TUBEKCULOSIS OF THE BONES. 181 



Traumatic dissemination is very likely to follow all imperfect 

 operations, in which portions of glands or infected capsules are left 

 behind by inoculation of the surface of the wound with the bacilli. 

 I have seen in a number of such cases as early as a week after the 

 operation the entire wound surface covered by a thick layer of 

 granulation tissue, which showed all the histological evidences and 

 possessed all the bacteriological properties of tubercular tissue. As 

 an additional testimony in favor of the operative treatment of 

 tubercular glands, I will quote from the paper of Schnell ( Ueber 

 Erfolge von Extirpation tuberculoser Lymphome, Dissertation, Bonn, 

 1885), who collected 56 cases of tuberculosis of the cervical glands, 

 which were treated by extirpation in the clinic at Bonn. In 37 of 

 these cases he was able to learn the ultimate result. In 57 per 

 cent, the operation was followed by complete recovery ; in 27 per 

 cent, the disease returned at site of operation ; and in four cases 

 death resulted from pulmonary tuberculosis. The largest number 

 of cases were patients between ten and twenty years of age. 



5. Bones. 



Tuberculosis of the bones is an exceedingly frequent affection in 

 children and young adults. Its favorite location is in the epiphy- 

 seal extremities of the long bones, although it is also quite fre- 

 quently met with in the short bones of the carpus and tarsus, 

 and some of the flat and irregular bones, as the ribs, scapula, ilium, 

 and vertebrae. Direct infection is never observed, and when the 

 disease has made its appearance it is only an evidence of the ex- 

 istence of tubercular infection at an earlier day, or the presence 

 of a tubercular process in some other organ. We observe clinically 

 what Miiller has demonstrated experimentally, that when the bacilli 

 of tuberculosis are present in the blood current, very often localiza- 

 tion takes place near the epiphyseal cartilage in young persons by 

 the microbes becoming arrested in one of the terminal branches of 

 an artery, the lumen of which becomes obliterated by the presence 

 of an embolus of granulation tissue containing bacilli, or the lumen 

 of the vessel is gradually diminished by the formation of a mural 

 thrombus, which forms around bacilli implanted upon the vessel 

 wall, and the lumen of the vessel is finally completely obstructed 

 by the growth of the thrombus. The new vessels in the vicinity 

 of the centres of growth in the bones of young persons, on account 

 of their imperfect structure and irregular contour, furnish the most 

 favorable conditions for the arrest of floating granular matter and 

 the localization of pathogenic microbes. This predisposing ana- 

 tomical element goes far to explain the frequency with which we 

 meet with tubercular foci in the epiphyseal extremities of the long 



