Tulercular Ostitis involving Elhoio-jcint. 479 



history was good, and previous health excellent. About three years 

 before his admission to the Royal Infirmary, Edinburgh, he had sprained 

 his right arm, and it had never been quite the same again. Some 

 months before his admission, a swelling had appeared just below the front 

 of the right elbow, and had gradually increased, till it burst and dis- 

 charged. On admission, there was still swelling there, and an open sore 

 with tough white sloughs lying in its centre. After poultices and 

 blisters, the sloughs separated and the sore closed, but about the same 

 time a chronic swelling appeared at the back of the elbow, and after 

 being opened, turned septic. As the patient's health began to suffer, 

 amputation was performed, and he made a good recovery. 



The section of the arm shows a mass of cicatricial tissue 

 in the site of the former swelling on the front of the arm. It 

 is not connected with the joint. The cartilage of the elbow 

 joint is almost entirely replaced by granulations. A caseous 

 cavity, which opened into the elbow-joint, is seen on the ulna, 

 and non- vascular deposits between this cavity and the joint. 



G. C. 2810. 

 Presented b^jF. H. MacLaken, F.R.C.S.E. 



139. Tubercular Arthritis, with Destruction of the 

 Articular Surface of the Humerus. — Bones of a left 



elbow — macerated, illustrating the above. 



The central portion of the lower articular surface of the 

 humerus is wanting, and the bone round it is greatly opened 

 out, as if in process of absorption. A portion of the smooth 

 articular surface of the capitellum remains, but on what is left 

 of the trochlear surface the bone is rarefied. Corresponding 

 changes are present on the articular surfaces of the ulna and 

 radius. Some new periosteal bone has been formed on all 

 the bones near their articular surfaces. 



There has evidently been a septic complication in the later 

 stages of the disease, but that the primary mischief was in the 

 bone is only a conjecture based upon the comparatively 

 localised destruction of the bone. G. C. 1148, 



7. 140. Advanced Tubercular Disease of the Elbow.— 



