172 CLINICAL FOKMS OF SURGICAL TUBERCULOSIS. 



zero, Baumgarten, Chiari, Hall, Janisch, Riehl, Vidal, and Finger 

 described a new affection, a diffuse tuberculosis of the skin and 

 mucous membranes, occurring as a sort of secondary localization in 

 patients suffering from advanced tuberculosis. To prove that 

 lupus and tuberculosis are identical it became necessary to furnish 

 the necessary experimental proof, and to show the uniform pres- 

 ence of the bacillus of tuberculosis in the lupus tissue. The inocu- 

 lation experiments with lupus tissue have already been mentioned, 

 and from them it can be learned that with few exceptions they 

 were followed by positive results ; that is to say, implantation of 

 lupus tissue into the subcutaneous tissue or peritoneal cavities of 

 animals susceptible to tuberculosis gave rise to local tuberculosis at 

 the point of implantation, and to dissemination of the process in a 

 manner characteristic of tuberculosis in man. 



Demme (" Lupus uud Tuberculose," Wurzburger med. Blcitt., 

 1887) reports two cases of cutaneous inoculation-tuberculosis in 

 man. The first case, a nurse girl, contracted an ulcerating lupus 

 from a child three years of age which died of tubercular ulceration 

 of the tonsils, and tuberculosis of other organs. The second case 

 was a child with eczema which slept in the same bed with its 

 phthisical mother. Sections of the eczematous skin, stained and 

 examined under the microscope, showed numerous bacilli. The 

 child died later of hemorrhage of the stomach, the cause of which 

 at the necropsy was shown to be a tuberculous ulcer of the stomach. 



Demme enumerates the following reasons as showing the identity 

 of lupus and tuberculosis : 



1. Similarity of histological structure. 



2. Presence of the bacillus of tuberculosis in the granulation 

 tissue of lupus. 



3. The production of typical tuberculosis in animals not immune 

 to this disease by implantation of lupus tissue, or injection of a 

 pure culture of the bacillus of tuberculosis obtained from lupus 

 tissue. 



4. The fact that patients suffering from lupus are frequently 

 attacked by and die of tuberculosis of other organs. 



5. The prevalence of tubercular affections among relatives suf- 

 fering from lupus (hereditary predisposition). 



Boeck has made the statement that, of sixteen cases of lupus, 

 three die subsequently of pulmonary and general miliary tubercu- 

 losis. Heiberg reports death from tubercular meningitis in a 

 lupus patient. 



Rassdnitz (" Zur Aetiologie des Lupus vulgaris," Vierteljahrs- 

 schriftf. Dermat. und Syphilis, 1882) collected 209 cases of lupus 

 and found that in thirty per cent, of all the cases it was associated 

 with other evidences of tuberculosis. He placed, also, great 



