42 LOCALIZATION OF MICRO -O EGA N ISMS. 



tion of carbolic acid. The swelling diminished, but the joint 

 became fixed by false ankylosis at nearly a right angle. Rest in 

 bed and extension with weight and pulley had no effect. Under 

 an anaesthetic brisement force was made, and a plaster-of-Paris 

 bandage applied. The operation was followed by a continued 

 fever, the temperature at times reaching 40 C. (104 F.), rapid 

 emaciation, cough, expectoration, and rales over both lungs, puru- 

 lent otitis media, and death in a few weeks. The necropsy 

 revealed acute miliary tuberculosis of lungs and several other 

 organs. The joint was the seat of a caseous osteo-tuberculosis. 



Verchere (" Coxalgie ancienne, Redressement et immobilisation 

 dans un bonne position, Meuingite tuberculeux, Tuberculose 

 miliare generalissee, Mort," Progrls Med., 1886, No. 24). In a 

 boy sixteen years old, who had suffered for one and three-quarters 

 of a year from coxitis, reduction of a semiflexed leg was made 

 under ether. But little force was used, and the limb was immo- 

 bilized. Patient was emaciated, but otherwise in fair health. 

 The next morning the temperature was 40 C. (104 F.), and 

 symptoms of meningitis were present. These subsided after ten 

 days, but a moderate fever persisted with gradual decline of health. 

 After two months, pulmonary signs could be detected ; four weeks 

 afterward, death. Post-mortem showed general tuberculosis and 

 tubercular meningitis. The author attributes the general dissemi- 

 nation to the redressement. 



In these cases, as in so many others of a similar character which 

 have been reported by different surgeons, the violence used in 

 straightening the limb caused laceration of some of the small ves- 

 sels in the tubercular focus, which opened a direct road for the 

 bacilli into the circulation, which by their rapid diffusion through 

 the systemic circulation, caused acute miliary tuberculosis. Im- 

 perfect operations for local tuberculosis have been followed by the 

 same disastrous consequences. The veins, in the indurated tissues 

 within and around the tubercular product, when opened by the 

 knife, scissors, or a sharp spoon, do not contract, and cells contain- 

 ing the bacilli, as well as free bacilli, find ready access into the open 

 vessels, and after they have entered the circulation miliary tubercu- 

 losis is produced by their localization in distant organs. In opera- 

 tion wounds, after incomplete removal of a tubercular focus, it is, 

 therefore, advisable to prevent the traumatic diffusion of the bacilli 

 by searing their surface with the actual cautery, which not only 

 prevents the entrance of bacilli into the circulation, but, at the same 

 time, adds to the prospects of a permanent result by destroying 

 infected tissues. 



Wartmann ( u Die Bedeutung der Resection tuberculos erkrank- 

 ter Gelenke fiir die Generalisation der Tuberculose," Gentmlblatt f. 



