. Diseases of bones and joints . n of the bonetissue. If the spread be rapid, a large piece of thebone will be killed at once, and a sequestrum mayresult, but the usual course is a slow spread and adestruction of the bone in small pieces, giving us theso-called bone sand so characteristic of the dis-ease. The tuberculous granulations may extend down- Qurseoftward to the limits of the lymphoid marrow. Herethey stop. Outward the granulations may maketheir way to the periosteum. Here also they stop,unless an abscess be formed and the contents forcetheir way through the periosteum into the tissues
. Diseases of bones and joints . n of the bonetissue. If the spread be rapid, a large piece of thebone will be killed at once, and a sequestrum mayresult, but the usual course is a slow spread and adestruction of the bone in small pieces, giving us theso-called bone sand so characteristic of the dis-ease. The tuberculous granulations may extend down- Qurseoftward to the limits of the lymphoid marrow. Herethey stop. Outward the granulations may maketheir way to the periosteum. Here also they stop,unless an abscess be formed and the contents forcetheir way through the periosteum into the tissuesoutside. The cartilage draws its nourishment fromthe subjacent bone marrow. When the tuberculousgranulations reach the under surface of the car- 54 DISEASES OF BONES AND JOINTS tilage they interfere with its nutrition, and it be-gins to degenerate. The first sign of this degenera-tion is often a fibrillation. Sometimes the tubercu-lous granulations can be seen under the microscopepushing their way through the cartilage. They may. Fig. 23. Low power photo-micrograph of a case of knee joint tuberculosisin a child about ten years old. The focus was located on the shaftside of the epiphyseal line. The tuberculous granulations madetheir way to the periosteum, and burrowed along under this, andthen under the articular cartilage. A—articular cartilage, B—epiphy-sis, C—epiphyseal cartilage, D—-periosteum, E—-tuberculous granu-lations. break through at some one spot, or they may spread Damage to the out and break into the joint at the margin of the Cartilage cartilage. Sometimes they spread out under the entire cartilage and lift it off. When they gain the DISEASES OF BONES AND JOINTS 55 joint, they infect the synovia on its surface, or, ifthe disease has reached the margin of the cartilagewithout breaking into the joint, then the synoviais probably involved by direct extension. The dis-ease then attacks the other bone or bones of the
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