LYMPHATIC TUBEECULOSIS. 23 



The secondary results of bone tuberculosis depend on the 

 anatomical relations of the bone involved. Increased epiphysial 

 growth is sometimes seen ; joint tuberculosis is a common 

 sequel. "When a diseased bone is in intimate relation with a 

 serous sac the latter may be involved by extension ; tuberculous 

 peritonitis, pleurisy, and meningitis at times arise in this way. 

 Disease of the bodies or laminae of the vertebrae may give rise to 

 paraplegia by causing pressure on the spinal cord or by directly 

 invading it. The intimate relation of the psoas muscle to the 

 vertebrae explains the frequency of psoas abscess in tuberculous 

 caries. Destruction of bone gives rise to various deformities of 

 the spine and joints. 



Tendon sheaths are liable to tuberculous infection, which 

 manifests itself as a chronic teno-synovitis. Primary infection 

 of these structures is probably blood-borne, but the intimate 

 relation of tendon sheaths to certain joints allows direct infection 

 from the joints themselves. Thus the flexor and extensor sheaths 

 may suffer in disease of the carpus, and the sheaths of the 

 peroneal and tibial muscles in disease of the tarsus. Conversely 

 disease of a tendon sheath may infect a joint over which the 

 tendon passes ; the tendon sheaths around the wrist are peculiarly 

 liable to invade the wrist-joint in this way. 



The mammary gland may be invaded by way of the milk 

 ducts, and then the inflammation is primarily parenchymatous 

 or through fissures of the nipple, when interstitial mastitis may 

 be expected. Secondary lymphatic glandular enlargement 

 follows. 



The lymphatic glands are often the site of localised tuberculosis. 

 The drainage area of the group of glands first involved must be 

 assumed to be the place of primary infection. The glands which 

 most frequently suffer are the tracheo- bronchial group, the 

 cervical chains, and the mesenteric group, corresponding respec- 

 tively to infections of the lung (or possibly of the trachea and 

 oesophagus), of the nose and throat, and of the small intestine. 

 The primary lesion may be insignificant, and there is good 

 reason for the belief that the bacilli may even penetrate 



