MESENTERIC-GLAND DISEASE.
This may be regarded as being practically always the result of tuber culous invasion through the gastro-intestinal tract, caused by the use of uncooked milk from infected cows. Pathological research has demon strated abundantly the fact that the tubercle bacillus may rapidly pass through the intact intestinal epithelium without leaving any local evidence of its point of entry. Thus the writer in his Cavendish Lecture (1908) has shown that the bacilli when injected into the stomach of the guinea-pig were detected by Symmers and himself in stained sections of the lungs a few hours later. ('almette and Guerin in a highly important research claim to have established the fact that when a similar experiment is performed upon a very young guinea-pig the bacilli are arrested by the mesenteric glands because the mesh or network in these organs is much closer than in adult animals. Behring advances the view that these filtered out and quiescent bacilli may years afterwards find their way into the lung and originate phthisis.
The above researches demonstrate the vital importance of preventive measures which may be easily and effectively carried out by sterilising the milk-supply.
Once mesenteric-gland enlargement has been detected, the treatment becomes clear and imperative. Open-air life, overfeeding and the im proved hygiene which constitute the essentials in the treatment of every form of local tuberculosis should be perseveringly carried out. Mesenteric gland disease has been demonstrated to be more amenable to such treat ment than arc the ordinary forms of tuberculosis. Even where involve ment of the peritoneum and bowel has already occurred the results of abdominal section have proved how readily tubercle in this portion of the body may be successfully overcome, as detailed under Peritonitis, Tuber culous. Every aid, however, should he pressed into the service of the physician in the struggle against the encroachments of the bacilli once they have entrenched themselves in the mesenteric glands, especially in view of the theory of Behring just mentioned. Cod-Liver Oil, Malt Extract and Creosote internally should be employed. For many years the writer, in mesenteric disease and other affections associated with marked wasting employs cod-liver oil by the inunction method at the same time that he administers the drug by the mouth. This can be carried out
in the following manner:—After a warm bath, the skin being thoroughly dried by friction with hot towels, a tablespoonful or more of Cod-Liver Oil is rubbed by the palm of the hand into the front and the sides of the abdomen, especially into the skin in the inguinal regions. A flannel roller is bound round the abdomen, reaching from the pubes to the middle of the sternum. Over this, and covering it in at all points, is applied a broad piece of moderately strong mackintosh sheeting. The friction should be continued night and morning for the first four or five days, the same soiled flannel being reapplied each time. Soon this becomes saturated with the oil under the impervious sheeting, and as the little patient twists, cries or coughs during the day and night, the oil is rubbed in incessantly. After the saturation of the flannel only one fresh and free application need be made in the day. The patient's clothes or linen are not much soiled, but the odour becomes very objectionable to the patient's friends, though he soon appears to become insensible to the discomfort himself. The binder need not be changed oftener than once in ten days.
The writer in 1875 first became satisfied about the value of cod-liver oil inunction, after observing its effects in one instance in an emaciated, scrofulous child, whose abdomen seemed distended with fluid almost to bursting, the umbilicus being protruded like the finger of a glove. The parents, believing the case to be hopeless, refused to permit tapping. The inunction was, however, persevered with, and after many weeks the patient recovered. A mass of enlarged glands, around which the great epiploon was probably matted and adherent, slowly and steadily dis appeared. This child became a strong, healthy man, but died 25 years afterwards from acute pulmonary phthisis, affording an illustration of the probability of I3ehring's theory already mentioned.
Vaccine therapy by injections in small doses is clearly indicated in all forms of abdominal tuberculosis, the Human Tuberculin being selected.