Tuberculosis of the Female Genitalia 343 



In many cases the peritoneum is so involved that, ovaries, 

 oviducts, uterus, and broad ligaments constitute a complex 

 adherent mass, as in Figures 104 and 106, where it is diffi- 

 cult, though generally possible, to identify the various parts 

 by rectal palpation. Pelvic adhesions due to genital tuber- 

 culosis resemble those caused by other infections. The ad- 

 hesions due to tuberculosis are often accompanied by palpa- 

 ble tubercles. Their recognition aids materially in diagno- 

 sis. Non-tuberculous pelvic adhesions are frequently ac- 

 companied by sclerotic abscesses of an ovary, oviduct, uter- 

 ine horn, or the three areas combined. In my collection, no 

 abscesses exist in any case of tubo-uterine tuberculosis, not 

 even abscesses of the lymph glands in the broad ligaments 

 of the uterus. Tuberculous pyosalpinx and pyometra, with 

 necrosis of the uterine mucosa, as indicated in Figures 96 

 and 97, is common enough. There is one important differ- 

 ence in the clinical history of tuberculous and non-tubercu- 

 lous pelvic adhesions. The non-tuberculous adhesions are 

 commonly preceded by acute metritis, largely with placen- 

 titis and retained fetal membranes ; tuberculous pelvic ad- 

 hesions ordinarily arise independently of acute metritis. 



The cow from which Figures 104 and 105 were taken was 

 entered in our clinic for sterility. There was slight uterine 

 catarrh (tuberculosis of the uterine mucosa) which abated 

 under antiseptic douches. The ovaries, oviducts, and uterus 

 were normal by rectal palpation. She appeared so well that 

 she was mated with a valuable herd sire. Soon afterward, 

 she broke down, and upon re-examination genital tubercu- 

 losis was evident. When destroyed, extensive generalized 

 tuberculosis was revealed. She entered our clinic without a 

 history, but upon the assumption of freedom from tubercu- 

 losis, and no careful search was made in that direction. Ap- 

 parently the disease was forced to its crisis by copulation, 

 the patient gave way to the infection, and a diagnosis of 

 genital tuberculosis became practicable. Fortunately the 

 sire escaped, largely perhaps because the cow was douched 

 just prior to copulation. The case illustrates vividly the in- 

 sidious and subtle manner in which genital tuberculosis in 



