Pathology and treatment of diseases of women . dency to the for-mation of a fistula and a further proliferation upward into the vagina.(Cases of Rieck13* and ) These ulcers have mostly underminededges and at the same time a tendency to connective-tissue newgrowthand elephantoid thickening of the labia exists (Rieck). Real tuberclesare, as a rule, not formed, and the appearance is not in any way charac-teristic. Lues, elephantiasis, and ulcus rodens may create similar pic-tures, so that the diagnosis must be made with the microscope. Theseulcerative tuberculous processes of the vulva ar
Pathology and treatment of diseases of women . dency to the for-mation of a fistula and a further proliferation upward into the vagina.(Cases of Rieck13* and ) These ulcers have mostly underminededges and at the same time a tendency to connective-tissue newgrowthand elephantoid thickening of the labia exists (Rieck). Real tuberclesare, as a rule, not formed, and the appearance is not in any way charac-teristic. Lues, elephantiasis, and ulcus rodens may create similar pic-tures, so that the diagnosis must be made with the microscope. Theseulcerative tuberculous processes of the vulva are extremely rare. (SeeFig. 107.) 198 DISEASES OF WOMEN 4. Ovary The ovary becomes diseased relatively rarely in comparison to thetubes and uterus. However, numerous cases are also overlooked here,since, as a rule, only the miliary form is present in the cortical layerand is with difficulty diagnosed macroscopically. The relatively rarer / ? ..??.:?.• Acutely in-flamed portionwith distinctly tuberculouschanges. Perforation Ulcer area. Cicatrix Perforation Fig. 107.—Primary Tuberculosis of the Vulva. (From Rieck, Monatschriftf. Geb. u. Gym, Vol. IX, p. 842.) cases of cheesy infiltration, however, cannot very well be overlooked andare easily interpreted. Primary ovarian tuberculosis so far has not been positively observed(Orthmann). In rare cases, ovarian tumors (cystoma) may also become infectedwith tuberculosis. 5. Peritoneum Peritoneal tuberculosis is very frequent, and attacks, as a rule, youngindividuals. It has always a secondary origin in one of three different ways. PATHOLOGY OF THE VAGINA AND UTERUS 199 (1) by hematogenous infection. (2) directly by immigration of bacilli from the intestines or the retro-peritoneal lymph-nodes. (3) by immigration of bacilli from the lungs and pleurae through thestomata of the diaphragm. The rarest form of infection is from the female genitalia, correspond-ing to the relatively rare primary infection of this tuberculos
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