. Operative gynecology. pelvic origin may be associated with a variety of other dis-eases. In one of my cases, for example, there was a miliary tuberculosis of theleft tube, and a dermoid cyst of the i-ight ovary 3 centimeters in diameter. Inanother case there was an ovarian cyst on the left side about 12 centimeters indiameter (5 inches), and an extensive peritoneal tuberculosis, covering the outersurface of the cyst as well, with effusion. In still another case a tuberculoustubo-ovarian abscess contained aronococci. 136 TUBERCULAR PERITONITIS. Etiology.—The cause in all cases is the invasion
. Operative gynecology. pelvic origin may be associated with a variety of other dis-eases. In one of my cases, for example, there was a miliary tuberculosis of theleft tube, and a dermoid cyst of the i-ight ovary 3 centimeters in diameter. Inanother case there was an ovarian cyst on the left side about 12 centimeters indiameter (5 inches), and an extensive peritoneal tuberculosis, covering the outersurface of the cyst as well, with effusion. In still another case a tuberculoustubo-ovarian abscess contained aronococci. 136 TUBERCULAR PERITONITIS. Etiology.—The cause in all cases is the invasion of the peritoneum bythe tubercle bacillus, which finds in the serous surface a suitable pabulum forgermination. The mode of invasion is often difficult to determine. In thecases seen by the gynecologist the proximal avenue is usually by the uterine tube,and in many instances it is quite clear that the disease has reached the tube by thevagina and uterus, because the tubercular lesions are also found in these Fig. 33().—Genekal Tubekculak Peritonitis. Showing the way in which the uterus, tubes, broad ligaments, and ovaries are studded with is also a commencing tuberculosis of the tubal mucosa. The case is also complicated by a coincidentepithelioma of the July 24, 18J5, No. 813. % natural size. Cases of dissemination of the tubercles over the peritoneum may also occurfrom a broken-down mesenteric gland, or by extension from tuberculous intes-tinal ulceis. Miliary tuberculosis involving all the organs of the body may arise from acheesy thoracic gland opening into a vein and distributing its products through-out the whole system. With this affection we have nothing to do. Predisposing causes are not easy to determine; in a series of sixteen casesof my own, the family history was good in twelve, tuberculous in two, and can-cerous in two. A previous depressed state of health does not seem to be such an importantfactor as one would naturally exp
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