EASES OF, this important subject is fully treated respecting the parts named. The spina rentosa of the fingers is a tuber cular disorder.
In some cases the characteristic symp toms are totally absent, even though the disease is steadily advancing; indeed, months often elapse before the tumefac tion is sufficiently large to attract atten tion.
Tubercular foci in bones, when no se questra are formed, may heal spontane ously, but in the presence of such the parts never undergo resolution. Of 314 cases studied by Riedel (Centralb. f. Chir., Feb. 1S, '93), nearly 46 per cent. were devoid of sequestra. These may be discovered by means of the probe through a fistulous opening. The prog nosis depends upon the ease with which operative proceedings can be resorted to.
Diagnosis.—The slight general mani festations, especially the unimportant temperature changes; the local enlarge ment, which in the case of fingers is sometimes very great before actual suf fering is induced; coupled with the family history of tuberculosis, usually facilitate recognition of the true nature of the affection.
Etiology and Pathology. — Heredity is an important feature of these cases, tuberculosis being usually traceable sev eral generations back. In many cases of bone tuberculosis the lungs are pri marily affected: a source of direct in fection. Tubercular foci may form in any part of the bone, but particularly in the spongy portion. At first limited to the size of a pea, perhaps, it gradu ally enlarges; circuitous foci are then formed, which coalesce. Several general foci of infection may thus be formed, all containing the bacillus of tuberculo sis. The detritus may become trans formed into a cheesy or liquid mass; if this does not occur, a sequestrum is formed, which sooner or later becomes free in the cavity, surrounded by caseous pus. Nature tries to remedy the defect present by inclosing the cavity in scle rotic bone-tissue, and an ivory-like en velope may thus be formed around the tubercular cavity. In other cases a limit ing pyogenic membrane is generated.
Fistulous ulcers are developed from these cavities, the pus breaking its way out wardly.
Treatment.—In the early stages symp tomatic treatment is indicated, the limb being immobilized in such a manner, however, as not to interfere with out door exercise whenever possible. In deed, fresh air is an important thera peutic factor in all these cases, as is also nutritious food and other means calcu lated to strengthen the patient's general powers. The sea-shore, the mountains, and pine-forests are very beneficial—as instanced by Arcachon in France. Local treatment is sometimes very effective. The best of these consists of injections with a syringe into diseased areas of a 10-per-cent. solution of iodoform in oil, sterilized by heating to the boiling-point. But each agent should be sterilized sep arately; in this manner the toxic effects of the iodoform are avoided. Betanaph thol, 1 part; camphor, 3 parts; when finely powdered and mixed, form an oily liquid which may be dissolved in ether, chloroform, and fats; Reboill has used this remedy in various strengths in tuberculous cavities, with signal success. Some surgeons favor igni puncture with galvanocautery or ther mocautery.
Operative measures consist mainly in exposing the affected area of bone and the use of the curette. This must be done thoroughly, however, every vestige of diseased bone or its contents being carefully removed. One small focus may serve for the development anew of all the symptoms. The same radical meas ures should be used in adjoining cavi ties or surfaces; no tuberculous centre should remain. The cavity should then be filled with iodoform-oil. Amputation used to be frequently resorted to in such cases; modern antiseptic methods have modified this tendency, and very few cases nowadays cannot be satisfactorily treated. Koch's tuberculin has been used with success by some, while others have reached opposite results with it. The measures indicated above are greatly to be preferred, and offer better chances of recovery.