198 CLINICAL FORMS OF SURGICAL TUBERCULOSIS. 



is evacuated by incision nnder antiseptic precautions, a spontaneous 

 cure is accelerated. If, on the other hand, a secondary infection 

 with pus- microbes takes place, the patient incurs the danger of 

 septic infection and local and general dissemination of the tuber- 

 cular process. 



That the bacilli do not grow in a tubercular abscess has been 

 definitely settled by Sehlegtendal (" Ueber das Vorkommen der 

 Tuberkel-bacillen irn Eiter," Fortschritte der Medizin, Bd. i. S. 

 537). He examined five hundred and twenty specimens of pus 

 from tubercular abscesses and found bacilli present in only 75 per 

 cent. Garre ( u Aetiologie der kalten Abscesse ; Driiseneiteruug ; 

 Weichtheil- und Knocheu-abscesse uud der Tuberculosen Gelen- 

 keiterungen." Deutsche med. Wochenschrift, 1886, No. 34) has 

 also made an extended series of observations to ascertain the pres- 

 ence of the tubercle bacillus in cold 1 abscesses. According to this 

 author, many tubercular ulcerations and abscesses are the result of 

 a mixed infection, as has been claimed by Hoffa for some cases of 

 empysema in cases of pulmonary or pleural tuberculosis. In cold 

 abscesses, and in the pus of tubercular cavities in bone, no pus- 

 microbes could be found, not even in cases that pursued a rapid 

 course. Cultivations of such pus remained sterile, while inocula- 

 tions produced typical tuberculosis. In such instances the pus 

 examined under the microscope showed none of the morphological 

 elements of pus, but was seen to consist of an emulsion composed 

 of detritus of broken-down tissue suspended in serum. He affirmed 

 that it is possible that in many cases of suppuration following in 

 the course of a tubercular process pus is the result of a mixed 

 infection, and that the pus-microbes had disappeared before the 

 examination was made. The walls of the tubercular cavity contain 

 the typical structure of the tubercular lesion, and the primary and 

 essential cause of the inflammation the bacillus of tuberculosis. 

 The infection follows the migration of the abscess in whatever 

 direction that may take place. If an additional infection from 

 without takes place, following either a spontaneous discharge or 

 after incision, the superficial granulations are destroyed by the sup- 

 purative process which is initiated, exposing the patient to the 

 additional risks of septic infection and a more rapid local and 

 general dissemination of the tubercular process. 



