American practice of surgery : a complete system of the science and art of surgery . fcondensing osteitis, as in the case figured; surrounding this is an area of rare-fying osteitis. The sequestra are of various shapes and sizes. A rare manifestation of tubercle in bone is that of acute diffuse miliary TUBERCULOUS DISEASE OF BONES AND JOINTS. 577 tuberculosis. This is said to occur quite apart from any large deposit. It isof unusual occurrence except in cases of acute general tuberculosis. Having now discussed the changes in synovial membrane and in bone, wemay proceed to describe the changes
American practice of surgery : a complete system of the science and art of surgery . fcondensing osteitis, as in the case figured; surrounding this is an area of rare-fying osteitis. The sequestra are of various shapes and sizes. A rare manifestation of tubercle in bone is that of acute diffuse miliary TUBERCULOUS DISEASE OF BONES AND JOINTS. 577 tuberculosis. This is said to occur quite apart from any large deposit. It isof unusual occurrence except in cases of acute general tuberculosis. Having now discussed the changes in synovial membrane and in bone, wemay proceed to describe the changes which occur in cartilage. Here again the changes are those which result from a chronic inflamma-tory process. It would appear that, as the tuberculous disease progresses inthe cancellous bone and approaches the articular cartilage, the latter soonshows indications of inflammation. The congestion of the cartilage is evidentat an early stage, and this is the more marked because of the fact that carti-lage in its normal condition possesses few blood-vessels, and instead of the usual. Fig. 248.—Tuberculous Deposit in the Astragalus. There is a small sequestrum lying in a cav-ity, the walls of which are formed by dense sclerosed bone. The patient had had the ankle joint ex-cised for tuberculous disease eleven years previously. (Original.) bluish-white appearance it now becomes pink in color and is obviously in-vaded by the development of new blood-vessels in its substance. The carti-lage cells undergo a change; they proliferate, the cartilage matrix becomes ab-sorbed, and the normal structure becomes replaced by granulation tissue. Thecartilage thus becomes perforated in spots, giving us the characteristic worm-eaten appearance which is familiar to those who have had the opportunity ofseeing the interior of a tuberculous joint at this stage of its existence. In thisgranulation tissue tubercles are found, and eventually, in patches, the wholethickness of the cartilage disappears fr
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