600 AFFECTIONS OF THE INTESTINAL CANAL. 



excessive susceptibility and the tendency of the tissues to become the 

 seat of extensive production of indifferent cells, on inflammatory irrita- 

 tion, last beyond the age of childhood. But, as in grown persons dif- 

 ferent organs are apt to be diseased from those affected in children, 

 the peculiar forms of the disease vary with advancing age. Even at 

 the commencement of puberty, the intestinal catarrhs which were 

 previously so frequent give way to affections of the lungs, etc. Hence, 

 in many autopsies we find calcareous mesenterio glands and cicatrizing 

 intestinal ulcers, while in the lungs there are fresh cheesy masses and 

 progressing destruction. But, very remarkably and inexplicably, ex- 

 perience shows that adults, who are rarely affected by these diseases 

 of the intestinal follicles and mesenteric glands, are often afflicted 

 by them when analogous diseases attack or have already affected their 

 lungs. We may express this bit of experience in another way, by 

 saying : caseous degeneration of the intestinal follicles and mesenteric 

 glands is rare as a primary and idiopathic disease in adults, but occurs 

 quite frequently secondarily, and as a complication of consumption of 

 the lungs. 



Except as a secondary tuberculous eruption in the vicinity of scrof- 

 ulous ulcers of the intestines, tuberculosis of the intestines and mesen- 

 teric glands is rare. This is still more true of tuberculosis of the in- 

 testines, in the strict sense. It appears in many cases as if the sec- 

 ondary tuberculosis of the intestines occurred simultaneously with sec- 

 ondary tuberculosis of the lungs, and as if the proper tuberculous con- 

 sumption of the intestine affected particularly those who had also the 

 tuberculous form of consumption of the lungs. 



ANATOMICAL APPEARANCES. Caseously infiltrated intestinal folli- 

 cles and the ulcers resulting from their breaking down are most fre- 

 quently found in the ileum. Not unfrequently the disease extends 

 thence to the colon, and remarkably often to the processus vermiformis. 

 In some cases the colon alone is affected, while the ileum remains free. 

 These appearances are rarely found in the jejunum, and very seldom 

 in the duodenum or stomach. The number of follicles affected varies. 

 Occasionally a considerable extent of intestine is regularly covered 

 with them ; far more frequently the disease is limited to several small 

 spots at some distance apart. In the earliest stage the swollen fol- 

 licles form slightly-prominent, rather hard gray nodules, about the 

 size of a millet-seed. These become yellow and less hard as the 

 cheesy metamorphosis commences. If the mucous covering have been 

 perforated by the pus, we find round u crater-shaped " ulcers (JRoJci* 

 tansky^s primitive tuberculous ulcer). In advanced stages the mucous 

 membrane and submucous tissue hi the vicinity of the primitive ulcer 

 are the seat of a gray and subsequently of a yellow infiltration. Ex- 



