The pain is in large measure the result of contracted muscles pulling tender joint surfaces together, and is consequently augmented during the muscle spasms just described to an extent causing the patient to cry out even during sleep. There is also usually a more or less deep-seated and constant pain or soreness, manifested in increasing degree as the lesion advances. These pains are also often referred, lesions in the upper ends of long bones usually giving rise to pain which patients refer to the lower ends. In hip-joint disease pain is often referred to the knee, and in Pott’s disease to the anterior part of the trunk. Slight but slowly increasing disturbance of function of a joint inaugurated by trifling muscle spasm, with complaint of aching pain, is significant and needs careful examination, it being a mistake to anesthetize patients for this purpose, as by the anesthetic the pathognomonic muscle spasm is abolished and mistakes in diagnosis favored.
Fig. 227
Tuberculous disease of the hip.
(Buffalo Museum.)
Fig. 228
Healed tuberculosis of the spine.
(Buffalo Museum.)
It will be seen that these features are also met with in tuberculous-joint disease, the fact being the conditions are not only allied but often associated.
Treatment.
—The treatment of tuberculosis of bone is constitutional and local. The former consists in the best possible hygiene and in those measures which are everywhere recognized as helpful in similar conditions. I believe in the internal use of benzosol, or its equivalents, in doses sufficiently large to influence the tissues. In addition the tonics and evacuants should be judiciously used. But it is mainly with local treatment that we shall here have to deal.