TUBERCULOSIS OF SEROUS MEMBRANES. 695 



and progressive organic wasting. These are always j^resent, though 

 in themselves they have no specific significance. 



The local symptoms are still more vague. Percussion causes pain, 

 and the practitioner might at first suspect peri-pneumonia. The 

 patient edges away, and tries to avoid the application of the plexi- 

 meter hammer. Firm pressure over the intercostal spaces sometimes 

 causes struggling, and produces indications of abnormal sensitiveness. 

 There is generally extensive partial dulness, sometimes complete dul- 

 ness towards the lower regions of the chest. 



On auscultation the lung may reveal the difi'erent indications of 

 chronic pulmonary tuberculosis, or simply diminution of the respira- 

 tory murmur at points, accompanied by crepitant, sibilant rales, and 

 moist, crackling sounds. As the anterior portions of the pleural sacs 

 are most commonly invaded, the anterior vena cava is compressed, 

 causing some difficulty in the return circulation, and producing venous 

 pulse, which may extend as high as the parotid gland; there is, how- 

 ever, no swelling of the dewlap. 



Respiration is frequent and difficult in consequence of adhesions 

 between the pleura and lungs, which are connected by bands of 

 fibrous tissue of varying extent. Coughing is rarely absent, and if the 

 lung is diseased may be followed by discharge containing numerous 

 bacilli. Otherwise the cough exhibits the pleuritic character, that 

 is, it remains slight, dry, paroxysmal, and painful. The pericar- 

 dium may be affected as well as the pleura; if the conditions occur 

 simultaneously the venous pulse in the jugulars will be particularly 

 apparent. 



The symptoms of tuberculous pericarditis are similar to those of 

 ordinary pericarditis, except that the exudation is less abundant ; in 

 a word, the symptoms are those of rather trifling exudative peri- 

 carditis. 



Tuberculosis of the peritoneum is frequently accompanied by that 

 of the pleura or the abdominal viscera. The lesions are localised on 

 the parietal peritoneum and epiploon, producing in time adhesions 

 between the viscera and walls of the peritoneal cavity, which afi'ect 

 the action of the digestive organs, gradually causing interference with 

 the peristaltic movement both of the rumen and the intestines. The 

 stagnation of alimentary matter favours fermentation, so that the 

 rumen becomes permanently distended. The right flank also is 

 swollen, and the abdomen exhibits a change in shape similar to that 

 in peritonism, which is a constant symptom of tuberculous peritonitis. 



As in the thorax, the tuberculous lesions seldom produce extensive 

 liquid exudation, so that ascites does not occur, but on palpation 

 the abdominal walls appear to have entirely lost their pliability and 



