AND MEDICAL SCIENCE 325 



not infrequently, chronic diseases of the joints. Now, discarding 

 the old term, it is the custom to speak of tuberculous joints and 

 tuberculous lymphatic glands, because it is known that the specific 

 Bacillus of tubercle is to be found in the tissues affected, though 

 perhaps nowhere else in the body. 



But how, it may be asked, in accordance with present ultra- 

 contagionist views as to the mode by which tuberculous affections 

 are disseminated, are we to explain the isolated occurrence of the 

 tubercle Bacillus within the tissues of joints, in the lymphatic 

 glands of the axillas, or within some of those in the neck ? The 

 two generally admitted channels for the entry of such micro- 

 organisms into the system are through the mucous membranes of 

 the air passages and that of the alimentary canal ; but entry by 

 either of these routes would not satisfactorily account for their 

 isolated presence in the glands of the axillas, or in some of those 

 not infrequently involved in the neck, or within the tissues of the 

 knee or hip-joints.' 



It has for a long time seemed to me that chronic inflammations 

 of lymphatic glands in certain cachetic states of the system (such 

 as we formerly labelled " scrofulous ") may be of such a nature as 

 necessarily to produce therein the little nodules which we recog- 

 nise and name " tubercle." And this same view was very ably set 

 forth in some detail by Mr. (now Sir) Frederick Treves,' at the 

 International Medical Congress of 1881, in a communication 

 entitled " Tubercle : its Histological Characters and its Relation 

 to the Inflammatory Process, as shown in Tuberculosis of Lymphatic 

 Glands." He pointed out that all the characters of the nodule 

 known as " tubercle," apart from the Bacillus which had not then 



» The frequency of tubercle Bacilli in association with pleurisy occurring in 

 persons, previously to all appearances perfectly healthy, as a sequence of falls or 

 blows upon the chest, and other facts cited by Prof. Osier in a valuable commu- 

 nication made to the British Medical Association last year, are difficult to account 

 for from the point of view of infection (" British Medical Journal," Oct. 15, 1904, 

 p. 999) ; and the difficulty increases in many cases of tubercular affections of the Fal- 

 lopian tubes, seeing that G. L. Basso has shown by an experimental investigation 

 on rabbits, that tubercular affection of the female genitals is of a descending 

 rather than of an ascending type. But " tubal tuberculosis has been found to be 

 commoner than that of the body of the uterus, while both are much commoner 

 than vaginal, cervical, and ovarian tuberculosis " ; and as infection from the 

 peritoneum seemed to be excluded, the frequency of this affection is at present 

 quite unaccounted for as a result of infection (" British Medical Journal," May 20, 

 190S, p. 1107). 



= " Transactions of the International Medical Congress, vol. 1., pp. 298-303. 



