=Definition.=—A general or local infectious disease caused by the
bacillus tuberculosis of Koch. The bacillus produces specific lesions
of the form of nodular bodies called tubercles that undergo caseous
necrosis with a tendency to involve neighboring tissue. There may be
a diffusion of the infection by way of the lymph and blood vessels to
various tissues and organs.
=Osteopathic Etiology and Pathology.=—Tuberculosis exists in all
countries. It generally prevails more extensively in warm than in cold
climates, and is of more frequent occurrence in the city than in the
country. Altitude, however, exerts more influence than latitude. The
disease rarely occurs in mountainous countries, owing to the purity of
the atmosphere. The disease is very prevalent in the West Indies and
the South Sea Islands. Tuberculosis is frequently met with in Canada
among the French Canadians and the English. All races are subject
to tuberculosis, but the Indians of this continent, the South Sea
Islanders and the colored race are very susceptible to the disease. It
is estimated that from seven to ten percent of the present death rate
in the United States is due to tuberculosis.
The tubercle bacillus was discovered by Koch in 1881. It is a short,
straight or slightly bent, rod. This bacillus has an exceedingly
tenacious hold on life and is found in greater or less numbers in all
tuberculous lesions.
It can live almost indefinitely outside the body. The bacilli are found
in great numbers in the sputum, which dries and flies in the atmosphere
in the form of dust. The organism is thus widely spread in regions
frequented by phthisical patients. The bacillus gains entrance into the
body by way of the respiratory tract in the vast majority of cases.
Milk from tuberculous cows will produce the disease, especially in
children, causing intestinal and mesenteric tuberculosis. The meat of
tuberculous animals is not necessarily infectious, although there is a
possibility of infection by this means. Tuberculosis may be transmitted
by direct inoculation; this does not often occur in man, but when it
does, the disease usually remains local, although general infection may
occur. Persons who follow certain occupations, as butchers, dissectors
of dead bodies, and handlers of hides, are more or less subject to
local tubercles of the skin. The virus may enter the body through any
fissure or excoriation on the skin; thus by washing the clothes or bed
linen of phthisical patients, by the bite of a consumptive, or by a cut
from a broken sputum glass of a consumptive, one may become infected.
It is stated that there may be hereditary transmission. In some cases
the virus may be transmitted and the disease may not appear for many
years.
=Predisposing Causes.=—Hereditary predisposition, which renders the
person more liable to accidental infection; delicate constitution;
scrofulous tendency; previous infectious diseases, as influenza,
whooping cough, measles, typhoid fever; diabetes mellitus, etc.
In young children meningeal, mesenteric and lymphatic forms of
tuberculosis are the most frequent. Pulmonary tuberculosis is usually
met with in adults, especially between twenty and thirty years or
age. The development of tuberculosis is favored by damp localities;
by improper and insufficient food; constant inhalation of impure
air; injuries to the chest, with or without laceration of the lungs,
and various osteopathic lesions that weaken the tissue through faulty
nutrition. Corresponding to the innervation of the organ or tissue
diseased will always be found anatomical derangements. “Every case has
a defective spine and thorax.” (Hayden[60]).
Bronchial catarrh, tonsillitis, diseases of the stomach and intestines,
especially enterocolitis, tubercular pneumonia, pleurisy (rarely),
intrathoracic tumors and congenital or acquired contraction of the
orifice of the pulmonary artery increase the susceptibility to
infection. Lessened vitality of the tissues, whether inherited or
acquired, is necessary before the germ can become implanted and
proliferate, producing tuberculosis of the tissues and organs. In
nearly every instance, when the lungs are involved, lesions are found
at the second, third, or fourth ribs. These lesions undoubtedly
predispose to the tubercular infection, by lessening the vitality
of the lung tissues through interference with the innervation or
vascular supply. Possibly a lesion at the second rib or second dorsal
vertebra would interfere directly with the vasomotor nerves of the
upper thoracic ganglia. The condition of the middle and lower cervical
vertebræ should be carefully examined, for lesions at that point would
involve the lymphatics of the lungs. The lowered vitality caused by the
lesion is the predisposing cause and the tubercular bacillus is the
=exciting cause= which determine the character of the affection.