CHAPTEE XVII. 



CLINICAL FORMS OF SURGICAL TUBERCULOSIS. 



IT is but a few years ago since the forms of tuberculosis to which 

 allusion will be made here were not correctly understood, and con- 

 sequently a rational surgical treatment was out of the question. 

 Most all of the localized tubercular processes were included under 

 the general term scrofula, and were looked upon as local manifesta- 

 tions of a general dyscrasia, and treated in accordance with this 

 view of their pathology. The discovery of the bacillus of tuber- 

 culosis has rendered the word scrofula obsolete, and has assigned to 

 the tubercular processes in the various organs and tissues of the 

 body their correct etiological and pathological significance and 

 paved the way for their successful surgical treatment. 



1. Skin. 



a. Tuberculosis verrucosa cutis. Riehl u. Paltauf ("Tubercu- 

 losis verrucosa cutis/ 7 Vierteljahrsschrift f. Dermatologie u Syphilis, 

 B. xiii. S. 14) have described an affection of the skin, under the 

 name of tuberculosis verrucosa cutis, in which the bacillus of 

 tuberculosis was constantly found, and which they attributed to 

 local infection, because all of the patients they examined were 

 persons handling animal products. Riehl (" Tuberkel Bacillen in 

 einem sogenannten Leicheu-tuberkel," Centralblatt f. Chirurgie, 

 1885, No. 32) has shown, by finding the tubercle bacillus in the 

 warty affections of pathological anatomists, the probable tuberculous 

 nature of this condition of the skin, although the infection may be 

 a mixed one. 



b. Lupus. The long debate which has been carried on for years 

 as to the identity or non-identity of lupus and tuberculosis has ter- 

 minated in favor of those who argued that lupus is a tuberculosis 

 of the skin, hence the term lupus should be omitted from nomen- 

 clature, and the term tuberculosis, as applied to the skin and mucous 

 surfaces, should be qualified by the anatomical name of the surface 

 affected. 



Finger (" Lupus und Tuberculose," Centralblatt f. Bacteriologie 

 u. Parasitenkundej B. xi. S. 348), in a lengthy and able article, 

 makes a careful inquiry into the identity of lupus and tuberculosis, 

 and after a careful review of all that pertains to this subject decides 



