! 



TUBERCULOSIS. 451 



When the ulceration penetrates the sub-peritoneal tissue, a 

 circumscribed peritonitis always follows, corresponding in extent 

 to the size of the ulcer. This peritonitis is decidedly marked by 

 nodules, which are either discrete or grouped together in clus- 

 ters, of a yellow or grayish-yellow color, and are imbedded in 

 the tissue of the peritoneum, which is swelled, opaque, and often 

 considerably injected and ecchymosed. Such an acute localized 

 formation of tubercles, accompanied by considerable hyperaBmia 

 of the peritoneum, may give rise either to a peritonitis confined 

 to the hypogastrium, or to a general purulent peritonitis. Fi- 

 nally, if in the peritoneum tubercle, in circumscribed places, is 

 softened and disintegrated, and if no protecting pseudo-membrane 

 has been previously formed, a perforation of the wall of the intes- 

 tine will take place, with an escape of the contents into the 

 abdominal cavity, and a general purulent peritonitis will set in, 

 with a rapidly fatal termination. Tuberculosis of the mucosa of 

 the uterus and the tubes exhibits similar characteristics. Here, 

 too, the primary tuberculous formation appears as flat, gray, or 

 grayish-yellow granulations, which are only exceptionally found 

 in the mucosa of the fundus uteri and that of the swelled and 

 winding tubes. I encountered most frequently ulcerative destruc- 

 tion of the mucosa to a considerable extent. These ulcers were 

 shallow, and were defined by abrupt, sinuous, and irregularly 

 eroded borders. Upon removing the cheesy, crumbly, and some- 

 times almost as if croupous, formation from the surface of the 

 mucosa, flat, grayish-yellow infiltrations about the size of hemp- 

 seed became at once visible. Real nodules are of as rare an 

 occurrence in this situation as in the mucosa of the larynx ; for 

 the prominence, which is the essential feature of a nodule, is 

 wanting. 



Tuberculosis and Scrofulosis of the Lymph-ganglia. O. Schiip- 

 pel* has arrived at results widely different from those of Virchow. 

 He admits the fact that there exists such a thing as primary 

 tuberculosis of the lymph-ganglia, and that this may arise and 

 terminate as a purely local disease. He describes the tubercles 

 of the ganglia as " globular, tolerably well-marked nodules of not 

 more than O. 3 mm. diameter, which are invariably and exclu- 

 sively located in the vascularized follicles of the ganglion." 

 Schiippel also considers only the nodules to be tubercles, and, in 

 his opinion, scrofulosis is nothing more than a miliary tuber- 

 culosis of the inflamed hyperplastic ganglion. This conception 

 I cannot accept as correct. True, sometimes we meet with 



* " Untersuchungen liber Lymphdriisen Tubereulose," 1871. 



