TUBEKCULOSIS OF. THE GENITAL ORGANS. 195 



B. c. Heft 3) examined the enlarged lymphatic glands in a case of 

 tuberculosis of the mamma, and found numerous tubercle bacilli. 



MALE. In the male primary tuberculosis is most frequently 

 observed in the epididymis, for the reason that the vessels in this 

 structure are more tortuous and smaller than in the remaining 

 portion of the testicle, or the vas deferens. Saltzman states (Cen- 

 tralblatt fur klin. Medicin, 1888, No. 11) that these anatomical 

 conditions are important factors in the arrest and localization of 

 floating bacilli. That in cases of tuberculosis of the testicle we are 

 only dealing with an external manifestation of an antecedent infec- 

 tion, becomes apparent by the clinical observation that not infre- 

 quently both testicles are infected, either simultaneously or some 

 time apart, showing that the infection came from the same source. 

 In other cases the primary localization takes place in the vesiculse 

 seminales, or in the structure of the prostate gland. Tuberculosis 

 of the genital organs in the male furnishes one of the best exam- 

 ples of the typical course of local tuberculosis of the testicle. A 

 small, hard nodule is first detected in the epididymis, and from 

 this starting-point the whole structure of the epididymis is infected, 

 when the infection slowly, but surely, extends along the vas 

 deferens to the vesicula3 seminales, the prostate gland, and bladder, 

 and from this viscus along the ureters to the pelvis of the kidney. 

 As a rule, the disease remains limited to the genito- urinary organs, 

 but, in some instances, metastatic infection takes place, either from 

 the genito-urinary organs, or from the primary source of infection. 

 A gentleman is now under my treatment who illustrates a number 

 of interesting points descriptive of the clinical behavior of genital 

 tuberculosis. He is thirty-five years of age, married for ten years ; 

 the marriage has been childless. He claims that he has never had 

 syphilis or gonorrhoea. Tuberculosis is hereditary in the family. 

 Nine years ago he noticed a small, hard swelling in the epididymis 

 of both testicles. Two years ago symptoms of cystitis appeared 

 which were not much improved by internal medication, and irriga- 

 tion of the bladder. Six months ago his left knee became swollen 

 and painful. Two months ago he commenced to suffer from severe 

 pain in the region of the left kidney. Temperature at this time 

 varied from 100 to 103 F. A swelling soon formed in the left 

 lumbar region, and four weeks ago I made an incision in the 

 lumbar region along the outer border of the erector spinse muscles 

 down to the kidney and evacuated a large quantity of pus. 

 Through this incision the kidney could be distinctly felt, and by 

 passing the finger around it, it appeared to be separated from the 

 structures surrounding it. The left knee presents all the appear- 

 ances of advanced tuberculosis. Pulmonary tuberculosis is not 

 present. The disease in both testicles remains latent, the testicles 



