Page:The Harveian oration 1888.djvu/36

28 tuberculosis of children was traced back in a large number of instances to a simple intestinal or bronchial catarrh; this was supposed 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 not produce tuberculosis." 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 effect, between them.

May I venture to offer an interpretation of the fact?

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 membrane 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 organs 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 epithelial or endothelial cells, or so modify the condition of the blood, that the tubercle bacillus finds a suitable soil in which to