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The vertebræ may become involved by infection taking place through the pharynx or œsophagus, and leading to a condition simulating tuberculous disease of the spine. When it implicates the intestinal canal and its accessory glands, the lungs, pleura, and bronchial tubes, or the brain, the disease is not amenable to surgical treatment. Differential Diagnosis.
Binswanger states that tuberculosis, aside from miliary tuberculosis or meningitis, produces no mental disorder except phenomena of the amentia of exhaustion. Ballet states that there exists a peculiar mental state in the tuberculous. It is compounded as rule of sadness, of looking on the dark side and of profound egoism. More rarely there are phenomena of excitation explained in part by fever.
The tuberculous ulcer, so often seen in the neck, in the vicinity of joints, or over the ribs and sternum, usually results from the bursting through the skin of a tuberculous abscess. The base is soft, pale, and covered with feeble granulations and grey shreddy sloughs.
When ulcers are associated with such diseases as tuberculosis, syphilis, diabetes, Bright's disease, scurvy, or gout, these must receive appropriate treatment. The local treatment of the tuberculous ulcer calls for special mention.
The vaccine treatment has been successfully employed in various tuberculous lesions, in pyogenic infections such as acne, boils, sycosis, streptococcal, pneumococcal, and gonococcal conditions, in infections of the accessory air sinuses, and in other diseases caused by bacteria.
Lastly, while a number of bacilli, with bovine culture and other characteristics, have been recovered from the bodies of children dying of tuberculosis, and these bacilli have proved virulent to calves when injected into them, yet, as a matter of historical fact, the actual number of instances in which children or other human beings have been definitely proved to have contracted the disease from the milk of a tuberculous cow is still exceedingly and encouragingly small.
Operation wounds made with instruments contaminated with tuberculous material have also been known to become infected. It is highly probable that the common form of tuberculosis of the skin known as "lupus" arises by direct infection from without. [Illustration: FIG.
When the condition has subsided, the limb is massaged and evenly bandaged to promote the disappearance of œdema. Tuberculous Lymphangitis. Although lymph vessels play an important rôle in the spread of tuberculosis, the clinical recognition of the disease in them is exceptional.
Three months later, when I saw it, nothing remained of its troubles but a slight squint and a stiffness in one of its knee-joints. These conditions, too, were rapidly diminishing. Another child, about nine years of age, also of tuberculous parents, was placed under her treatment. One leg was an inch and a half shorter than the other.
The caseated tissue of a gumma differs from that of a tuberculous lesion in being tough and firm, of a buff colour like wash-leather, or whitish, like boiled fish. The degenerated tissue separates slowly and gradually, and in untreated cases may be visible for weeks in the floor of the ulcer. [Illustration: FIG.
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