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is from one of these sources and by one of these routes. The effort will be made to outline the claims for each of these positions, for it must be clearly understood that we shall not be able to institute scientific and rational methods of prevention unless we know from what source or sources the infection comes, and how it gains entrance to the body. CAN FOREIGN M.^TTER BE INHALED DIRECTLY INTO THE LUNGS? One can feel fairly safe in benoquin price answering in the af- firmative. All are familiar with the macroscopic appearance of the lungs of deceased firemen, miners, and workers monobenzone benoquin in other dusty occupations. Like manv others, I once believed that it was impossible for foreign matter of any kind to benoquin 20 be inhaled into the air sacs of the lungs. It does not seem reasonable to believe that dust can reach the air sac, for we should naturally think that the air excursions would drive foreign matter against a moist mucous mem- brane, where it would be picked up by the cilia and wafted along out through the bronchi and trachea. October 3, 1903.] COBB: PULMONARY TUBERCULOSIS. 641 That is precisely what does happen to nearly all the particles of foreign matter, but a portion, an infinitesmal part, does gain benoquin cream 20 the air sacs, penetrate their walls, and become deposited in the nearby lymphatics and bronchial glands. The literature on anthracosis has been fairly worked up, and it would seem that the (|ucstion of inhalation was already settled in the affirmative. This is not the case, however, for many great writers deny that foreign matter ever is inhaled and explain its presence in the lungs by the fact that it is picked up by the lymphocytes and carried to the bronchial glands and other glands of the lungs ; or that these particles are picked up by the lymphatics of the trachea, pharynx, etc., emptied into the great veins, and screened out of the pulmonary arteries in the lungs. Let us analyze these two statements and see if they are reasonably true. If this foreign matter is picked up \>y the wan- dering cells, where do they pick it up and how do they manage to deposit it so uniformly in all such lungs? And then why is the matter deposited in the lungs by preference to other organs? Even wan- dering cells sooner or later get into the lymph stream, and if benoquin vitiligo the matter were picked up by them in the bronchi, even in the smallest bronchia, such mat- ter would reach the tracheal chain of lymphatics, and buy benoquin cream if continued, would be emptied into the great veins, .\ttention is directed to the anatomical fact benoquin online that Heme of the bronchial glands receive any portion I if the lymph radicles of the bronchial mucous mem- Ijrane, these being collected by the tracheal glands. The basement membrane of the bronchia is not per- forated by these radicles and the bronchial glands only receive the radicles from the interalveolar tis- sue. Therefore we can safely say that foreign mat- ter, to reach the bronchial glands, must either pene- trate the air sac to the lymph radicles lying below, or be screened out of the pulmonary circulation into the interalveolar lymph radicles. The lungs are undoubtedly great sieves or screens for the circulation, and an infected embolus or other foreign body gaining the circulation is nearly cer- tain to be washed out in lung tissue. Interference with a gluteal or rectal abscess of tuberculous origin, will often set up an intense pulmonary infection by the great number of bacilli being poured into the circulation and screened out buy benoquin in the lungs. Or again, we note that the infection of one apex is followed by the infection of the opposite apex, and we feel morally certain that this second apex has screened the bacilli from the circulation and that they have benoquin cream for sale not reached it by backward aspiration of sputum. I think these are true clinical pictures of what actually happens. They are certainly strong arguments against the inhalation theory. There is another side, however, 'for if one will mount a section of the lungs of a rabbit that has been confined in a heavy atmosphere of benoquin monobenzone cream lamp black he will find the pigment in the air sac itself, and often it can be seen sticking through the walls of the sac. Between the air vesicles, " frequently at the juncture of the an- gles of several, minute openings or stomata exist ^ they usually connect buy benoquin online with microscopic passages lead' ing into the lymphatic channels. By means of these channels particles of inhaled foreign matters, often deeply pigmented, are carried from the air sacs into the lymphatics and become lodged within the inter- loljular connective tissues" (Piersol). " The interalveolar sa^pta are considerably thickened and pigmented, and the walls of the air vesicles are thickened and contain numerous dark colored patches. In the air vesicles particles are found in considerable numbers, some of them lying free on the surface of the epithelium, others con- tained within detached epithelial cells, whilst others again are found within swollen epithelial cells, still attached to the wall. In addition to these are numerous nucleated cells lying free in the cavity. In the lymphatics around the small branch of the pulmonary artery, the masses of carbon pigment are specially numerous. . . . The mucous mem- benoquin cream brane of the bronchus is entirely free from pigment of any kind " (Woodhead). The lymph ganglia of the neck and other portions of the body show com- paratively little pigmentation and if they do pick up much foreign matter from the mucous membrane of the trachea they arrest very little, thereby differing in function from the glands of the lungs. If coal dust and other dust is picked up from the bronchial and tracheal mucous membranes and emptied into

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