338 TUBERCULOSIS 



phthisis^ generally first appears in the apices of the lungs. The 

 upper respiratory passages are less frequently affected primarily, but 

 primary tuberculosis of the larynx is not rare. Primary tuberculosis 

 of the nose is comparatively rare.(^The pleura is often involved in 

 phthisis, and it may be involved primarily^ The lymphatic tissue, 

 including the tonsils, forms a favorite soil for the development of 

 tuberculosis. Children frequently suffer from a slow grade of tuber- 

 culosis of the lymphatic system. (" In this form of the disease tubercle 

 bacilli frequently cannot be found, or in small numbers only, and the 

 condition was formerly generally known as scrofula, or scrofulosi^. Of 

 the vascular system, the heart muscle itself is rarely the seat of tuber- 

 cular lesions; the pericardium is involved more frequently. ( The 

 vessels generally become involved by the extension of a tubercle into 

 the vessel wall, but sometimes submiliary and miliary tubercles may 

 be developed on the intima from bacilli which have been transported 

 by the blood current. The lymphatics, except the thoracic duct, are 

 rarely the seat of tubercles/ Of the gastro-intestinal tract the mouth 

 and pharynx are occasionally the seat of the disease, the esophagus 

 and stomach almost never, but the intestines very frequently, 

 salivary glands and pancreas are rarely the seat of tubercular lesions, 

 the liver and the spleen very frequently, particularly the former. 

 Both the male and female genito-urinary organs are frequently 

 tubercular, particularly the kidneys, testicles, and Fallopian tubes. 

 The adrenals are occasionally affected by tuberculosis, arid then a 

 bronze discoloration of the skin occurs. This condition is known as 

 Addison's or bronze disease. Bones and joints are frequently affected, 

 muscles, fascia, and tendons rarely, except by secondary extension of 

 advanced tubercular processes in other structures. When tuberculosis 

 of the skin occurs as a very chronic, slow, ulcerating process on the 

 hands or face it is known as lupus. (^There is also a rare, warty, 

 granulomatous form of skin tuberculosis called tuberculosis verrucosa 

 cutis. The so-called postmortem tubercles of the skin of physicians, 

 veterinarians, butchers, etc., are fairly common.y 



Tuberculosis in Cattle. The organs most frequently affected in 

 tuberculosis of cattle are, as in man, the lungs. In the early stages 

 the affection assumes the character of a miliary tuberculosis of one or 

 more lobes. The small grayish-white nodules are found distributed 

 in a generally congested pulmonary tissue. In the later stages 

 larger nodules are seen which, when incised, discharge a dry, caseous, 

 or a more liquid material. Caseation by confluence and agglom- 

 eration of numerous large and small tubercles in the latter stages, 

 sometimes involves considerable portions of the lungs, and the process 

 is then known as a caseous infiltration. Cavity formation in the 

 lungs occurs in advanced cases in cattle as in man, while the formation 

 of numerous hard fibrous, caseous, or calcareous nodules in the pleura 

 leads to that picture of tuberculosis in cattle called pearl disease. 

 Tubercular affections of the abdominal organs and the gastro- 



