CHAPTER XVI. 



TUBERCULOSIS. 



OF all the microbic diseases, tuberculosis is of the greatest 

 interest and importance to the surgeon. Of the greatest interest 

 because the tubercular lesions which come under his care are more 

 clearly understood from a scientific standpoint than most of the 

 other surgical diseases, and of the greatest importance on account 

 of their great frequency. That large class of diseases which were 

 grouped under that indefinite and vague term, scrofula, in the text- 

 books of but a few years ago, have been shown by recent research 

 to be identical with tuberculosis etiologically, clinically, and ana- 

 tomically. It is the object of this part of the book to give a brief 

 description from a bacteriological and clinical standpoint of such 

 localized tubercular lesions which by general consent are regarded 

 as surgical affections and requiring surgical treatment. 



HISTORY. The results obtained from the crude inoculation 

 experiments, which were made by Villemin, pointed strongly 

 toward the infectiousness of tuberculosis, and since that time dili- 

 gent search was made to discover and isolate a specific micro- 

 organism which should be characteristic of this disease. Theories 

 were advanced, microbes were found and described which were 

 supposed to bear a direct etiological relationship to tuberculosis, 

 but nothing definite was known on the subject until Robert Koch 

 (" Die Aetiologie der Tuberkulose," Berl. kiln. Wochenschrift, 

 1882, No. 15), in 1882, announced to the profession his great dis- 

 covery. He had found and demonstrated the true cause of tuber- 

 culosis, the bacillus of tuberculosis, and in his first publication 

 brought such convincing proof of the correctness of his claim, that, 

 with few exceptions, it brought conviction even to the most scepti- 

 cal. He had not only found the bacillus, but showed that it was 

 constantly present in all tubercular lesions. He had isolated and 

 cultivated the bacillus from tubercular tissue ; and, finally, he had 

 furnished the crucial test had produced artificial tuberculosis in 

 animals by inoculation which was identical with tuberculosis in 

 man. A number of pathologists, who inoculated animals with 

 non-tubercular material, claimed that they had produced pathologi- 

 cal conditions analogous to those found in animals which had been 

 infected with the virus of tuberculosis. Further experimenta- 



