450 TUBERCULOSIS. 



become confluent, and in some localities are packed together 

 without a trace of separating tissue. The same condition may be 

 observed in the omentum after it has grown together into a firm, 

 bulky mass. Sometimes there are present simultaneously recent, 

 cobweb-like, freely vascularized pseudo-membranes, which may be 

 crowded with submiliary gray tubercle granules, not surpassing 

 in size a pin's point. 



Of the mucous membranes I shall consider only the mucosa of 

 the larynx, the intestine, the uterus, and its tubes. The differ- 

 ent forms of tubercle cannot be traced in mucous membranes, 

 because the nodules and infiltrations lie near the surface and 

 rapidly soften, disintegrate, and lead to ulcerative destruction 

 of the mucosa. 



Doubts have been raised (Rheiner) whether or not the ulcers 

 in the posterior wall of the larynx, which are so often combined 

 with tuberculosis of the lungs, are really tuberculous in nature. 

 As is well known, they are either f ollicular or cleft-like, either 

 shallow and superficial, or sinuous ulcers, which, penetrating 

 into the depth, sometimes cause necrosis of the cartilages of the 

 larynx. All doubts regarding the tuberculous nature of these 

 ulcers will disappear if we see though not in many instances, it 

 is true in the mucosa of the larynx, at the borders and the 

 basis of the ulcers, yellow, flat infiltrations, the size of millet- 

 or hemp-seed. 



The mucosa of the lower ileum, the cwcum, the ascending and 

 transverse colon, offer a good chance to study, macroscopically, 

 the genesis and the course of tuberculosis. Not infrequently we 

 see intestines in which there are all transitions, from minute, 

 follicular nodules and superficial ulcers, springing from them to 

 an ulceration, extending over several square inches in circum- 

 ference, the so-called tuberculous phthisis of the intestine. 



The formation of tubercles, and the consequent ulceration, is 

 sometimes chronic and sometimes acute in its course (Eoki- 

 tansky). I would mention here that the deepening and spreading 

 of the ulcers is due to a continuous new formation of tuberculous 

 nodules, which are seen as flat, grayish-yellow, and yellow forma- 

 tions, the size of hemp-seeds, imbedded in the inflamed tissue. 

 In the chronic course of tubercle formation a thickening of the 

 mucosa and of the sub-peritoneal tissue takes place, in the neigh- 

 borhood and at the base of the ulcer. The ileo-coecal valve may 

 remain as a ledge-like projection, of several lines in thickness, 

 of considerable density, and undermined by a number of sinu- 

 ous ulcers, emptying above and below the valve. 



