Tuberculous diseases of bones and joints : their pathology, symptoms, and treatment / by Sir W. Watson Cheyne.

  • Watson Cheyne
Date:
1911
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Licence: In copyright

Credit: Tuberculous diseases of bones and joints : their pathology, symptoms, and treatment / by Sir W. Watson Cheyne. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    conclusively shown by Koch and others to be the tubercle bacillus. A further and very important point in the history of tubercles is that they are very irritating structures, and that the tissue in which they lie becomes the seat of simple inflammatory changes which extend far beyond the limits of the tuberculous disease and produce very marked and destructive effects. To sum up we see that tuberculosis is an infective disease due to the growth in the tissues of a parasitic micro-organism —the tubercle bacUlus. It is characterized by the production of a special form of tissue which may either present the form of nodules or of a more diffuse infiltration, the characteristic element of this tissue being the epithelioid cells. This tissue shows a great tendency to undergo a peculiar form of degener- ation termed caseation, and it also excites and keeps up a condition of inflammation in the tissues around. The primary nodule does not remain single but leads to fresh development of nodules both in the immediate vicinity and also frequently in distant parts. It is only by taking into consideration the histological characters of the tissue, the tendency to caseation, the presence of bacilli, the multipHcity of the nodules, &c., that we can come to a definite conclusion as to the tuberculous nature of a disease. Of the various points which I have mentioned those which I consider most important are the presence of epithelioid cells, the multiplicity of the nodules or the extent of the epithelioid infiltration, and the subsequent caseation. When we have numerous and evidently spreading tubercles or large tracts of tuberculous infiltration, and where caseation is occurring, I know of nothing else which this can indicate but tuberculous disease. Limited collections of epithelioid and giant cells may occur around parasites of various kinds, but there is no tendency to extension of the process or to the formation of fresh epithelioid collections at a distance, while the constant tendency to multiplication is a characteristic of the tubercu- lous process. I attach but little importance to the demonstra- tion of tubercle bacilli as a means of diagnosis in these CHE WW. ° CHEYNE 0