188 CLINICAL FORMS OF SURGICAL TUBERCULOSIS. 



are not infrequently in direct communication with the wrist-joint 

 by means of small synovial sacs, it extends to the joint by con- 

 tinuity of surface. 



Konig (" Die Bedeutuug des Faserstoffes fur die pathologisch- 

 anatomische und die klinische Eutwicklung der Geleuk und Seh- 

 nenscheiden-Tuberculose," Centralblatt f. d. gesammte Med., 1886, 

 No. 25) assigns to the bacillus of tuberculosis properties which place 

 it among the agents which produce fibrinous inflammation. The 

 rice bodies in the tendon-sheaths the seat of a chronic inflammation 

 he considers as the product of a fibrinous inflammation caused by 

 the presence of the bacillus of tuberculosis. Nicaise, Poulet, and 

 Villard (Nature tuberculeuse des hygromes et des synovites tendi- 

 neuses a graim riziformes, 1884) examined four cases of hygroma 

 containing rice bodies, and found in all of them the bacillus of 

 tuberculosis. I have observed this form of inflammation of the 

 tendon-sheaths in the common extensors and flexors of the hand, 

 the peroneus longus, the tendon of the patella, and the tendo- 

 Achillis. One of these cases was remarkable for its acuity. 

 The patient was a man sixty years of age, laborer, and addicted to 

 intemperance. About the beginning of the year I examined him 

 at the request of another physician, and found an oblong swelling 

 on the dorsum of the hand corresponding to the extensor tendon of 

 the index finger. The swelling was not painful, and but little 

 tender on pressure. Fluctuation was well marked ; on deep 

 pressure movable bodies could be distinctly felt which were recog- 

 nized as corpora oryzoidea. An operation was advised, but was 

 declined. A few weeks ago the patient was admitted into the 

 Milwaukee Hospital, being completely incapacitated from following 

 his occupation. At this time the dorsum of the hand corresponding 

 to the index and middle fingers, and the radial aspect of the fore- 

 arm as far as the middle, presented a continuous swelling with 

 well-marked fluctuation. The swelling had become painful, and 

 exceedingly tender on pressure. Under strict antiseptic precau- 

 tions the swelling was incised in its entire length, and a large 

 quantity of synovia-like fluid and softened rice bodies escaped. 

 The sheath of the extensor commuuis digitorum and extensors of 

 the wrist were lined with a thick layer of fungous granulations, 

 and near the annular ligament numerous loose attached rice bodies 

 were found. The tendon-sheaths were carefully dissected out, and 

 the whole wound, after thorough disinfection, dusted with iodoform, 

 drained and sutured. A copious antiseptic dressing of iodoform 

 gauze and sublimated moss was applied, and the forearm and hand 

 fixed upon an anterior splint. Inoculations of the fluid from the 

 sheath upon potato remained sterile. Cultivation upon solidified 

 serum, obtained from a hydrocele, showed, after a few weeks, a 



