TUBERCULOSIS OF THE PERITONEUM. 189 



scanty culture of the bacillus of tuberculosis. Implantation of one 

 of the rice bodies into the subcutaneous connective tissue of a 

 guinea-pig resulted in a typical tuberculosis, starting from the 

 point of inoculation, spreading to adjacent lymphatic glands, and 

 finally resulting in miliary tuberculosis. 



8. Peritoneum. 



Primary tuberculosis of the peritoneum has recently been de- 

 scribed as a local tuberculosis amenable in some cases, at least, to 

 operative treatment. Localization of the bacillus takes place in 

 accordance with the form of tuberculosis, of which three distinct 

 varieties are recognized by pathologists and clinicians : 



a. As a part of a general diffuse tuberculosis ; 



b. Extension of an adjacent tubercular process to the perito- 

 neum ; and 



c As a primary tuberculosis. 



For the surgeon, only those cases have interest which are classi- 

 fied under the second and third varieties. The prevalence of the 

 affection in the female sex among the cases which have been 

 reported, points to the Fallopian tubes as the primary seat of infec- 

 tion with secondary invasion of the peritoneum from this source. 

 Although the genital organs in the male are more frequently the 

 seat of tuberculosis than in the female, so far only two cases of 

 peritoneal tuberculosis in males have been reported, one by Kiim- 

 mell and the other by Lindfors. Tuberculosis of the peritoneum 

 by extension from a tuberculous focus in the genital organs can 

 only mean an infection by contact, the bacillus of tuberculosis 

 transferred from the primary seat of infection, and localization by 

 implantation upon the peritoneal surface. Implantation experi- 

 ments in animals furnish a good illustration of the manner in which 

 the process becomes diffuse. At the point of implantation a granu- 

 lation mass forms around the graft, and from here innumerable 

 tubercle nodules take their starting-point, forming everywhere 

 granulation-tissue, in which the bacillus may have found a new 

 habitat. The movements of the abdominal walls and the peristal- 

 tic action of the intestines are potent factors concerned in the local 

 dissemination of the tubercular infection. In primary tuberculosis 

 of the peritoneum the infection takes place in the same manner as 

 in intact joints, by floating bacilli becoming arrested in the capillary 

 vessels of the membrane where the primary nodule forms, from 

 which again, as from a graft, dissemination takes place. These 

 cases are, in the true sense of the word, not cases of primary tuber- 

 culosis, as the peritoneal affection is only a local expression of an 

 antecedent infection. In peritoneal tuberculosis we observe the 



