28 



tuberculosis of children was traced back in a large number of 

 instances to a simple intestinal or bronchial catarrh ; this was suj> 

 posed to lead first to swelling of the corresponding abdominal or 

 thoracic lymph glands, and then to their caseation ; and when once 

 caseation had commenced the conditions for the development of 

 tubercle were assumed to be present." 



But, says Dr Hilton Fagge, whom I have just quoted, "Nothing 

 is more certain than that in man, the inspissated pus of a common 

 abscess, or the caseous matter of an atheromatous artery, or of a 

 degenerating new growth or gumma, does ')iot produce tubercu- 

 losis." We may neglect then the consideration of these caseous 

 glands as "caseous foci" and yet their existence antecedent to or 

 associated with tuberculosis is so general, that to the mind of the 

 practical physician it would seem as if there must be some distinct 

 relationship, as to cause and efiect, between them. 



May I venture to offer an interpretation of the fact 1 

 Suppose that in an individual we have such a condition of the 

 glands either inherited or acquired, such a "vulnerability" so to 

 speak, that from more or less slight irritation of the mucous mem- 

 brane of the throat, of the lungs, or of the intestines, the glands in 

 connection with those parts become enlarged and inflamed and, 

 instead of recovering, become caseous, these oi-gans then would no 

 longer be able to perform their function, whatever that function 

 may be ; and if it be that of modifying or destroying the effete 

 material coming to them as the result of normal changes 

 in the mucous membrane, this effete material must pass on into 

 the circulation generally, and produce its noxious effects — lessen, 

 it may be, the vitality of the white blood-corpuscles, or the epithe- 

 lial or endothelial cells, or so modify the condition of the blood, 

 that the tubercle bacillus finds a suitable soil in which to 



