130 ANNUAL REPORT OF THE Off. Doc. 



It is interesting to note that Dr. ilartzelTs two cases were both 

 of the verrucous variety, the origin in both l)aving been almost cer- 

 tainly bovine. 



Drs. Joseph and Trautmann report three cases of verrucous tuber- 

 culosis of the skin occurring among employes of the municipal abat- 

 toir in Berlin, who worked exclusively with tuberculous animals. 



Case I. — J. (x., aged forty-five years. Was never ill before, and 

 no tuberculosis in his family. His duties were to cut up tubercular 

 and condemned carcasses. In 1892 or 1893 he received a small 

 wound of the middle finger of the left hand, and a nodule soon formed, 

 surrounded by a zone of redness. It i«creased slowly until 1897 or 

 1898, when the thermocautery was resorted to with partial success. 

 About a year ago the man tore the first finger of the same hand on a 

 bone from a tubercular cow. The wound cicatrized in about eight 

 days, but later a nodule developed on the site. When examined, in 

 August, 1891, the disease was confined to the first and middle fingers 

 of the left hand. On the first finger nodules about the size of a pea 

 protruded from the surface 1 ram. to 2 mm., moderately read, and 

 having in the center a broken area covered with small crusts. The 

 nodule on the middle finger was much larger and the verrucose con- 

 dition more developed. 



Case II. — J. O., aged thirty-five years. No history of tuberculosis 

 in family. The patient, his wife,. and three children had always been 

 healthy. Has been employed in the abattoir for one year, and al- 

 ways in division reserved for tuberculous animals. Three months 

 before he had suffered a wou«d of two fingers, following which the 

 disease developed. On the little finger is a hard, rough, thickened 

 area, extending entirely through the skin. On one side is an ulcer 

 which goes deep into the corium. 



Case III. — K. S., aged thirt.y-eight years. Employed in handling 

 tubercular material. He showed a typical tuberculosis of the skin. 

 As the case was being treated by another physician, the details are 

 not given. 



It would seem that instances of infection through wounds are not 

 as uncommon as has been supposed heretofore. Their value has been 

 questioned on the grotmd that inoculations do not always corres- 

 pond to natural infeclions. I do not pretend that such cases settle 

 the whole question definitely, but they do prove beyond question that 

 there is no peculiar quality in the tissues of man which makes him an 

 unfit soil for the bovine tubercle bacillus. Furthermore, they afford 

 us means of comparison with similar cases in which the invading or- 

 ganism is of human origin, wounds of the hand while operating on 

 tuberculous cadavers, or in cleaning cuspidors used by phthisical per- 

 sons, being not uncommon. I have been at some pains to study the 

 reports of such infections, and feel bound to conclude that the bovine 



