TUBERCULAR ABSCESS. 197 



toms have appeared on the sound side, and when on the affected 

 side the vesiculse seminales are already attacked, also in cases of 

 primary tuberculosis of the seminal vesicles. The impotence fol- 

 lowing the operation should be no centra-indication, for in all 

 reported cases of tuberculosis of the seminal vesicles, impotence 

 always occurs in a short time, in fact it is regarded as a cardinal 

 symptom of the disease. 



Strumpell (" Beitrage zur Diagnostik u. Aetiologie der Tuber- 

 kulose des mannlichen Urogenital-apparates," Munch, med. 

 Wochenschrift, B. xxxiv. No. 31, 1887), after a careful study of 

 four cases of primary tuberculosis of the genito-uriuary organs in 

 men, came to the conclusion that infection takes place through 

 the urethra. The tubercle bacilli, finding no place for localization 

 and growth in the urethra and bladder, finally reach the prostate 

 gland, or the epididymis, the whole process resembling inhalation- 

 tuberculosis, in which the disease manifests itself not in the mucous 

 membrane of the bronchial tubes, but in the apices of the lungs. 



11. Tubercular Abscess. 



The specific effect of the bacillus of tuberculosis on the tissues 

 is to produce a chronic inflammation which invariably results in 

 the production of granulation tissue. The granulation tissue must 

 be considered in the light of a protective wall to the surrounding 

 healthy tissue. The degenerative changes which take place in the 

 granulation tissue are caused by local anaemia and the chemical ac- 

 tion of the ptomaines of the tubercle bacilli, and consist in caseation 

 and liquefaction of the cheesy material into a fluid which has always 

 been regarded as pus until recent investigations have shown that it 

 is simply the product of retrograde tissue-metamorphosis. I believe 

 that it can now be considered as a settled fact that the bacillus of 

 tuberculosis produces no suppuration, that its presence indicates only 

 a specific form of inflammation, which terminates invariably in the 

 formation of granulation tissue, and that when suppuration occurs 

 secondary infection with pus-microbes has taken place. A tuber- 

 cular abscess, without the presence of pus-microbes, does not con- 

 tain pus, but the products of degenerative changes in the fungous 

 granulations. If the bacillus meets with sufficient resistance on the 

 part of the surrounding tissues, it finally exhausts the nutritive 

 material in the granulations and dies, or remains in a latent con- 

 dition, the granulation material is converted into cicatricial tissue, 

 and the local lesion is cured. These are the cases which terminate 

 most frequently in spontaneous cure. If liquefaction of the infected 

 tissues takes place and the products of degeneration are absorbed, 

 a similar favorable termination is possible. If the same product 



