TUBERCUI.O-INFECTION OF MAN. 
557 
it not rather be the whole lung of the same side that would be 
involved ? 
And, why, if not on account of anatomical peculiarities, is the 
right lobe more frequently, in fact, as a rule, the first to be in¬ 
volved by the tubercular process. Furthermore, wherein is this 
tissue-predisposition to find expression? It must ultimately re¬ 
side in some way in their anatomical characteristics; in physical 
vasculo-mechanical arrangements, rather than in some mysterious 
depraved cell-quality, for which we know as yet at least no 
equivalent, no expression! 
That is where I prefer to seek it. Cancellated bone-tissue in 
a sense resembles the lung-tissue, and the conditions, anatom¬ 
ically speaking, that surround a tuberculosis of the lung, to my 
mind, in some respects exactly parallel a case of osteomyelitis. 
The trauma, the interrupted, slowed blood-stream, sluggishly 
wending its way through the fragments of bone, impeding its 
flow and carrying with it the messengers of pain, inflammation, 
suppuration, destruction, fever, chills and death perhaps—the in¬ 
fecting germs—all the corresponding phenomena are present! 
And, if that be not the case, then why do we have primary tuber¬ 
culosis of brain, of bone, the heart even (Vargas), and other 
tissues and organs, where the disease cannot possibly be attributed 
to germ-inhalation? 
Inflammation of bone always originates in its vascular struc¬ 
tures, i.e., the peritoneum and medulla and never (Green’s Pa¬ 
thology, page 522) remains strictly limited to either of these 
parts; hence, the term osteomyelitis, inflammation of bone and 
marrow. Conner’s description must forever remain classic: ’Tis 
a pity that he wrote so little, but his classroom lectures will never 
be forgotten by those whose good fortune it was to listen to 
them! 
Among the bones which are primarily affected are the bodies 
of the vertebrae, the ends of the long bones, the bones of the car¬ 
pus and tarsus, the phalanges, and less often the metacarpal bones 
and the ribs. The shafts of the tvnical long bones are rarely af¬ 
fected by tubercular processes: that is to say, cancellated bone is 
