

SCROFULOUS DISEASE OF THE MESENTEREC GLANDS. 601 



tensive losses of substance result from the breaking down of the 

 cheesy infiltration and of the infiltrated tissue itself, and the union of 

 several primitive ulcers (Rokitansky's secondary tuberculous ulcer). 

 The ulcer extends particularly in the circumference of the intestine, so 

 that finally the ulcers form bands of various width around the interior 

 of the bowel. Infiltration and destruction sometimes go on in the 

 floor of the ulcer, so that it extends in depth also, and may finally 

 perforate the wall of the intestine. As the destruction advances 

 toward the serous coat, a circumscribed peritonitis occurs at the part 

 about to be attacked. Even on external examination of the intestine 

 we can usually tell the points where the ulcers are located, as the 

 serous coat is there cloudy and thickened, and occasionally covered 

 with scanty fibrinous exudations, or attached by these to neighboring 

 loops of intestines. These adhesions of portions of intestine to each 

 other not unfrequently prevent the escape of the contents of the intes- 

 tine into the abdominal cavity when perforation of the intestine takes 

 place. In such cases the contents do not gush out through the perfo- 

 ration till we break up the adhesions at the autopsy. If capillary 

 haemorrhage have occurred from the extension of the ulcer, we find the 

 edges and base of the ulcer suffused with blood and covered with dark 

 clots. Complete cure of these ulcers of the intestine is rarely seen. 

 On the other hand, we often find undoubted signs of incomplete cica- 

 trization as a callous, darkly-pigmented or non-pigmented connective 

 tissue forms the floor of the ulcer, and by its retraction appears to 

 have approximated the edges. If the edges of the ulcer approach 

 each other so nearly as to come in contact, they unite together. In 

 such cases a ridge-shaped resistant swelling always remains on the 

 inner surface, while there is a cicatricial retraction on the outer surface 

 of the intestine. 



The swelling of the mesenteric glands may be so decided that the 

 individual glands will attain the size of a pigeon's egg, and a collec- 

 tion of them may form a tumor as large as the fist. As long as the 

 increase in size depends on simple cellular hyperplasia, a section will 

 show the glands to be succulent and of a grayish-red color. "We often 

 find only a few points of the swollen glands changed to a yellow 

 cheesy mass ; in other cases, one or more glands are caseously degen- 

 erated throughout. On post-mortem examination we frequently find 

 shalky, irregular, sometimes branched, concretions, surrounded by nor- 

 mal or atrophied parenchyma in these mesenteric glands, as a result 

 of cheesy degeneration which may have run its course years before. 



In genuine tuberculosis of the intestinal mucous membrane, small 

 gray nodules, either discrete or united into groups, appear in the early 

 stages. If we find such groups of miliary bodies at parts where there 



