TUBERCULOSIS AND CANCER OF THE PERITONAEUM. 655 



miliary tuberculosis. The few white nodules found in the thickened 

 serous membrane of the intestines over scrofulous ulcers are also of 

 more pathological than clinical interest. The extensive develop- 

 ment of the proportionately large, whitish tubercles, which are occa- 

 sionally scattered through the peritonaeum, is more important. The 

 vicinity of the different nodules is either suffused with blood, or the 

 escaped haernatin has been changed to pigment, and the white tu- 

 bercle is surrounded by a black areola. The omentum is usually 

 rolled up, and strewn with tubercles ; it forms a nodular swelling, 

 resembling a sausage. Besides the tuberculous formations, there is 

 usually thickening of the peritonaeum from inflammatory prolifer- 

 ation, and there is a large quantity of fluid, sometimes bloody, in 

 its sac. 



Cancer of the peritonaeum is also rare as a primary disease, but 

 is usually propagated from neighboring organs, as the liver, stom- 

 ach, female sexual organs, and, more rarely, from the intestines. 

 Scirrhus and medullary cancer usually occur as numerous granula- 

 tions and nodules, scarcely so large as a pea, and scattered over the 

 entire peritonaeum, or as diffuse, flat degenerations of the peritoneal 

 tissue. Alveolar cancer occasionally forms large, or even immense, 

 tumors. But along with these, which are usually located in the 

 omentum, almost all the organs of the abdomen, as well as the pari- 

 etal portion of the peritonaeum, are also covered with small, gelati- 

 nous-looking tumors. In alveolar cancer, the intestines often adhere 

 together in places, and the fluid in the peritoneal sac is consequently 

 capsulated. 



The symptoms accompanying tuberculosis and cancer of the in- 

 testines closely resemble those of simple ascites. The most impor- 

 tant symptom is the gradual distention of the abdomen by the in- 

 creasing collection of fluid within it. The unusual sensitiveness of 

 the abdomen to pressure, which is absent in other forms of ascites, 

 the rapid occurrence of cachexia, and the exclusion of all other 

 causes for the collection of fluid in the abdomen, render it probable 

 that there is a degeneration of the peritonaeum. This suspicion 

 can only be rendered a certainty by the discovery of one or more 

 tumors. From the shape and extent of these tumors, from the age 

 of the patient, and from the coincident occurrence of tuberculosis 

 or of cancer in other organs, we decide which form of degeneration 

 exists in the case before us. 



