An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White.
- William Williams Keen
- Date:
- 1899
Licence: Public Domain Mark
Credit: An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
![the bacillus of tuberculosis is that known hitherto as caries; that is, an absorp- tion of the bony tissue, giving it a worm-eaten appearance. Necrosis is more freciuently the result of acute inflannnation produced l)y the ])resence of the pyogenic cocci, but, as we have seen, it may occasionally be due to the action of the bacilli of tuberculosis. Tuberculosis of the joints (known often as white swelling, tumor albus, hip disease, ankle disease, etc.) usually results from infection by the opening of a primary nodule from the bone into the joint. A primary tuberculosis of the synovial membrane, however, may also occur. As the consequence of infiltra- tion with miliary tubercles we find a thickening of the membrane with forma- tion of granulation-tissue which may not be accompanied by any collection of fluid in the joint. At other times there is considerable turbid or bloody fluid, or suppuration may take place and the joint contain the characteristic thin and pale tubercular pus. AVhen the tendency to the formation of granulation- tissue is excessive, the condition known as caries sicca exists. Little or no pus is formed, but there is extensive loss of bone as the result of caries. Occasionally circumscribed tubercular nodules form on the synovial membrane and project into the joints as small pedunculated tumors, consisting of fibrous tissue, but containing a softened tuberculous mass in the interior. In the serous form of tuberculous synovitis numerous '■'rice bodies'' or '■'melon-seed bodies are seen in some cases, either free in the joint or attached to the capsule by a pedicle. They are composed of concentric layers of fibrin, a substance which is so often associated with the formation of tubercles. As the disease progresses the articular cartilage is attacked by the granu- lation-tissue in the joint, and ulceration takes place, or granulation-tissue may form in the epiphyses and perforate the cartilage from beneath. In cases of long standing the disease spreads from the capsule to the surrounding tissues, and the connective tissue, the tendons, and even the muscles, become involved in a gelatinous degeneration. This peculiar change is supposed by some to be a saturation of the diseased tissue with a fluid of a mucous or synovial character. Under favorable conditions a more or less complete restoration of the joint- cavity may take place, but when the disease is once Avell develo|)t'd the best that can be hoped for is a fibrous or bony ankylosis. If suppuration takes place, the abscess may open externally, and fistuhie communicating with the joint may be established. In long-standing cases of joint-suppuration amyloid changes are found in the internal organs. Tuberculosis of the tendon sheaths is usually secondary to bone or joint disease, but it occurs occasionally as a primary affection. A thickening of the tendon sheaths takes place and develops into a cylindrical doughy swelling, Avhich is usually not painful. Rice or melon-seed bodies often form. A por- tion of the new tissue softens down and fistulous openings occur. If the sheath is laid open by a longitudinal incision, a mass of gelatinous tissue is found which can easily be stripped off. Such an operation may result in cure. Tuberculosis of the hpnphatic glands is a very common affection. Enlarged glands may be found at the autopsies of children dying of almost any disease, and on examination prove to be the seat of tubercle. The disease may occur in the glands secondarily to the involvement of some adjacent organ, as in the bronchial or mesenteric glands from pulmonary or intestinal tuberculosis. In the glands of the neck, which are by far most frequently affected, the disease often appears to occur primarily, but is in reality usually secondary to a catarrh of a mucous membrane or to a cutaneous eczema. The bacilli are few in num- ber except in the glands nearest to the primary focus, and in many glands they cannot be found. In abscesses of lymphatic glands they may be found in the](https://iiif.wellcomecollection.org/image/b21217014_0116.jp2/full/800%2C/0/default.jpg)
