166 TUBEKCULOSIS, 



shape of a hard swelling the size of a hazelnut. The second case 

 was a young man who injured himself with the point of a knife 

 above the external epicondyle of the humerus. Eighteen days later 

 a swelling the size of a pea appeared at the site of injury with an 

 ulcerated surface covered by pale flabby granulations. In the 

 axilla of the same side one of the lymphatic glands was found 

 enlarged to the size of a hazelnut. The third case concerned a 

 woman fifty years of age, who is supposed to have infected herself 

 by washing the clothes of a person the subject of a tubercular 

 abscess of the spine, and who with her fingers scratched an acne 

 pustule on her face. At this point, six to eight days later, a pain- 

 ful swelling the size of a pea formed which subsequently became in- 

 durated and opened spontaneously in six weeks. At the end of three 

 months the place of inoculation presented an ulcer with indurated 

 margins. In the fourth case the inoculation followed in the track 

 made by the needle of a hypodermic syringe in a girl twenty years 

 of age. The swelling opened after six weeks, and a small quantity 

 of pus was discharged. Four months, subsequently, the fistulous 

 opening communicated with an abscess cavity the size of a silver 

 dollar, lined by a wall of granulation tissue In all of these cases 

 no evidences of tuberculosis could be detected in any of the inter- 

 nal organs, and the local disease could be traced in every instance 

 to some antecedent lesion through which the infection had evidently 

 taken place. The diagnosis in all cases was based on an examina- 

 tion of the granulation tissue for the bacillus of tuberculosis, which 

 was always found present. 



Tschering (" Inoculations-tuberculose bei Menschen," Fortschritte 

 der Medicin, 1885, No. 3) reports an exceedingly interesting case 

 of inoculation-tuberculosis occurring in a person who injured a 

 finger with a broken spittoon used by a phthisical patient. From 

 the little wound the tubercular infection extended to a tendon 

 sheath and later to the axillary lymphatic glands. 



Lennander (Abstract, Annals of Surgery, June, 1890) reports a 

 case of tuberculosis of the skin following vaccination. The patient, 

 a student of philosophy, thirty-five years old, presented tubercu- 

 losis of the skin of the right upper arm. The lesion had developed 

 after the first vaccination, and later extended over a larger part of 

 the upper arm. After repeated curetting and cauterizing the place 

 healed over finally after grafting by Thiersch's method. 



I have seen a number of cases of well-marked tuberculosis of 

 the skin in which the diagnosis was verified by inoculation experi- 

 ments and microscopical examination in every instance. I had 

 every reason to suspect that the lesions were the result of cutaneous 

 inoculation. I also had under treatment a well-marked case of 

 extensive subcutaneous tuberculosis of the hand in the person of 



