278
Genito-Urinary Tuberculosis.
During the year 1903, one case of this form of tuberculosis was met with. This is rather suprising when one considers the frequency of tuberculosis amongst the Chinese. When dealing with this subject, no mention will be made of the presence of tubercular foci in the kidney itself. Such a condition has frequently been found in ordinary cases of acute miliary tuberculosis. In fact WALSHAM has demonstrated the presence of tubercle bacilli in the glomeruli of the kidney without any visible change in the vessels of the glomerulus or in the neighbouring tissues.
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The question as to the occurrence and mode of production in these cases of genito-urinary tuberculosis is one of difficulty. If the tuberculosis is of renal origin then we may account for the condition by the pouring out from the blood of tubercle bacilli into the tubulus of excretion. But supposing the disease be primary in the lower parts of the tract, e.g., in the bladder or Epididymis, how are we to explain the spread of the discase to the kidney along channels and against the flow of their secretion?
The following case came under my notice a few months ago:--A Chinese adult, aged about 40. Tubercular foci were found in the Epididymis and body of the left testicle. Many of these had caseated, became secondarily infected and burst externally through the scrotum. The vas deferens was thickened and nodular and contained caseated nodules. The bladder was in a condition of early tuber- cular cystitis. Extending from here along the left ureter, the tubercular infection spread up to the left kidney, producing there extensive and typical tubercular disease. The condition on the right side was very interesting. The tubercular process had just commenced to involve the right ureter, and could be traced for about 1 inches upwards along its course. Beyond this point there was no trace of any pathological condition. Such a pathological discovery must be one of extreme variety as in all previous cases which I have had the opportunity of ex- amining, no clue was ever present to indicate the manner of extension of the disease.
BAUMGARTEN in 1901 endeavoured to refute the prevalent idea regarding the spread of the disease, that, given tuberculosis in the pelvis of the kidney the tubercle bacillus could travel down one ureter, infect the bladder, and all tissues and organs in the immediate surrounding, subsequently affecting and passing along the opposite ureter to the other kidney in which new tubercular foci are produced. BAUMGARTEN used as support for his argument, the non-inotility of the tubercle bacillus and, as a result, the impossibility of the micro-organisms to travel along any canal or tube, e.g., the vas deferens or the ureter, contrary to the flow of the secretion. In drawing his conclusions, however, he apparently overlooked the new universally acknowledged physiological and experimentally proved fact that all muscular tubes are capable not only of peristaltic movement but also of anti-peris- toltic movement. And this is more particularly the case, should the lower end of· such tubes be closed-a condition of affairs which could easily obtain in tubercular disease. This anti-peristaltic movement has been demonstrated in the case of the ureter but not so far as the vas deferens is concerned. When one considers these points it is a simple matter to understand the pathology of the condition. This case has been put on record as a pathological proof of the extension of the process and its gradual ascent from bladder to kidney.
VARIETIES OF TUBERCULOSIS IN CHILDREN UNDER 5 YEARS OF AGE.
Results of 812 Post-mortem Examinations.
1. Children under 2 years of age.
(1.) Acute Tuberculosis.
5
(2.) Caseons Tubercular Pneumonia, (8.) Tubercular Enteritis,
11
Total,
18