canal as the primary portal of entry. The right lung, however, showed two areas of cavitation in the upper lobe and a cassous focus the as
eise of a charry in the lower.
1.59, a boy of 3 years. In this child there were tuberculous visors in the intest-
there ines,both large and small, and the conditions thus appeared to be of older stænding
than the pulmonary. In the upper lobe of the left lung was a focus as large as a
walnut.
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