TUBERCULOSIS OF THE SKIN. 173 



importance on the observations that lupus is prone to develop in 

 the scar left after the healing of a localized tuberculosis in lym- 

 phatic glands, and that lupus is often observed upon the nose or 

 eyelids in cases of chronic nasal or conjunctival catarrh. In ten to 

 fifteen per cent, of his cases lupus could be traced to a hereditary 

 predisposition. Demme observed miliary tuberculosis in two of 

 his cases after scraping lupus. Pontoppindau asserted that, in his 

 experience, in fifty to seventy-five per cent, the patients manifested 

 additional evidences of tuberculosis. 



Quinquaud (De le Scrofule, These, Paris, 1880) saw in three 

 cases of lupus pulmonary tuberculosis appear as the final cause of 

 death. 



Of thirty-eight cases that came to the personal knowledge of 

 Bessnier (Le Lupus et son Traitement. Ann. de Dermat., 1883), 

 eight of them suffered from pulmonary phthisis. Of two patients 

 treated by Aubert, one died of acute pulmonary tuberculosis, and 

 the other of tubercular pleuritis after scarification, Renouard was 

 able to ascertain the existence of pulmonary phthisis in fifty per 

 cent, of his cases of lupus. 



Block (" Klinische Beitrage zur Aetiologie u. Pathogenese des 

 Lupus," Vierteljahrsschrift f. Dermat. u. Syphilis, 1886) met with 

 tuberculosis in other organs before or after the development of 

 lupus, in 114 out of 144 cases. Bender ( u Ueber die Beziehungen 

 des Lupus vulgaris zur Tuberculose," Eerl. klin. Wochenschrift, 

 1886) examined 374 cases of lupus. In 159 of these cases an 

 accurate account could be obtained. In 99 of the latter number 

 symptoms of other antecedent or coexisting tuberculous lesions 

 existed. In 77 of the cases tuberculosis in an etiological or clinical 

 aspect was present. 



Leloir ("Recherches nouvelles sur les relations qui existent 

 entre le lupus vulgaris et la tuberculose, " Annal. de Dermat. et 

 Syphilis, I., viii.) observed several cases in which after years a 

 lupus of the face gave rise to a pseudo-erysipelatous swelling of the 

 face which disappeared after a time, to be followed by swelling of 

 the submaxillary lymphatic glands, which remained stationary. 

 Soon after the affection of the lymphatic glands had appeared, 

 febrile disturbances, gastric symptoms, and evidences of pulmonary 

 infiltration followed. In all of these cases, Leloir believes that 

 the virus of tuberculosis had left the primary location and had 

 migrated through the lymphatic vessels and glands into the lungs. 

 In ten out of his seventeen cases, the tubercular nature of lupus 

 was clinically manifest. 



Sachs (Beitrage zur Statistic des Lupus," Centralblatt f. Chi- 

 rurgie, 1887, No. 2, p. 19) ascertained that of 105 cases of lupus 

 which he had collected, in eighty-six per cent, the patients had 



