Tuberculosis of bones and joints.

  • Nicholas Senn
Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: Tuberculosis of bones and joints. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    70/578 page 38
    of fragmentation, are within their grasp. If they are present they always mark the location of the starting-point of the tubercular infection, as only the older leucocytes undergo this change. The number and size of the epithelioid cells are also subject to great variation, and are further modified by the nutri- tive conditions within and in the immediate vicinity of the nod- ule. If cell-proliferation is active the epithelioid cells appear densely packed in the reticulum, nutrition is greatly impaired, and the new cells undergo degenerative changes before they attain their average size. The leucocytes are scattered among the giant and epithelioid cells, and as they reach the ])art through the inflamed wall of the capillaries in the immediate vicinity they are most numerous in the periphery of the nodule and along the course of tlie affected vessels. Hie product of tuhercular inflammation acts as an irritant, and produces an inflammation of a chronic type in its immediate vicinity. Blood-Supply of Tahercle-Nodule.—li tubercle is primarily an endovascular product, as is so often the case, its outer wall is fibrous, composed of remnants of blood-vessels, in the interior of which the essential tubercular product can be seen and studied. The blood-vessel, at a point corresponding with the tubercle, becomes obliterated by a tubercular thrombus from the very beginning, and the tubercular tissue is cut off from further blood-supply, as new blood-vessels ncvet form in tubercle. If the tubercle-nodule originates in the paravascular spaces, the cells which accumulate push the vessels apart and form an avas- cular inflammatory product between them. If a number of tubercles become confluent, the capillary vessels between them are blocked and are converted into tubercular tissue, thus cut- ting off permanently the blood-supply to the infected area. Some of the old authors were familiar with the defective blood- supply of tubercle. Mr. Stafford ( A Treatise on the Injuries, the Diseases, and the Distortions of the Spine, p. 151. London, 1832), in speaking of scrofulous affections of the vertebrse, ui reference to the blood-vessels in and around the foci, says : If
    digitised image 1
    digitised image 2
    digitised image 3