

TUBERCULAR 



1553 



the tibia. T. of the Ulna, a prominence at the base 



of the coronoid process which gives attachment to the 



.alis amicus. T. of the Zygoma, a tubercle at 



-.action of the anterior root with the zygoma ; it 



attachment to the external lateral ligament of the 



^ower jaw. 



ibercular (tit-bur 1 -ku-lar) [tuberculum, a tubercle]. 



:.;ing the physical appearance of a tubercle, 

 .berculate, Tubercled (tu-bur-ku-ldt , tu' -bur-kid) 



*, a tubercle]. Warty ; bearing tubercles, 

 iberculated (tu-bur 7 -ku-la-ted) [tuberculum, & tuber- 

 ;le]. Furnished with tubercles ; tuberculous, 

 iberculation (tu - bur- ku - la' -shun ) [ tuberculum , a 

 : :Ie]. The formation, development, or arrange- 

 of tubercles ; the process of affecting a part with 

 ubercies. 



ibercule \tu'-bur-kul) [tuberculum, a tubercle]. A 

 ubercle. 

 .berculiform (tu-bur 1 ' -ku-lif-orm) [tuberculum, tuber- 



ma, form]. Shaped like a tubercle. 



.berculin ( tu-bur' -ku-lin) [tuberculum, a tubercle]. 



Koch's Lymph ; Paratoloid ; a glycerin-extract of cul- 



ures of the bacillus of tuberculosis. It is a brownish, 



leutral, albuminoid liquid, soluble in water, and consists 



Ijwobably of ptomains of the tubercle-bacilli. Dose 



1 1 lypodemiatically rr^ ii£ of a I per cent, solution. 



to be used therapeutically only with great care. 



extremely valuable in the diagnosis of tubercu- 



n cattle. Unof. Klebs and Hunter have en- 



,jle»vored to eliminate from tuberculin its dangerous 



ornts. Hunter has prepared certain modifications 



lich he has named the two principal, respectively 



: CB. Trudeau has concluded that Modification 



3B contains much less of the remedial element than 



culin, and is quite as dangerous, while Modifi- 



ao B is as efficacious as tuberculin, and free from 



ome of its dangers. See also Tuberculocidin. 



::ulinized (tu-bur 1 ' -ku-lin izd) [tuberculum, tuber - 



Submitted to the action of tuberculin. 

 culinose i tu-bur* -ku-lin-os) [tuberculum, tuber- 

 A term applied to some of the modifications of 

 i aberculin. See also Tuberculin. 



::ulitis (tu-bur-ku-li'-tis) [tuberculum, tubercle; 

 :nflammation]. The inflammation in the tissues 

 mounding a tuberculous node. 



culization \tu-bur-ku-liz-a' -shun) [tuberculum, 

 ibercle]. i. The formation of tubercles, or the con- 

 iition of being charged with tubercles. 2. Treat - 

 lent with tuberculin. 



:ulocidin (tu-bur -ku-U/-sid-in) [tuberculum, 



> kill ]. Alexin ; a precipitate 



:aed by Klebs from Koch's tuberculin by precipitat- 



■g the noxious substances with platinum chlorid, the al- 



.lmoses remaining in solution. See also Tuberculin. 



ur'-ku-loid) [tuberculum, tubercle ; 



,<fef, like]. Resembling tubercle. 



:ulose (tu-bur' -ku-loz). See Tt.berculate. 



- bur- ku- lo> '-sis) [tuberculum, a tu- 



e j. An infectious disease due to the introduction 



the system of the bacillus tuberculosis, discovered 



t in 1882. It has a very wide-spread, almost 



universal, distribution, and it is estimated that fully 



le-seventh of all mankind die of it. The bacillus, the 



etiologic factor, gains entrance into the body 



ith the inspired air, with the food, and by direct 



oculation. The commonest mode of introduction is 



" inhalation ; in consequence, the respiratory tract is 



-t frequent seat of tuberculosis. The bacilli 



■come disseminated in the air chiefly through the 



,;ency of the sputum of persons afflicted with 



Jmonary tuberculosis. The sputum of such in- 



contains countless bacilli, which are held in 



II 



TUBERCULOSIS 



it as long as it is moist, but are scattered through the 

 air when the sputum becomes dry and pulverulent. 

 When tuberculosis is acquired through the food, an 

 occurrence not rare in childhood, it localizes itself 

 primarily in the intestinal tract. The food which most 

 often conveys the disease is milk from tuberculous 

 animals, more rarely tuberculous meat. Direct in- 

 oculation does not play an important role in the causa- 

 tion of the disease. The status of heredity as a factor 

 in the propagation of tuberculosis is not yet fully settled. 

 Isolated instances of apparently hereditary trans- 

 mission, both in man and in animals, are recorded, 

 and demonstrate that the disease may be inherited ; 

 but in the majority of cases the acquisition of tuber- 

 culosis is post-natal. There is, however, a mani- 

 fest tendency of the disease' to attack the offspring of 

 tuberculous parents, which, as it is not the result of 

 hereditary transmission, must indicate the existence 

 of a predisposition or susceptibility which is transmitted 

 from parent to child. The lesion produced by the growth 

 of the bacillus of tuberculosis is known as the tubercle 

 (miliary or gray tubercle or nodule). This is a small, 

 grayish, translucent nodule, from ^ to 2 mm. in 

 diameter, firmly imbedded in the surrounding tissues. 

 By the coalescence of neighboring tubercles larger 

 masses, the so-called tuberculous infiltrations, are 

 produced. Histologically a typical tubercle consists 

 of three groups of cells, the epithelioid, the giant-cells, 

 and the round or lymphoid cells. The first are oval 

 in shape, have a vesicular nucleus, and are the result 

 of the proliferation of the fixed connective tissue and 

 endothelial cells ; perhaps, also, of epithelial cells. 

 The formation of the oval cells is the first effect pro- 

 duced by the tubercle-bacillus. The giant-cell is a 

 large multinuclear mass, usually situated in the center 

 of the tubercle. It may be the product of repeated 

 nuclear multiplication in a single cell, without division 

 of the cell-protoplasm, or the result of the coal- 

 escence of several adjacent cells. The round cells are 

 leukocytes that have emigrated from the blood-vessels, 

 and they may be so numerous as to conceal the other 

 cells (lymphoid tubercle). The bacilli are found 

 in the giant-cells, between and in the epithelioid 

 cells, and, in later stages, in the round cells. New 

 blood-vessels are not formed in the tubercle. The 

 tendency of the tuberculous formation is to undergo a 

 peculiar form of coagulation, known as cheesy 

 necrosis. This gives rise to a structureless, yellowish- 

 white mass, which microscopically shows an almost 

 total absence of nuclei in the central area, while at the 

 periphery nuclei, both normal and in various stages of 

 degeneration, are found. The necrotic tissue does not 

 as a rule take any stain. For this degeneration two 

 factors are responsible : the absence of blood-vessels 

 and the action of peculiar poisons elaborated by the 

 bacillus. The breaking down of tuberculous areas in 

 the interior of organs gives rise to cavities, which may 

 be seen in muscles, bones, brain, lymphatic glands, 

 and elsewhere, but are most pronounced in the lungs, 

 where they may attain a very large size. On surfaces — 

 skin and mucous membranes — tuberculosis often leads 

 to the formation of ulcers, which are characterized by 

 an irregular, eroded appearance and by the presence 

 of tubercles. Tuberculous areas occasionally become 

 secondarily infected with pyogenic or saprophytic 

 organisms. The tubercle-bacillus itself is capable of 

 producing pus, but the majority of the so-called 

 tuberculous cold abscesses are merely collections of 

 fatty and disintegrated cells and tissue-detritus. 

 Tuberculosis is primarily a local disease — extension 

 takes place by continuity and contiguity, along the 

 lymph-channels, along the respiratory and intestinal 



