194 BACILLUS TUBERCULOSIS. 



losis. Of course, this percentage of findings would be con- 

 siderably less if it were possible to hold autopsies on all 

 the dead. The existence of these lesions, without actual 

 evidence, clinically, of disease, is sufficient to warrant the 

 opinion that infection with attenuated organisms does occur, 

 and that even when the bacilli are virulent the healthy body 

 is able successfully to ward off the infection. Individual 

 predisposition is of great importance. 



Persons not naturally susceptible to tuberculosis may be 

 deprived of their resistance to the disease by any of the 

 causes which reduce resistance to infection in general. Dia- 

 betes and tuberculosis are rarely found associated. This is 

 perhaps due to the large amount of sugar in the tissues 

 of the diabetic. 



When infection occurs through the respiratory tract, the 

 infection usually remains localized in the lungs, but the 

 organs adjacent to the lungs may sooner or later also become 

 involved. General infection occurs when the tubercular 

 lesion ruptures into a bloodvessel. 



The healthy nasal mucosa appears to offer considerable 

 resistance to tubercular infection. The tonsils are a frequent 

 portal of infection. Tuberculosis of the cervical lymph- 

 glands may have its origin in infection through the tonsils. 

 Pulmonary tuberculosis may be secondary to tubercular cer- 

 vical adenitis. Kissing a tubercular person should be 

 refrained from, nor should a tuberculous individual ever be 

 allowed to kiss a child. This interdiction applies to the 

 parents and members of the family as well as to strangers. 



Facial tuberculosis, or lupus, as it is more commonly called, 

 is due to infection with the tubercle bacillus through the 

 skin. Infection never occurs through the unbroken skin, 

 but always at the site of a wound or an injury. Acne 

 pimples may serve as an infection atrium. The surgeon is 

 extremely liable to skin infection. Inoculation at autopsies 

 has also been reported. These anatomic tubercles usually 

 contain very few bacilli. The subcutaneous injection of dead 

 tubercle bacilli results in the formation of an abscess. 



That primary infection may occur through the gastro- 

 intestinal tract is true. This may follow the ingestion of 



