Tuberculous disease of bones and joints : its pathology, symptoms, and treatment.

  • Cheyne, William Watson, Sir, 1852-1932.
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: Tuberculous disease of bones and joints : its pathology, symptoms, and treatment. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    names of encysted tubercle and tubercular infiltration. In his opinion the encysted tubercle begins as a deposit of grey miliary tubercles in the cancellous spaces of bone leading to absorption of the intervening bony septa, and the formation of a space containing caseating tubercles surrounded by a more or less well-developed fibrous wall. In the other form there is at first a transparent greyish or reddish infiltration of the bony tissue followed by the formation of pus, and chiefly affecting the spongy bones. In Germany this subject was discussed by Meinel, liokitansky, Virchow, and others, who all adopted some-, what similar views, though with slight modifications. It is unnecessary to follow all the phases in the development of the views on tubercle of bone; they varied according to variations in opinion on the subject of tuberculosis generally. Nor need we dwell on the discussions as to how far these caseous deposits were, on the one hand, the results of the devel< >p- ment of tubercle, or, on the other, only dried up and otherwise altered pus, and not the consequence but the forerunner, and, to some extent, the cause of tubercular development. Up till quite recently the diagnosis was made only by the naked eye, and thus it was only cases where distinct miliary tubercles or larger caseous masses were present that were included under this heading. Hence, on the one hand, it was by no means always possible to exclude gummata and other affections of bone from the group of tubercular affections ; and, on the other hand, it was only when distinct miliary tubercles or larger caseous masses were present that the disease was diagnosed. Conse- quently, till the histological side of the question was brought into prominence, the opinion of most surgeons was that, while tubercles were undoubtedly found in bones, they were compara- tively rarely present, and that there was no necessary relation between the well-known strumous diseases of bones and joints and tuberculosis; at any rate, no identity of origin. Even Yolkmann, who has since done so much to establish the tuber- cular nature of scrofulous diseases of bones and joints, was at