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Casce in which the genitourinary tract has been involved have bemi comparatively
few in my mxperimɩce here. The majority of these showed merely a few miliary tuber-
ales as maboli in the glomerular capillaries, constituting part of a general bamÃO
infection, As examples of cases in which the kidney was found fosaliy sấŸooted in
conjunction with widespread tuberculosis may be mentioned Now 54,72,65,243 and 271.
The last merita special mention on account of the peculiar distribution. The exien-
siye alimsitary infection-tuberculous uiosration of both large and mall intestinec
casented adherent desentarás glanda, extensive infectiorm of the peritoneus--and, the
equal distribution of tuberales throughout both lungs would point to the alimentary
canal as the primary portal of antay. The condition of the kidneys,howevaz,doen nat
support the idea of a hamatogenous origin from entrance of tuberals basilli indo
the general siroulation from the lungs. Bach kidney showed a large focus in a sinlă.
ar situation at the lower pole,as larga na a sobnut, and cassous,most advanced at the
margin between the cortex and a pyramid, and passing in as if later it would die-
charge into the palvis. No naked-eye involveumėt of the ureters was detected, The
fosi gave the impression that they arose from affection of the tubules in courses of
exoration (as mentioned by Assheff and Israel). The foci were each in a more advano-
ed state than a few smaller,pin-head and wiliary tubercles in the cortical area of
the right, kidney which had more likely arisen by hawatogenous infection. The kidney
foul appeared of considerably older standing than the pulmonary condition and showed
more advanced saaukkion than the mediastinal glands but less than the mesenteric,
There were no indications of an ascending infection from lower down the urinary
traat. Other vissora,þiver and splom, showed sparse tubercles only and these were, in
the formar et all events, confined to the peritoneal surface. Briefly, the age of the
kidney condition appeared to be less than that of the alimentary but more that: that
of the pulzonary, and the mode of involvement is obscure.
Others of interest azei No 47,in which sach kidney contained a tubareuìous mási
towards the upper pola, the size of a colaut, without my indication of any miliary
or other infection in the remainder of the organ; nor did the other viscera shor
tuberoles in their interior, though ting were preset on the murfree of the liver
and apåsen, Nevertheless sech was shaped liice an inferet and was almost certainly
of haematogenous origin. No 98. In this the kidney condition was advanced; bath
ware affected,but the right more than the left. The onlyeos were hollowed and had
communicated, the suvity being lined by tuberculous deposit. No 229,m infant of only 9 months,showed generalised tuberculosis and in addition to miliary infestien of the kidneys,ons calyx in the left was hollowed out and lined by tuberculous
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