No7i- Venereal Infections which Invade the Genitalia 321 



value of other tissues for food. Hence, much genital tuber- 

 culosis may pass unnoted. 



The genital mucosa offers a highly vulnerable field for 

 tuberculous invasion, but genital exposure to tuberculosis 

 Is rare as compared with exposure through contaminated 

 food. That is, when open pulmonary tuberculosis exists, 

 the patient is constantly contaminating mangers, food, and 

 water by means of her sputum, so that companions are ex- 

 posed daily and hourly. When genital tuberculosis exists, 

 the exposure may be identical, because of the genital .dis- 

 charges contaminating food and water, but the special ve- 

 nereal exposure occurs only during the very brief period of 

 copulation. 



I have not observed tuberculous orchitis or epididymitis. 

 There is no example of either in my pathologic collection of 

 genitalia, and no specimen in the collection of any depart- 

 ment of the college. The scattered records in veterinary 

 literature of tuberculous orchitis and epididymitis do not 

 serve as a very accurate basis for outlining the clinical 

 symptoms. In a general way, it is stated that the epididymis 

 and testes show painless enlargement and hardening. The 

 demarcation between the epididymis and the testis gradu- 

 ally becomes clouded, and finally is lost. Apparently the 

 epididymis usually becomes involved first, and the disease 

 extends thence to the gland. The tuberculous process is 

 said to be located usually in the parenchyma, having its 

 basis in the mucosa of the epididymis and testis. In this 

 manner the disease may be well advanced before peripheral 

 inflammation or tuberculous extension involves the peri- 

 toneal coverings, to cause adhesions and hydrocele. Rarely, 

 abscessation is said to ensue, resulting in a fistula. 



The clinical diagnosis of tuberculous epididymitis and 

 orchitis is difficult. Painless tumefaction of the testis is not 

 characteristic of tuberculosis, but may ensue from various 

 pyogenic infections. Peritoneal adhesions, hydrocele, and 

 abscessation are quite as probable, if not more so, from other 

 infections than from tuberculosis. Next to the excision of 

 the testis and its examination, tuberculin offers the best 



