SURGICAL TUBERCULOSIS The tuberculous infection is caused by the tubercle bacillus (Robert Koch).
This discovery has enabled us to classify a considerable number of affections under a single head, and the improved methods of examina tion have aided us in recognizing the cause of numerous surgical diseases of the bones and joints which we used to regard as separate diseases. We have thus not only advanced our knowledge of these affections, but have also materially furthered their treatment by recognizing their con nection with the general affection. For the description of the biology of the tubercle bacillus, the mode of infection, and the pathologic anatomy of the initial lesions, we refer to Schlossmann (Tuberculosis, vol. ii).
All the characteristics of tubercular inflammation which we know from the study of the tuberculosis of the lung (Fig. 114) are also found in those diseases which we comprise by the term surgical tuberculosis, though we naturally find some differences according to their location and to the nature of the affected tissue. The rapid growth of the tuber cles, their lack of blood-vessels, their speedy breaking down, the exuber ant granulations testify to a low power of resistance of the newly-formed tissue. Nature attempts to wall off the process against the advancing poison by calling to her aid tremendous numbers of lcueocytes and by the throwing out of granulation tissue, but this latter crumbles down easily and the destruction can be checked only with great difficulty.
The caseous tubercles liquefy in their centre, are filled with purulent material, and several of these tubercles may run together, thus forming a cavernous abscess filled with thin pus containing only a very few The formation of these abscesses progresses only very gradually and with slight general symptoms (cold abscess) because the abscess is only the result of a slow death of the tissues and not the result of a victorious fight by which the infectious focus is strangled and expelled. In favor able cases scar-tissue will be formed from the granulations, but here also we observe the same weakness against the invaders. Quite frequently these cannot be killed and absorbed; the focus is walled in and encap sulated, and thus the dangerous germs may remain alive for years inside the health.. body.
We consid( r under surgical tuberculosis the affections of the lymph vessels, the lymph-nodes, the muscles, bones and joints.