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July 1, 1899


Author Affiliations

Professor of Clinical Surgery, Omaha Medical College; Surgeon-in-Chief to the Presbyterian Hospital, etc. OMAHA, NEB.

JAMA. 1899;XXXIII(1):24-26. doi:10.1001/jama.1899.92450530024002e

It seems to be generally held that the lymphatic system affords the main avenue for tubercular invasion. Thus in children, whose exposed facial integument, with repeated abrasions, invites a tubercular cervical adenolymphangitis, (1) in the adult the nasopharyngeal space, directly exposed to multiple bacterial irritations, favors this predisposition an entrance into the lymphchannels and, with suitable soil, general dissemination through the larger ducts to the bronchial and mediastinal glands. Through the same system a tubercular invasion may develop from the genital lymphatics, with easy access to the histologically allied tissue—the serous peritoneum. These neighboring glands in the process of caseation may directly infect the peritoneum, or a hematogenic deposit in this region of recurrent congestions may follow as a secondary expression of a distant tuberculosis. From the intestinal canal also an ulceration may allow the tubercle bacilli to reach the peritoneum, and thus start the destructive process on this organ.