TUBEKCULOSIS OF THE MOUTH. 191 



laparotomy under antiseptic principles may be considered free from 

 danger, the operation is certainly indicated. It consists in a free 

 incision, thorough evacuation of the fluid, and free drainage. 



Lindfors, in a monograph on this subject ( Centralblatt f. Gynd- 

 kologie, February 15, 1890), analyzes 109 recorded cases, which 

 he divides into seven classes. The acute variety may assume the 

 form of circumscribed, general, or suppurative peritonitis ; in the 

 chronic there may be a free or an encysted effusion, there may be 

 simple adhesions, or the intestines may be so adherent as to cause 

 intestinal obstruction. Lindfors thinks that the presence of acute 

 or chronic pleurisy has an important bearing on the diagnosis of 

 tubercular peritonitis. He is strongly in favor of laparotomy and 

 the free use of iodoform within the cavity. 



The most recent and comprehensive work on tuberculosis of the 

 peritoneum, which has just appeared from the pen of Vierordt 

 (" Ueber die Tuberculose der serosen Haute," Zeitschrift f. klin. 

 Medicin, B. xiii. Heft 2), should be consulted by those who wish to 

 secure for reference an exhaustive treatise on this subject. 



9. Mouth. 



We have now every reason to believe that many cases of ulcer- 

 ation of the tongue and cavity of the mouth which have been 

 heretofore diagnosticated and treated as carcinoma, were not car- 

 cinoma, but tuberculosis. The recent advances made in the micro- 

 scopical, bacteriological, and experimental methods of examination 

 have succeeded in separating from syphilitic affections and malig- 

 nant disease of the mouth a number of cases which belong to the 

 long list of affections which are now classified under the head of 

 surgical tuberculosis. The cavity of the mouth is exposed to direct 

 infection with microorganisms which might be obtained in the 

 air we breathe, the food we eat, and the water we drink. Kemem- 

 bering the frequency with which superficial abrasions and ulcera- 

 tions occur in this locality, it is not strange that primary tuberculosis 

 should occasionally develop here. The tubercle bacillus produces 

 the same tissue-changes here as on the surface of the skin, the pri- 

 mary pathological product consisting of granulation tissue which 

 undergoes molecular retrograde tissue metamorphosis followed by 

 ulceratiou. The tubercular ulcer is covered by the products of coagu- 

 lation-necrosis, and is surrounded by a zone of infiltration, which, 

 however, does not present the same feeling of hardness as carcinoma. 

 Schliferowitsch (" Ueber Tuberculose der Mundhohle," Deutsche 

 Zeitschrift f. Chirurgie, B. xxvi. Hefte 5. u. 6) gives an exhaustive 

 resume of the literature on the subject to date, and has collected all 

 the recorded cases in which the diagnosis of tubercular disease of 



