TUBERCULOUS DISEASE
Tuberculous disease of joints results from bacillary infection through
the arteries. The disease may commence in the synovial membrane or in
the marrow of one of the adjacent bones, and the relative frequency of
these two seats of infection has been the subject of considerable
difference of opinion. The traditional view of Konig is that in the knee
and most of the larger joints the disease arises in the bone and in the
synovial membrane in about equal proportion, and that in the hip the
number of cases beginning in the bones is about five times greater than
that originating in the membrane. This estimate, so far as the actual
frequency of bone lesions is concerned, has been generally accepted, but
recent observers, notably John Fraser, do not accept the presence of
bone lesions as necessarily proving that the disease commenced in the
bones; he maintains, and we think with good grounds, that in many cases
the disease having commenced in the synovial membrane, slowly spreads to
the bone by way of the blood vessels and lymphatics, and gives rise to
lesions in the marrow.
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