5% PATHOGENIC MICROORGANISMS 



Tuberculosis of the skin or lupus is a common disease. Involve- 

 ment of the bones and joints may occur, and according to Fraser 27 

 may in many cases occur without any previous tuberculosis. Tuber- 

 culous meningitis is not infrequent in children, and is always fatal. 

 Calmette quotes Grunberg's studies of the comparative frequency of 

 mortality of children from tuberculosis in 568 families. He analyzed 

 209 deaths by tuberculosis in children from birth to fifteen years, 

 from birth to one year, 82 per cent were meningitic, 6 per cent were 

 pulmonary and 3 per cent other forms of tuberculosis. At fifteen years, 

 only 6 cases were meningitis,? pulmonary and 5 of other forms. 



The liver may be the site of tubercles, and tuberculosis of the spleen 

 has been observed though it is not particularly common. The kidneys 

 and the geni to-urinary system are frequently involved, and the supre- 

 renal gland may be tuberculous, and in this case may lead to a condition 

 spoken of as Addison's disease. 



In the intestines themselves, various forms of tuberculosis have been 

 described. It appears that the only parts of the body in which tuber- 

 culosis is not common are the muscle tissues themselves, and the wall 

 of the stomach. 



Rosenberger 28 has reported finding tubercle bacilli in the circu- 

 lating blood of all cases of human tuberculosis which he examined. 

 This announcement aroused much interest and has led to many investi- 

 gations by other workers. Rosenberger 's results were obtained by 

 morphological examination of smears of citrated blood taken from the 

 patients, dried upon slides and laked with distilled water. Many other 

 observers have failed to confirm Rosenberger's results. Anderson 29 

 examined 47 cases in which tubercle bacilli were found in the sputum 

 and one case of joint tuberculosis. In none of these 48 cases was he 

 able to obtain tubercle bacilli, either by morphological examination 

 nor by guinea-pig inoculation. Brem 30 subsequently found that 

 laboratory distilled water may frequently contain acid-fast saprophytes 

 a fact which may account in many cases for errors when morphologi- 

 cal examination alone is relied upon and blood examined by the tech- 

 nique of Rosenberger. This, too, is suggested by the finding of acid- 

 fast bacilli in the blood of perfectly healthy individuals. Therefore, 

 although the bacilli may be present in the blood in a certain number of 



27 Fraser, Jour. Exper. Med., No. 4, 16, 1912. 



28 Rosenberger, Am. Jour, of Med. Sc., cxxxvii, 1909. 



29 Anderson, U. S. P. H. Service, Hygienic Lab., Bull. 57, 1909. 



30 Brem, Jour. A. M. A., liii, 1909. 



