GENITAL TUBERCULOSIS. 19 



unimportant. It is, however, exposed to infection from the 

 digestive and the urinary tracts and from the genital organs. 

 Caseous mesenteric or retroperitoneal glands may involve the 

 peritoneum l>y continuity or actually burst into the sac. 

 Tuberculous ulceration of the intestine almost invariably gives 

 rise to local peritoneal tuberculosis, and may originate a more 

 widely spreading infection. Tuberculous infiltration of the 

 Fallopian tubes is very favourably situated for direct extension 

 to the peritoneum through their ostia or coverings. Of the male 

 genital organs the seminal vesicles are in close contact with the 

 lower part of the great sac, and the tunica vaginalis of the testis 

 may communicate with the peritoneal cavity through an 

 unobliterated funicular process. A pleural tuberculosis may 

 extend to the abdominal cavity either by means of the lymphatics 

 of the diaphragm or by actual continuity when a defect exists 

 in the posterior part of the diaphragm. Such a defect is not 

 uncommon between the costal and vertebral attachments of the 

 muscle. Diffusion of tuberculosis in the peritoneum is aided 

 by the constant movements of the abdominal walls and the 

 peristaltic action of the intestines. 



The genital system, like other systems, may be invaded through 

 the blood stream, and the localisation of tuberculosis in the 

 epididymis is explained on this hypothesis as being due to 

 the sluggish blood and lymph circulation in that part of 

 the gland which lies at the junction of the blood supply of 

 the testicle proper and the blood supply of the vas deferens. 

 However, it is believed by some authorities that genital tuber- 

 culosis, although usually secondary to pulmonary phthisis, 

 even in these instances is due to an ascending infection 

 along the urethra. The mucous membrane of the prostatic 

 portion is bored like a sieve, and so affords a ready lodgment to 

 bacilli. Excretion of living tubercle bacilli by the kidney may 

 also infect the parts below. Whether the prostatic deposit of 

 tubercle be brought by the blood stream, or ascend the urethra, or 

 descend the ureter, it lies at the junction of the urinary and 

 genital systems, and may serve as a focus of infection for both, 



22 



