INOCULATION TUBEECULOSIS. 167 



the mother of several children, who had died of pulmonary tuber- 

 culosis. The disease originated near the tip of the index finger at 

 the site of a former abrasion in which a papillomatous swelling 

 formed. This ulcerated and partly healed, when the disease com- 

 menced to spread along the subcutaneous connective-tissue, and had 

 extended almost over the entire dorsum of the hand at the time 

 she came under my care. A number of fistulous openings existed 

 which discharged only a few drops of thin, serous pus daily. The 

 subcutaneous tissue was transformed into a mass of granulation 

 tissue which was removed after free incision with a Volkmanu's 

 spoon, and the wound surfaces were freely iodoformized. The 

 process of repair was slow but satisfactory. 



TUBERCULAR INFECTION OF WOUNDS. Eiselsberg's case has 

 already been described in which tubercular infection took place 

 through a small punctured wound of the arm. 



Middeldorpff ("Ein Fall von Infection einer penetrireuden 

 Kniegelenks-Wunde durch tuberculoses Virus," Fortscliritte der 

 Medicin, 1886) reports the case of a healthy carpenter who opened 

 his knee-joint by the cut of an axe, and dressed the wound with a 

 soiled handkerchief. The wound healed kindly, but later the joint 

 became swollen, tender, and painful. Resection was performed, 

 and on examining the capsule it was found very much thickened. 

 In the granulation tissue bacilli were found. 



Czerny (Centralblatt f. Chirurgie, 1886) reports two cases in 

 which tuberculosis followed in wounds treated by Reverdin's trans- 

 plantation of skin. In both instances the patients were healthy, 

 and the skin transplantation was made during the treatment of 

 extensive burns. The skin was taken from limbs amputated for 

 tubercular affections. In both cases tuberculosis of the adjacent 

 joint occurred and in one of them tuberculosis of the granulating 

 surface. 



A case of tubercular infection through earrings is related ( Wiener 

 med. Presse, 1889) in a girl, fourteen years of age,t)f a perfectly 

 healthy family, who wore earrings left to her by a friend who had 

 died of pulmonary tuberculosis. Soon ulcers appeared on the lobes 

 of both ears, the cervical glands became swollen, and percussion and 

 auscultation revealed infiltration of the apex of the left lung. Tuber- 

 cle bacilli were found in the ulcers and sputa. This case is only 

 another instance of inoculation-tuberculosis where from the point 

 of injection the disease extended along the lymphatic system and 

 finally systemic infection occurred from the entrance of the bacilli 

 into the general circulation. 



Wahl (" Mittheilungen eines Falles von Inoculations Tuberculose 

 nach Amputation des Unterarms," Verh. der Deutsehen Gesellschaft 

 /. Chirurgie, XV. Congress) amputated the arm of a boy suffering 



