192 CLINICAL FORMS OF SURGICAL TUBERCULOSIS. 



the cavity of the mouth could be made with some degree of certainty. 

 The cases number 88, and include those of primary and secondary 

 tuberculosis. From a careful study of this affection he has come to 

 the conclusion that it occurs seldom in the very young, and that it 

 attacks most frequently persons between forty and fifty years of age. 

 The appearance of the tubercular ulcer is characteristic. If on the 

 tongue, it is found on the borders near the tip of the organ. It 

 appears as an oblong ulcer, with raised, ragged borders of firm con- 

 sistence, showing the color of fresh granulations. The floor appears 

 as if covered by a pseudo-membrane ; if this covering is removed, 

 the surface left easily bleeds. The surface of the ulcer is uneven, 

 as if covered with papillae. The discharge of pus is slight, and, in 

 many cases, miliary abscesses may be found around the ulcer. Pain 

 is not as severe as in carcinoma. Lymphatic glands may become 

 secondarily infected, but this is not often the case. In the primary 

 form of the disease the presence of tubercle bacilli is the safest cri- 

 terion in fixing the diagnosis. 



10. Genital Organs. 



Cornet has made some experiments on tuberculosis of the genital 

 organs in animals. In rubbing a pure culture of tubercle bacilli 

 in abrasions of the penis, he produced a tubercular lesion of that 

 organ. In bitches tuberculosis of the vagina and uterus could be 

 produced by injection of a pure culture into the vagina. The local 

 lesions were followed by general tuberculosis. 



FEMALE. Direct tubercular infection of the genital tract in 

 women has been observed, but the cases so far reported are few. 

 Zweigbaum (Centralblatt f. Bacteriologie und Parasitenkunde, B. xi. 

 S. 558) describes a case of primary tuberculosis of the portio vagi- 

 nalis uteri, which, at the time of examination, appeared in the shape 

 of an ulcer the size of a walnut, with thick, indurated margins, and 

 cheesy floor. Numerous tubercle bacilli were found in the secretion 

 taken from the surface of the ulcer. Evidences of pulmonary 

 tuberculosis were apparent at this time. After a few weeks the 

 ulcer extended toward the left vaginal wall and left labia majora. 

 A section of a fragment of tissue removed from these parts on 

 staining showed numerous bacilli. This form of tuberculosis is 

 not frequent, as the author could find only two cases of vulvo-tuber- 

 culosis in literature, although genital tuberculosis is quite a frequent 

 affection. In the absence of tubercular lesions of the vagina and 

 uterus, it is doubtful, if infection of the Fallopian tubes can take 

 place by the entrance of the bacillus through the genital tract, and 

 the relatively frequent occurrence of the disease in that part of the 

 genital organs is only explainable by attributing it to auto-infection 



