TUBERCULOSIS. 



689 



Even when the hings are unaffected it may happen that the lym- 

 phatic glands of the mediastinum (superior or inferior oesophageal 

 lymphatic glands) and the hronchial lymphatic glands may be so 

 diseased that the oesophagus is completely surrounded and compressed 

 by them, and its function thus seriously impaired (Fig. 276). 



In the abdomen the mesenteric glands are most exposed to disease, 

 and when infected through the intestinal tract they assume the form 

 of large flattened masses arranged along the mesentery. 



In the digestive tract, as in the trachea and bronchi, tuberculosis 

 has a marked tendency to assume the ulcerative form. Disseminated 

 or aggregated tubercles develop in the thickness of the mucous mem- 

 brane, and, after rapidly softening, become ulcerated. The nature of 



Fig. 276.— Tuberculosis of lymphatics. PG, Left lung ; PD, right lung ; TT, 

 tuberculous oesophageal lymph glands; A, aorta; ffi, oesophagus (the lung 

 is divided transversely near its centre). 



these lesions can only be determined by noting their character and 

 examining the discharge. 



The ulcerations are localised in the mouth and pharynx, in the second 

 half of the small intestine towards the ileum, and in Peyer's patches. 



Tuberculous lesions develop in the vaginal sheath of the male genital 

 organs exactly in the same way as in an ordinary closed serous cavity ; 

 tubercles may also develop on the surface or in the substance of the 

 testicle. They become aggregated, undergo softening, spread towards 

 the interior, and may break down, thus forming abscesses. In the 

 female genital passages the disease invades the thickness of the walls, 

 but shows a marked tendency to ulceration, as in the intestine or 

 trachea. 



In the udder tuberculosis is generally diffuse, shows a tendency 

 to hypertrophy and the free formation of fibrous or sclerous tissue ; 

 only tubercles in the glandular layer of the acini become ulcerated. 

 In time the whole of the secreting structure undergoes diffuse tuber- 

 culous suppuration, fibro-caseous masses form in the depths of the tissue 

 and may soften, producing deep-seated tuberculous " cold abscesses." 

 D.c. Y y 



