TUBERCULOSIS. 449 



quent ulceration of the pseudo-membraneous adhesions, between 

 the parietal and visceral layer, and a final perforation of the 

 intestine from without inward. 



That tuberculous nodules of the peritoneum, however, may 

 heal up in the same way as those of the lungs is proved by cases 

 in which the small intestines are found massed together and 

 thickened, and at the periphery surrounded by a thick, pseudo- 

 membraneous capsule. Upon detaching the firmly agglutinated 

 loops, the visceral peritoneum was found strewn with nodules, 

 either isolated or in groups, of the size of a millet- or hemp-seed. 

 They were colorless, half translucent, and sometimes transparent, 

 having a vesicular appearance j or they were white, firm, fibrous, 

 even cartilaginous, while many of the nodules and clusters were 

 surrounded by a narrow area of dark brown or gray pigment. 



I have sometimes found, in the peritoneum, a second form of 

 tuberculosis, of a subacute character i. #., a miliary tubercu- 

 losis with repeated recurrences. The conditions were the fol- 

 lowing: after opening the abdominal cavity, which was filled 

 with a serous or haBmorrhagic exudation, I saw in both peritoneal 

 layers, besides firm nodules encircled by pigment, others which 

 were of a grayish-yellow or yellow color, surrounded by an 

 injected or haemorrhagic area, and still other nodules which were 

 gray or grayish-yellow in color, tolerably soft, easily mashed, and 

 imbedded in the cloudy, swelled peritoneum. Scarcely a doubt 

 could arise that, in such cases, the " fibrous " and pigmentary 

 nodules were the oldest, or they might even be healed, judging 

 from their analogy to the " obsolete" or " cartilaginous " nodules 

 of the lung, and also from the fact that pigment can form only 

 after a certain length of time. That, however, repeated recur- 

 rences had taken place was proved by the presence of tubercu- 

 lous nodules in their different stages, such as we have become 

 acquainted with through the researches of Laennec. 



A third form is the acute, miliary tuberculosis of the pleura 

 and the peritoneum, which is always combined with tuberculosis 

 of other organs. We find the pleura and the peritoneum thick- 

 ened by pseudo-membraneous layers and pervaded by innumera- 

 ble tubercles, which, in some parts, are isolated and in others 

 coalesced. Some of these are mere dots, the size of a pin's point, 

 and others are as large as a millet- or hemp-seed. All of them 

 show a nearly uniform grayish-yellow or yellow color. Pseudo- 

 membraneous callosities of varying thickness may be throughout 

 crowded with yellow tubercles, which have, to a great extent, 

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