20 CLINICAL APPLIED ANATOMY. 



the process spreading on the one hand to the seminal vesicles 

 and along the vas to the epididymis, and on the other to the 

 urinary bladder. 



Of the female genital organs, the Fallopian tube most commonly 

 suffers. As is the case with gonorrhoea, the infection may ascend, 

 but the vagina is well protected by its squamous epithelium, and 

 the cervical canal by its cylindrical epithelial coat and its narrow- 

 ness. Infection may be carried to the uterus, tubes, or ovaries by 

 the blood stream. Intestinal tuberculosis may directly infect the 

 tubes, ovaries, uterus, or bladder when infected coils of gut are 

 in contact with the viscera mentioned. 



Tuberculosis of the urinary system may originate in the kidney 

 as a blood-borne infection, the bacilli settling in the vascular 

 tufts or in the tubes during the process of excretion. The 

 infection may ascend from the genital system in the male, for 

 the trigone of the bladder is easily invaded from the prostate, and 

 since the mucous membrane of this region is here most fixed, it is 

 less likely to free itself during the processes of distension and 

 evacuation of the bladder. The kidney may be infected from the 

 bladder by an extension along the ureter, or by way of the lympha- 

 tics of that tube, or by regurgitation of urine. The kidney is 

 sometimes invaded in genital tuberculosis without the inter- 

 vention of" bladder tuberculosis ; in such cases it is suggested 

 that the infection spreads from the epididymis by way of the 

 lymphatics of the vas deferens, thence to the lymphatics of the 

 ureter, and so to the kidney. The bladder is thus excluded from 

 the track of infection. The fact that the bladder in the female is 

 less likely to become tuberculous than the bladder in the male is 

 accounted for by the absence of prostate, which is a common 

 focus of infection. 



The brain and its membranes are usually infected as part of an 

 acute miliary tuberculosis derived from a caseous focus elsewhere 

 in the body. Direct infection from the ear sometimes occurs, and 

 in some cases an infection from the lymphatics outside the skull 

 appears to be possible. The continuity of the lymphatic sheaths 

 of the cranial nerves with the lymphatics outside the skull supplies 



