Tuberculosis. 487 



than another, as the disease may have advanced much more 

 rapidly in the one issue. Still less can we state with certainty 

 that the disease has not entered by a given channel because no 

 lesions are left to show the transit of the bacillus along its sup- 

 posed course. We frequently find tuberculosis of the bronchial 

 or mesenteric glands, when we can detect no lesion in the lung, 

 nor intestine. The bacillus has been passed on without establish- 

 ing any lasting lesion in transit. 



It is often too confidently asserted that the infected dust in- 

 haled, falls directly on the air cells and determines the extensive 

 pulmonary tuberculosis that ensues. So on the other hand, it 

 is often too arrogantly assumed that tubercle bacilli ingested with 

 food, must necessarily show their results mainly in the intestines, 

 mesenteric glands and liver. That solid particles can find their 

 way directly into the lungs, has long been demonstrated by the 

 pulmonary anthracosis of the miner, and the deadly phthisis of 

 the stone hewer and cutler. The experiments of Cornet, Tap- 

 peiner and others in producing pulmonary tuberculosis, by com- 

 pelling the inhalation of infected spray, corroborate this experi- 

 ence very satisfactorily. Yet it does not follow that all of the 

 offensive matter penetrated the air cells at once on the air in- 

 haled. The heavy particles of steel, quartz and even of coal 

 dust must be mainly arrested on the surface of the moist air pas- 

 sages, yet, under the irritation caused by their presence and the 

 consequent arrest of the ciliary motion, they would slowly gravi- 

 tate downward to the pulmonary cells. In the case of the in- 

 spired tubercular spray or dust, we must recognize the possibility 

 of the approach of the bacillus to the lungs through the lymph 

 and blood channels as well. The bacilli lodged in the pharynx, 

 and, above all, in the tonsillar follicles, can readily enter the 

 lymph vessels, and are finally poured into the lower end of the 

 jugular vein, but a few inches from the right heart, by which 

 they are instantly propelled into the lungs. If then the lung is 

 the most receptive and least resistant organ, it may easily be that 

 this is the first point where the bacillus can establish a strong 

 and effective colony. Apart from this the colonization of the 

 tonsillar follicles may determine a constant supply of fresh ba- 

 cilli, which may gravitate down with the abundant mucus toward 

 the lungs. 



