90 



i 



are peculiarly susceptible, the dog and eat insusceptible 

 to anthrax as well as to tuberculosis, I would suggest the 

 possibility that the etiology of anthrax also may be found, 

 not in a bacillus as the Europeans suppose, but in nar- 

 row lymph-spaces. 1 



Dr. P'ormad promulgates the dogma (p. 3) " Scrofulous 

 beings " (i.e., those with narrow lymph-spaces) " can have 

 no other than a tuberculous inflammation, although it 

 may remain local and harmless." Are scrofulous beings, 

 then, assured against syphilitic, erysipelatous, diphtheritic 

 inflammations, or are these merely varieties of the tuber- 

 culous ? 



As yet the presence of the bacillus in sputum has pos- 

 sessed a confirmative rather than a diagnostic value, for 

 in the cases in which it has been detected the diagnosis 

 has been usually already assured by the physical signs. 

 Whether or not the bacillus may be present in cases 

 called chronic bronchitis, etc., where the symptoms and 

 the family history beget a suspicion not yet supported 

 by physical exploration, must be decided in the future. 

 In this connection it may be proper to mention an in- 

 stance which has fallen under my own observation. 2 



A young gentleman of my acquaintance, in whose 

 family history there is no record of consumption, but who 

 had for months suffered from a persistent and annoying 

 cough, requested me one day to examine a microscopic 

 slide which he had prepared. The diagnosis was easy, 

 tubercle bacilli in sputum. He then informed me 

 that the sputum was his own. Physical exploration by 

 one of our most experienced physicians revealed subse- 

 quently a circumscribed area of consolidation in the right 

 lung. 



Frankel has always found the bacilli in laryngeal ulcers 

 of tuberculous patients, but never in those of syphilitic 



1 Dr. Formad will enlighten us, in subsequent " Pathological Studies," as to 

 what he will permit us to call " true" tubercle, and announces that a student of his 

 is incubating a cognate topic- Possibly we may yet learn what constitutes " true" 

 pus ; and how many spirits can stand on a needle-point, 



a I have recently learned from my friend Professor W. H. Welch, of NewYork, 

 that two essentially similar cases are known to him. 



