TUBERCULOSIS OF THE SKIN. 171 



in favor of its tubercular origin and character. He alludes to the 

 views of Hebra, Virchow, Klebs, Hueter, and others. From a 

 clinical standpoint Hebra brought the different varieties of lupus 

 under one common head. He separated it entirely from syphilis, 

 but otherwise did little to fix its pathological significance. He 

 adopted the classification of Fuchs, and the older French and 

 English authors, who taught that it was one of the manifestations 

 of scrofula, and that anatomically it was composed of granulation 

 tissue. Yirchow classified it with the granulomata, but denied its 

 identity with scrofula. Rindfleisch described it as a proliferation 

 of epithelial cells, as a sort of phthisis cutauea. Eppinger referred 

 to it as a product of connective-tissue growth and proposed its 

 classification with carcinoma. Klebs looked upon it as a specific 

 affection, and histologically included it among the small-celled leu- 

 cocytoses. Hueter, who in his pathological views was generally far 

 in advance of his time, affirmed that it was a form of fungous 

 inflammation, the specific cause of which, when introduced into the 

 organism, produced a miliary tuberculosis. Volkmaun included it 

 among the affections composed of granulation tissue. Friedlander 

 (" Ueber locale Tuberculose," Volkmann's Klinische Vortrdge, 

 1881, No. 31) was the first to take a positive stand in asserting that 

 lupus is a tubercular affection of the skin, and showed its histologi- 

 cal identity with other recognized forms of local tuberculosis. He 

 demonstrated the presence of miliary tubercles in it, and that these 

 nodules were composed of giant and epithelial cells, the same as in 

 tubercles of the lungs. The views entertained by Baumgarten as 

 to the histological structure of lupus are different from those just 

 described. He believed that in the miliary tubercle the abundance 

 of epithelioid cells predisposed to caseation and suppuration, while 

 he recognized in lupus, as the most characteristic distinguishing 

 features, absence of caseation and suppuration and the presence of 

 cicatricial tissue. He admits, at the same time, that lupus may be 

 closely allied to tuberculosis. 



Schiiller (" Ueber die Stellung des Lupus zur Tuberculose," 

 Centralblatt f. Chirurgie, 1881) opposed Baumgarteu and empha- 

 sized the fact that caseation, characteristic as it might be for all 

 tuberculous affections, always constitutes only a secondary condition 

 and depends upon the soil present in and around the nodule. The 

 absence of caseation in lupus, which in rare cases, however, has 

 been shown to be present by Cohuheim and Thoma, could not be 

 urged as a positive and infallible diagnostic criterion of the non- 

 tubercular nature of lupus. 



Neisser (Die chronische Infections- Krankheiten der Haut, Ziems- 

 sen, B. xiv., 1882) accepts fully and pleads strongly in favor of 

 the tubercular nature of lupus. In the meantime Pantlen, Bizzo- 



