LIPS, .MOUTFI. ETC. In tuberculosis of the lips, which is a rare disease, there develops on the lip an extremely sensitive ulcer. This ulcer has much the appearance of an epithelioma or a chan cre. Tubercular laryngitis is most frequently secondary to tuberculosis of the lungs. Miliary tubercles form in the submucosa and are accom panied by a catarrhal inflammation of the mucous membrane. With necrosis of the tubercles. ulcers are formed. These ulcers often run together, involve adjacent parts, and determine extensive destruction of tissue. Tuberculosis of the tongue is marked by the appearance of small nodules on the upper surface or edge of the organ. These open on the surface and become ulcers. It is a rare condition except when associated with tu berculosis of other parts. Tuberculosis also occurs in the palate, tonsils, pharynx, oesophagus, and stomach. The lesions are similar to those described in other mucous membranes, that is, the formation of nodules, a catarrhal inflamma tion, and necrosis with the formation of ulcers.
INTESTIcES. In tuberculosis of the intestines there is involvement of Pet'er's patches and of the solitary lymph nodules as well as ulcers of the mucous membrane between the patches. As a primary lesion it is extremely rare in adults, much less rare in children, where there is apt to be involvement of the mesenteric glands or a tubercular peritonitis. In the secondary form of the disease in adults the lungs are the usual seat of the primary lesion. The ulcers occur chiefly in the colon, efecum, and ileum. They may be very extensive, affecting the greater portion of the mucous membrane of both large and small intes tines. The ulcers are irregular in shape, rough in outline, their long axes transverse to the lumen of the gut. They usually involve not only the mucous membrane, but also the submueosa and muscular coats. They rarely perforate. With healing of the ulcers, extensive sear tissues may form, so contracting the bowel as to cause steno sis. Not uncommonly tubercles are present on
the peritoneum adjacent to the intestinal ulcers. Tuberculosis of the rectum is quite frequently associated with fistula, the fistula. being of the nature of a tuberculous ulcer.
In tuberculosis of the breast, nodules form in the gland. These may become necrotic, commu nicate by fistulous openings with the surface, and form ulcers. In the majority of eases the axil lary glands are involved.
Tubercular lesions may occur in the brain as part of a general miliary tuberculosis. In such eases it affects the meninges, causing a tubercu lous meningitis, usually associated with an in crease in the fluid within the ventricles (acute hydrocephalus). In chronic tuberculosis of the brain the lesion is a meningo-encephalitis, the tubercles affecting both meninges and brain tissue proper. The lesion is usually localized'and there are in most cases several nodules. These nodules vary in size from a quarter of an inch to nearly an inch in diameter, sometimes being even larger. The nodules on section present a grayish yellow appearance, a necrotic sometimes almost fluid centre, and are surrounded by an area of clear soft tissue. The nodules are usually attached to the pin mater and extend from the surface into the brain. The nodules may interfere with cere bral circulation, causing softening, or sinus thrombosis, or may incite an acute meningitis. The pia is apt to be thickened and adherent to the brain surface. Instead of several nodules there may be one large solitary tubercle. Lesions quite similar to those described for the brain may occur in the cord either with or without brain lesions. See BACTERIA; DISEASE, GERM THEORY OF.
Consult: Latham, Pulmonary Consumption (London, 1903) : Osier, Practice of Medicine (New- York, 1901) ; Ziegler, Pathological Anato my (Eng. trans., ib., 13S7) Blebs, Tuberculose (Hamburg, 1893) ; and monographs by Virchow (1863-65) and Koch (1832-90).