78 ILLINOIS ACADEMY OF SCIENCE 



bacillus, a much debated question. A study of tne re- 

 lation of infected lymphatic glands to other localizations 

 of the tubercle bacillus, is strongly convincing that the 

 paths of transmission are by the way of the lyTuphatics, 

 though, of course, there is the obvious transmission from 

 one portion of an organ to another by contiguity. 



THE ANATOMICAL POINTS OF LOCALIZATION" 



Though it formerly had appeared that the tubercle 

 bacillus might develop in any anatomical localization, 

 the lungs being the most frequent location, it would now 

 appear that the glandular tissue is primarily and most 

 frequently involved.^ 



The bones and joints are involved secondarily in 

 children. The apices of the lungs are involved most 

 frequently in adults, our own autopsies showing the up- 

 per lobe more than 95 per cent, the middle lobe more than 

 80 per cent, and the lower left lobe slightly below 80 per 

 cent, and more often involved than the right lower. 



The effects of the growth of the tubercle bacillus on 

 the infected tissues is a matter of greatest interest, in 

 view of the fact that it is this particular phase of the 

 situation upon which hinges the hopeful outlook for the 

 future. It is the reactions to the primary lesion which 

 must determine prognosis. The pathology, therefore, of 

 the primary lesion, is all important. The following case 

 cited by Dumas and Beclere® possibly throws some light 

 on the character of the primary lesion. 



"The breast fed infant of 13 month contracted tuber- 

 culosis from a nurse and developed spleno-pneumonic 

 bacillaire with signs of tracheobronchial glandular in- 

 volvement. The child threw it all off finally, and six 

 years later not a trace can be found except one small 

 shadow, evidently a calcified gland. This was probably 

 the initial lesion, and around it was a perituberculous 

 congestion so intense that it simulated pleurisy of the 

 right side." 



* Deycke's Epidemiological Observations on the Occurrence of Tuber- 

 culosis in Turkey. 



• Bulletins de la Societe Medical des Hopitaux, Paris. 



