SCROFULOUS DISEASE OP THE MESENTERIC GLAXDS. 603 



have had repeated attacks of diarrhoea accompanied by fever. Death 

 as a result of scrofulous ulcers of the intestine is far rarer than we 

 might suppose. It most frequently depends on a subsequent consump- 

 tion of the lungs, or a secondary tuberculosis. 



If obstinate diarrhoea join itself to the symptoms of consumption 

 of the lungs, or if it occur as the chest symptoms begin, it is very 

 probable that the intestinal follicles are caseously degenerated, and 

 that ulcers have developed. Even in such cases the diagnosis is not 

 certain, for so-called colliquative diarrhoea occurs during disease of the 

 kidney and consumption of the lungs, without our being able to find 

 any evident structural changes of the intestine en autopsy. Perhaps 

 these diarrhoeas are the analogues of the abundant sweatings of the 

 phthisis patient, and of the oedema of the subcutaneous connective tis- 

 sue ; and it is not improbable that thinning of the serum of the blood, 

 a so-called " dropsical crasis," favors the occurrence of serous transu- 

 dations into the intestines. If the diarrhoea cease, and be replaced 

 by constipation, and great sensitiveness of the abdomen to pressure, 

 there is still greater probability that the previous diarrhoea was caused 

 by intestinal ulcers, for from the above symptoms we may decide that 

 there is peritonitis, and we know that this very frequently accompanies 

 ulcers, which are advancing toward the serous coat. 



Caseous degeneration limited to the mesenteric glands, whose 

 remains are often found on autopsy, can hardly be recognized with 

 certainty during life. The intestinal catarrh may long since have dis- 

 appeared, while the swelling and change of the mesenteric glands con- 

 tinue, just as the swelling of the peripheral glands in many cases out' 

 lasts the exanthemata that have caused it. It is very rare for con- 

 volutions of glands, even when considerably swollen, to become 

 evident to the touch. We may always suspect this disease when we 

 find a person who has had obstinate diarrhoea, and scrofulous swelling 

 of the peripheral lymphatic glands, with a protuberant belly. In 

 scrofulous catarrh, as we designate intestinal catarrh, which is accom- 

 panied by cheesy degeneration and swelling of the mesenteric glands, 

 the nutrition and development of the patient are also affected ; the so- 

 called tabes mesenterica does not appear to be due to the impermeabil- 

 ity of the mesenteric glands, but solely to the intestinal catarrh. If 

 this be removed, the patients may recover perfectly, and on autopsies 

 we often find chalky masses embedded in the mesenteric glands of 

 robust individuals who have died of acute disease. 



We should suspect proper tuberculous ulcers when diarrhoea 

 occurs during decided tuberculosis of the lungs. The secondary erup- 

 tion of tubercles on the covering of the intestines has no symptoms, 

 except the partial peritonitis which usually accompanies it. 



