TUBEKCULOSIS OF THE TENDON-SHEATHS. 187 



one animal that was inoculated with tuberculous material lias lived 

 for five months, and in this case a large abscess formed at the point 

 of inoculation a few weeks after the operation. Examination of 

 the contents of the abscess showed abundant bacilli of tuberculosis ; 

 a gland in the groin remains enlarged, and the disease, if not 

 arrested by the suppurative inflammation, may have become latent. 



7. Tendon-sheaths. 



Tuberculosis of the tendon-sheaths, or, as Hueter terms it, tendo- 

 vaginatis granulosa, has only recently been recognized and described 

 as an independent primary lesion. Hueter, in his most admirable 

 text-book on surgery (G-rundriss der Chirurgie, B. i. S. 127), says 

 that this affection is seldom met with as a primary lesion, but that 

 it appears usually as a complication of joint tuberculosis. Volk- 

 mauu, in his classical article on diseases of joints ("Die Krank- 

 heiten der Bewegungsorgaue," Pitha u. Billroth, B. xi. S. 866), 

 devotes only a few sentences to this part of his subject. The first 

 scientific treatise on this affection came from the clinic at Gottingen 

 by Riedel. Another important paper on the same subject was 

 published by Beger (" Die Tuberculose der Sehnenscheiden," 

 Deutsche Zeitschrift f. Chirurgie, B. xxi. S. 385), who reports four 

 cases that occurred in the clinic at Leipzig. 



The chronic tendo-synovitis, or compound ganglion of the older 

 text-books, has been shown to be, on careful clinical observation, 

 microscopical examination, and bacteriological research, cases of 

 local tuberculosis. The extension of tubercular processes along 

 tendon-sheaths from a tuberculous joint after perforation has, for a 

 long time, been known to occur, but as a primary lesion it has 

 only been recently introduced into surgical nomenclature. When 

 this affection occurs primarily and independently of tuberculosis of 

 an adjacent joint, infection with the bacillus of tuberculosis takes 

 place by localization of floating microbes in some small vessel, and 

 subsequently the pathological processes in the tendon- sheaths 

 resemble those of tuberculous joints. In some cases the products 

 of the disease are massive granulations which occupy the inner 

 surface of the tendon-sheath, in others the fungosity is less, but a 

 copious synovial exudation is thrown out, while in a third class the 

 granulations form hard white masses, the so-called corpora ory- 

 zoidea. The intrinsic tendency of the disease consists in progressive 

 extension by continuity of structure along the tendon primarily 

 affected, and when this tendon is part of a compound tendon the 

 disease gradually creeps from tendon to tendon until all of the 

 sheaths are involved. As this affection is met with most frequently 

 in the tendon-sheaths surrounding the carpus, and as these sheaths 



