44() MUCOUS MEMBRANES. 



again, forming small clusters, and already exhibiting a minute 

 (3entral cavity. The gradual and uniform extension of the 

 growing and softening tubercles from these centres, necessarily 

 gives rise in the first place to a circular ulcer, the " lenticular 

 tuberculous ulcer." Several such ulcers, becoming confluent, 

 form secondary ulcerations of larger size, whose outlines are 

 most irregular. These gradually extend over progressi^'ely 

 \vider areas of tlie mucous surface, until at length the de- 

 nuded parts exceed the healthy surface in amount, the rela- 

 tively intact portions forming narrow borders between adjoiniiig 

 ulcers. 



§ 385. These observations, which primarily refer to tu)>er- 

 culosis of the urinary bladder, may be transferred to any part 

 of the uro-genital tract, and particularly to the lining membrane 

 of the ureters. The anatomical appearances in the latter case 

 however, are markedly complicated by the introduction of a 

 catarrhal element. The tuberculous ureter is at first only in a 

 state of catarrh ; the swollen mucous membrane pours out a 

 thick, viscid, purulent secretion ; and the swelling, together with 

 the discharge, may affect the state of the urine, causing the chief 

 clinical symptoms of tuberculous disease of the ureters, before a 

 sinofle tubercle is formed. Tuberculosis of the womb is second- 

 arily complicated with an overgrowth of the connective tissue, 

 partly in the submucous, partly in the muscular layer, which 

 may attain very considerable proportions ; hence a positive en- 

 largement of the organ as a Avliole, is associated with a progressive 

 loss of substance from its inner surface. Even more peculiar is 

 the complication of tuberculous ulceration of the bowels with a 

 papillar}^ and polypoid hj^pertrophy of the unaffected residue of 

 the mucous membrane. This may assume such proportions, that 

 the entire membrane may be masked by the dark-red, congested 

 polypi, as large as peas, between whose bases the ulcerated 

 surface itself may escape notice unless looked for. The com- 

 ])lication is not, however, a common one. Far more common, 

 and much more difficult to distinguish from the tubercular 

 affection proper, is the combination of tuberculosis with that 

 scrofulous overgrowth of the Ijanphatic follicles with which we 

 have already become familiar, as it occurs in the lymphatic 

 glands (§ 203, et seqq,). 



§ 386. The very same regions of the digestive system whicli 



