Tuberculosis

For A Consumption

Take Ash-keyes so soon as they look wither'd, set them into an Oven, the bread being drawne, in a pewter, or rather an earthen dish, and being so dryed pull off the out side, and reserving the inner part, or the seed, or keyes, beat them to fine powder, and either mix it with good English honey, and so eat of it, first and last, morning and evening, a pretty deale of it at once, upon the point of a knife, or else drink of the powder in some posset Ale, or thin broth. Mares milk, or Asses milk, which is best, being drunk warm morning and evening, is the most soveraigne Medicine for it.

Tuberculosis. Tuberculosis is an infectious disease due to the deposition and multiplication of the tubercule bacillus in the tissues of the body. It is characterized either by the formation of tubercules, or by a wide spread infiltration, both of these conditions tending to caseation, sclerosis, or ulceration.

A tubercular lesion may undergo calcification.

A tubercule is an infective granuloma, appearing to the unaided vision as a semitransparent mass, gray in color, and the size of a mustard seed.

The microscope shows that a tubercule consists of a number of cell clusters, each cluster consisting of one or of several polynucleated giant cells, surrounded by a zone of epitheloid cells which are surrounded by an area of leucocytes. Giant cells, which also form by coalescence of the epithelioid cells, are not always present. The bacillus, when found, exists in the epithelioid cells, and sometimes in the giant cells; it may not be found, having once existed, but having been subsequently destroyed. It is often overlooked.

In an active tubercular lesion, even if the bacillus be not found, injection of the matter into a guinea-pig will produce lesions in which it can be demonstrated.

A tubercule may caseate, a process that is destructive and dangerous to the organism. Caseation forms cheesy masses, which may soften into tubercular pus, may calcify, and may become encapsulated by fibroid tissue. Tubercular disease of the bones and joints have already been described in a previous chapter.

Treatment. Destroy the bacilli present and radically remove infected areas which are accessible. Incomplete operations are apt to be followed by diffuse tuberculosis.

Bier's venous or obstructive hyperemia is especially to be recommended in tuberculosis of the ankle joint (for technic, see chapter on Therapeutics).

Plenty of fresh air, good nourishing food and tonics are indicated as a routine treatment.

Tuberculosis of Bone. Tuberculosis of bone is always dependent upon infection of the marrow of bone by the tubercule bacillus. This germ obtains entrance to the bone marrow and causes the formation of miliary tubercules which arise from the proliferation of the connective tissue of the marrow around the primary tubercule. Other secondary tubercules are formed by extension of the tubercule bacillus. The centres of these tubercules become caseous, and, by fusion of adjacent caseous areas, also cause softening in the bone marrow.

The tuberculous process, as a rule, begins in the epiphysis in the long bones, and may affect any of the bones.

Symptoms. In cases of tuberculous disease confined to the bones alone, the first symptom usually is pain, which ordinarily is not severe and has a gradual onset. Oftentimes, at first on palpation, no difference in the shape of the bone can be detected.

Toes affected by a tuberculous process, slowly enlarge at first without heat or pain; ultimately the skin becomes thickened, and reddened, and the digit is painful to pressure or motion. Oftentimes the skin is perforated at one or more points by sinuses lined with tuberculous granulations, through which caseous pus is discharged.

The diagnosis in these cases always lies between tuberculosis, actinomycosis, syphilis, and osteomyelitis, and exact determination of the origin of the cause oftentimes can be made only by inoculating animals with a discharge from the sinus, or by detection of pyogenic organisms, or of the miliary tubercule, the histologic unit of tuberculosis, or by detecting the peculiar yellow bodies seen in actinomycosis.

Treatment. From a clinical point of view tuberculosis of bone should be considered in the same category as malignant disease, and the indications for treatment in all cases of tuberculous bone disease are the same as in malignant disease; which is, complete removal of the infected area, whenever it is possible.

In some cases the mere opening and curetting of tuberculous areas in bone is oftentimes enough to set up sufficient reaction in the bone and in the surrounding tissues, to put an end to the tuberculous process. Complete resection of bones may at times be avoided by this treatment.

In addition to the local treatment of opening, curetting and drainage, or the complete excision of the bone, the greatest care should be employed in the management of the general hygiene of the patient, including feeding and fresh air. Often removal to a climate which is unfavorable to the development of tuberculosis in general, is also extremely desirable.