602 AFFECTIONS OF THE INTESTINAL CANAL. 



are no Peyefs glands, it gives the best means of making the very 

 difficult diagnosis between miliary tubercles and swelled follicles. 

 Tuberculous ulcers result from the cheesy degeneration, softening, and 

 breaking down of miliary tubercle ; these never become so extensive 

 as the ulcerations dependent on caseous degeneration of the follicles, 

 and in their vicinity we find fresh tuberculous granulations, instead of 

 cheesy infiltration of the tissue. 



In the numerous cases of secondary tuberculosis of the peritonaeum, 

 we find those portions corresponding to the intestinal ulcer thickened 

 by proliferation of connective tissue, and covered with numerous small 

 nodules. The eruption of tubercles has often spread from these points 

 along the lymphatics to the mesentery. 



SYMPTOMS AND COTTBSE. It is generally difficult to decide whether 

 a scrofulous child has simple intestinal catarrh, or if there be cheesy 

 degeneration of the intestinal follicles and ulceration of the intestine. 

 The case is suspicious when the passages are preceded by pain, when the 

 abdomen is sensitive to pressure, and particularly when these symp- 

 toms are accompanied by a lingering fever. Not unfrequently the 

 diarrhoea disappears for a time, although the intestinal ulcers may 

 remain ; the child appears to improve ; but some slight error in diet, 

 catching cold, or some other undiscoverable cause, again induces fre- 

 quent, copious, fluid evacuations. If these renewals of the intestinal 

 affection be accompanied by an increase of the fever, the child soon 

 loses again what strength and flesh he had gained during the interval. 

 Occasionally this variation from good to bad continues for years, and, 

 even when the diarrhoea has ceased for months, we are not at all cer- 

 tain that the ulcers have healed. On autopsy we often find the mu- 

 cous membrane of the small and even of the large intestine covered 

 with numerous ulcers, when, perhaps, there has been constipation 

 instead of diarrhoea. This is not strange, when we remember that the 

 thinness of the dejections depends solely on the catarrh accompanying 

 the intestinal ulcers, and that the severity of the catarrh varies just as 

 much as the hyperaemia and oedema in the vicinity of a cutaneous 

 ulcer. When the large intestine is free from ulcers and consequently 

 from catarrh, the fluid contents of the intestines entering them become 

 of normal consistence, so that consistent stools are passed during life, 

 and on autopsy we find the lower part of the intestine filled with firm 

 faeces. The longer the disease lasts, the more nutrition is affected by 

 it. The patients are often considered much younger than they really 

 are. Young men of twenty look like boys ; girls attain the age of 

 nineteen or twenty without the breasts developing or the menses 

 appearing. Frequently, we do not discover the cause of this retarded 

 development, till, on careful examination, we find that for years they 



