196 CLINICAL FORMS OF SURGICAL TUBERCULOSIS. 



proper are intact, the epididymis moderately swollen aud indurated, 

 the vas deferens on each side somewhat firmer than normal. The 

 disease has extended from the epididymis to the pelvis of the kid- 

 neys, all of the intervening organs being involved in the tubercular 

 process. The only apparent manifestation of general tuberculosis 

 is presented by the left knee. An interesting feature in this case 

 is the formation of a paranephric abscess around a pyelo- nephritic 

 kidney, which must be referred to a secondary infection with 

 pus-microbes. 



Tuberculosis of Urethra and Glaus Penis. Kraske has observed 

 a case of tuberculous ulceration of the urethra extending from the 

 membranous portion to the neck of the bladder, in a patient thirty- 

 three years of age. The patient was treated for chancre. The 

 autopsy revealed advanced tuberculosis of the geni to-urinary tract, 

 and pulmonary tuberculosis. In another case, a man, forty-nine 

 years old, a tuberculous ulceration existed on the dorsum of the 

 glans, the size of a cent piece. This sore was also mistaken for 

 primary lesion of syphilis. There were no signs of pulmonary 

 tuberculosis. The glans was amputated, when it was observed 

 that the tuberculous infiltration extended deeply into the cavernous 

 structure. The lesion could not be traced to genital contact, and 

 under the microscope showed the typical structure of tuberculous 

 tissue. 



Vesiculce Seminales. In 1829 Dalmar described a chronic inflam- 

 mation of the seminal vesicles, the description of which corresponds 

 closely to that of tuberculosis. Since then this affection has been 

 described by Albers, Jaye, Naumann, Humphrey, and Kocher, and 

 lately it has been studied by Rayer, Cruveilhier, and Reclus, as 

 secondary to tuberculosis of the lungs. As a secondary affection, 

 this trouble is not only seen in connection with tuberculosis of the 

 lungs, but is more common after primary tuberculosis of the epi- 

 didymis, either as a continuation of the cheesy degeneration in the 

 vas deferens, or spreading by contiguity of tissue from the prostate. 

 Primary tuberculosis of these organs is extremely rare, and still 

 less often diagnosed, and up to the present time no surgical inter- 

 ference has been attempted. 



Ullman (CentralblaM f. Chirurgie, No. 8, 1890) reports a case of 

 primary tuberculosis of the right testicle with secondary affection of 

 the seminal vesicles on both sides, in a lad seventeen years of age, 

 where, after removal of the right testicle he extirpated these organs 

 through a semilunar incision in the perineum. The general health 

 of the patient improved, but a small urinary fistula remained, as 

 during the operation the bladder had been opened. He is of the 

 opinion that the seminal vesicles should be removed in primary 

 tuberculosis of the testicle or epididymis, when no suspicious symp- 



