The pathology of tuberculous bone / by Cornelius Black.
- Black, Cornelius, 1822-1887.
- Date:
- 1859
Licence: Public Domain Mark
Credit: The pathology of tuberculous bone / by Cornelius Black. Source: Wellcome Collection.
Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.
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![cumference of each of such islets, and, in this way, se]>arate and distinct excavations, as in the pulmonary tissue, may occui*. When, again, the tuberculous exudation is limited to a certain number of the cancelli, the latter, by the germination and growth of the exuda- tion, may be destroyed; but the circulation of the surrounding can- celli remaining, a plastic exudation may take place upon the surface of such excavation, and thus a healing process is established. It will readily be seen, that it is in the last-recited extent of the disease that the removal, by operative procedure, of the tuberculous portion of bone is likely to be followed by a happy result; whilst, on the other hand, it is manifestly apparent, that where the tuberculous exudation has invaded the whole or the greater number of the can- celli of a bone, resection or amputation is the only means which promises a favourable result. It has already been stated, that, during the progress of tubercu- losis of bone, the adjacent articular structiu’es become similarly affected; and, as the process of ulceration occurs in the latter, it is, as a general rule, by extension of the disease from the extremity of the bone to the adherent cartilage, and thence to the other struc- tures of the joint. As a preparatory step, however, to the ulcera- tion of the cartilage, an exudation is thrown out between it and the extremity of the bone by the vessels of the latter, and this exuda- tion, undergoing a certain development into cells, constitutes a seemingly false membrane, to which important functions, in the subsequent destruction of the cartilage, have been ascribed. Of itself, and by virtue of an inherent ]noperty, this false membrane has no power to cause the absorption of the cartilage; but, by interposing between it and the bone, from the vessels of which the cartilage draws its pabulum of support, the healthy nutrition of the latter is destroyed, and its subsequent ulceration is in consequence decreed. It is extremely rare to find this false membrane interven- ing between the whole extent of the cartilage and the adjacent bone. It much more commonly exists in patches, and these invariably cor- respond with diseased points of bone beneath. \A'here the cartilage is yet adherent to the bone, no such false membrane is to be found, and the condition of the bone beneath is proportionately normal. Hence, the formation of this false membrane is but the natural result of the advance of the disease to the surface of the articu- lating extremity of the bone; and the subsequent destruction of the cartilage is no more ascribable to the influence of any power of absor[)tion on its part, than is the destruction of the peri- osteum, or of the superjacent soft tissues, to an inherent power of absorption in the exudation which occurs beneath the former, and amongst the latter, in the progress of the disease to the surface of the body. The true explanation, then, seems to be, that where, in the progress of the ulcerative stage of tuberculosis of bone, the cartilages of the adjacent joints ulcerate, they, in a great measure, do so as the result of an exudation thrown out between them and](https://iiif.wellcomecollection.org/image/b22342588_0032.jp2/full/800%2C/0/default.jpg)
