CO129-468 - Governor Sir Stubbs - 1921 [6-8] — Page 78

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in whom the right lung was attacked, and in No 97 the left. En No 119 there was in

addition a cerebellar focus,

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In one case,No 95, the mediastinal glands and the meninges were the only parts

found affected, there being no tuberoles, either focal or miliary, in the lunga,

The mode of extension to produce the peculiarly limited distribution of lungs and

meningos ás obscure and is,parhaps, analogous to brain affections secondary to säher

pulmonary conditáone, bronchiectasis, for exemple. There is not, so far as I am aware,

any lymphatio connection between the lungs and the base of the brain, and if the

extension occurred by way of the blood-stream, why should the secondary infection be

so limited ? One would almost sertainly expect to find signs in other organa.

I am also unable to suggest any signifiomce for the fact that, in the combination of lungs and meninges of the sevens cases in which one ling only was affected, in

of six it was the right and is five cases in which both were involved in three the right was more affected than the left. Again,in No 97, in which the mediastinal glands and meninges vere tuberculous, but no signs were detectedz in the lungs, tho

glands were those of the right side only.

The combination of lungs,meninges and spleen was a little more common, fifteen of

such being met with, and in two of them, Nov 33 and 186,only one lung was involved,

in each case the right.

In this connection it may be worth noting that the involvement of the splee

with miliary tubercles as the only abdominal visous affected has not been very ing frequent and may find an explanation, perhaps,if one regards the splom as the meet- ing point of lymphatic and blood terminale. I may refer here to the observations of Durse upon what he calls an unusual for of tuberculosis net with at Salonica amongst Senegalese and Arab troops. He noted that the mediantinal and peribronchial lymphat- io systems were first affected and later the pleura and pericardium. In the early #tages the glands were merely enlarged,but later they suppurated or became cassous, At the onset there were no lesions of the parenchyma of the lung and even later not the ulcerating and caseous form, only a few scattered tubercles. He considered that it was in the splee that the lesions passed from the lymph into the blood-stremn, Then the spleen was noraal no tubercles were found in the lungs, but when the former

was invaded the latter were also affected.

Examples of this in children,i.e. cases in which the oplem me the only abdominal viscus involved and the connection referred to between this and the julmonary find- inge sem to find support in some of the instances of this series,s.g. Nos 33,34,

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65; and, as was pointed out above, in the peculiar limitation at times to the lungs

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