TUBERCULOSIS OF THE LYMPHATIC GLANDS. 175 



A yellowish nodule grew from the periphery of the iris of the 

 right eye. and numerous millet-seed bodies from its surface ; the 

 pupil was closed, but there was no acute inflammation. The local 

 disease increased rapidly in extent. The eye was enucleated after 

 three weeks' treatment. The disease was found to be confined to 

 the iris and ciliary body. Under the microscope the new-growth 

 showed the characteristic structure of tubercle. In 32 recorded 

 cases in which microscopic and bacteriological tests left no doubt 

 as to the tubercular nature of the disease, one eye only was affected 

 in 29 ; the average age of the patients was twelve, youngest four 

 months, oldest fifty-one years. In 10 cases bacilli were searched 

 for, but only found in 4 ; in one of the remaining 6 cases, however, 

 the inoculation test was successful. A number of patients recovered 

 completely and permanently after enucleatiou. 



3. Tuberculosis of the Internal Ear. 



That an ordinary otitis media with perforation of the tympanum 

 may occasionally be transformed into a tubercular lesion by the 

 entrance from without of bacilli of tuberculosis there can be no 

 doubt. Habermanu (Prager med. Wochenschrift, March 7, 1888) 

 has recently investigated this subject by examining, post-mortem, 

 18 tuberculous subjects in whom either otorrhoea or deafness without 

 active discharge had been observed during life, and in nine of these 

 he could demonstrate the presence of tubercular lesions in the 

 auditory canal. In one case he found in the left auditory appara- 

 tus tuberculosis of the entire middle ear, where the tympanum was 

 intact. In another tubercular subject, a man, thirty-eight years of 

 age, in whom tuberculosis of the ear was observed a year and a 

 half before death, the post-mortem revealed extensive tuberculosis 

 of the cochlea, in the internal auditory canal, and in the superior 

 semicircular canal, while the other semicircular canals and the 

 vestibule were destroyed by caries. 



4. Lymphatic Glands. 



That most cases of chronic inflammation of the lymphatic glands 

 are in their origin, course, and final termination, cases of local 

 tuberculosis has been satisfactorily shown by clinical experience, 

 inoculations, and cultivation experiments. The tubercular virus 

 enters the lymphatic circulation undoubtedly most frequently 

 through some superficial abrasion, ulceration, eczema, or some 

 other affection of the skin, as any loss of continuity of surface 

 may furnish the necessary portio invasionis for the entrance of 

 bacilli from without. Yolkmann found tubercle bacilli in the 

 skin of an eczematous forearm. In perhaps 95 out of 100 cases 



