168 TUBEKCULOSIS. 



from gangrene, the result of an injury, and discharged the patient 

 with the wound completely healed, except a small granulation sur- 

 face from which the drainage-tube had been removed. At home 

 the wound was dressed by a girl suffering from tuberculosis. The 

 wound showed soon all the characteristic appearances of fungous 

 disease, and the lymphatic glands became infected from this source. 



Konig (Die Chirurgische Klinik in Gottingen, Leipzig, 1882) has 

 observed sixteen cases of inoculation-tuberculosis following opera- 

 tions for tuberculous disease of bones, and two such cases have been 

 described by Kraske (" Ueber tuberculose Erkrankuug der "Wun- 

 den," Centralblattf. Chirurgie, 1885, p. 565). 



INOCULATION FOLLOWING CIRCUMCISION. A number of cases 

 of inoculation-tuberculosis following circumcision are on record in 

 which the infection often occurred in the practice of orthodox Jews, 

 who performed the operation in accordance with the directions laid 

 down in the Mosaic laws. The loose connective-tissue of the pre- 

 puce, richly supplied with lymphatics, is an admirable surface for 

 absorption, and when brought in contact with infectious material 

 would furnish the most favorable conditions for the production of 

 local lesions and the transportation of microbes along the lymphatic 

 channels to more distant parts. 



Lehmann (" Ueber einen Modus der Impftuberculose beim Men- 

 chen," Deutsche med. Wochensehrift, 1886) has observed ten cases 

 of inoculation-tuberculosis in Jewish boys caused by sucking the 

 wound after ritual circumcision by a phthisical person. Ten days 

 after circumcision the wound became the seat of ulceration, and the 

 inguinal glands began to enlarge. Four of the children died of 

 tubercular meningitis, and three died after a prolonged illness 

 caused by multiple tubercular abscesses. 



Hofmokl has reported a similar case, and Weichselbaum detected 

 the bacillus of tuberculosis in the circumcision wound. 



Elsenberg (Centralblatt f. Bacteriologie u. Parasitenkunde, B. ii. 

 S. 577) has 'described three new cases of inoculation-tuberculosis 

 after circumcision. All the cases were infants, and the disease 

 appeared primarily in the wound, or cicatrix, and later, in the 

 inguinal glands. Local treatment by evidemeut proved successful. 

 The diagnosis was corroborated by microscopical examination of the 

 granulation tissue. 



Meyer (" Em Fall von Impftuberculose in Folge ritueller Cir- 

 cumcision," New Yorker Med. Presse, June, 1887) reports a case 

 in which circumcision was performed according to the rites of the 

 church eight days after birth by an old man, and in which four 

 weeks after the operation an induration appeared at the frenulum 

 and the inguinal glands about the same time began to enlarge. 

 Syphilis was suspected, and the patient was put on a specific course 



