TUBERCULOSIS OF SEROUS NEMI3RANES. That of the pleura has been mentioned. Tubercular pleu risy may, however, occur independently of any lesion in the hmg proper. Tubercular peritonitis may be primaij', but is more 'frequently associ ated with tuberculous disease of some adjacent organs. Thus in women nearly half the eases are due to extension from the Fallopian tubes. In man the initial lesion may be in the seminal vesi cles or prostate. It may be part of a general miliary tuberculosis. In the tubercular peritoni tis of pulmonary phthisis the infection seems to reach the peritoneum through the intestines. In some cases minute tubercles are scattered over a part or all of the peritoneum and are usually ac companied by a serous or sero-fibrinous exudate. There may be larger areas of tubercular tissue which undergo necrosis. Secondary infection by the pyogenie cocci may occur, resulting in a purulent exudate. In what is known as chronic fibroid tuberculosis of the peritoneum there is little exudation, the tubercles are firm and pig mented, and the peritoneal surfaces matted to gether by fibrous adhesions. It is not uncommon to have tumor-like formations. These may be due to sacculated exudations, to matting together of omentum or intestinal coils, or to enlargement of mesenteric glands. Tubercular pericarditis
may be primary or secondary, acute or chronic.
In the acute miliary form the membrane is studded with tubercles and there is usually some sero-fibrinous exudate. In rare cases the exudate is large, Musser in one ease 34 ounces of fluid in the pericardial sac. In chronic cases the membrane is thickened, adherent, and usually shows several cheesy tubercular masses. The bronchial and mediastinal lymph nodes are regu larly involved.
Tuberculosis occurs in bones, periosteum, and joints. In tuberculous osteitis the tubercles may be small and scattered, or less in number and of considerable size. Abscesses are sometimes fanned. The adjacent joints are frequently in volved. The spongy parts of the bone are more susceptible than the hard parts. The vertebra, carpal and tarsal bones are most commonly affected. The chronic, purulent periostitis of poorly nourished children is frequently tubercu lar. For description of the lesion in tubercular arthritis, Seel SVNOVITIS.