174 CLINICAL FOKMS OF SUKGICAL TUBERCULOSIS. 



coexisting tuberculosis in other parts of the body, or a hereditary 

 predisposition to tuberculosis could be shown to exist. 



The above literature furnishes strong clinical evidence of the 

 identity of lupus with tuberculosis, but the following bacteriologi- 

 cal researches furnish the final and conclusive proof. Koch in his 

 paper on the etiology of tuberculosis (previously quoted) states that 

 he produced a pure culture of the bacillus of tuberculosis from a 

 case of lupus which resembled in every respect the culture obtained 

 from recognized tubercular lesions, and with the fifteenth genera- 

 tion from this source, one year after the first cultivation, he inocu- 

 lated five guinea-pigs by subcutaneous injection, and produced 

 typical tuberculosis in all of them. 



Doutrelepont (" Tuberkel-bacillen im Lupus," Monatschrift /. 

 prald. Dermatologie, 1883), in seven cases of lupus, found the bacillus 

 of tuberculosis invariably present in greater or less number, either 

 within the cells, or dispersed in small groups between them. He 

 never found them in giant cells, but in their immediate vicinity. 

 In a second paper the same author ( u Zur Therapie des Lupus/' 

 Monatschrift f. prakt. Dermatologie, 1884) reports eighteen addi- 

 tional cases of lupus, in each of which the presence of the bacillus 

 could be demonstrated. 



Demme (" Zur diagnostischeu Bedeutung der Tuberkel-bacillen 

 fur das Kindesalter," Berl. Idin. Wochenschrift, 1883) in six cases 

 of lupus detected the bacillus of tuberculosis. Pfeiifer (" Tuberkel- 

 bacillen in der lupos erkrankten Conjunctiva/ 7 Berl. klin. Wochen- 

 schrift^ 1883) demonstrated the presence of the specific microbic 

 cause of tuberculosis in a case of lupus of the conjunctiva. 



Schuchardt and Krause (" Ueber das Vorkommen der Tuberkel- 

 bacillen bei fungosen und scrofulosen Entziindungen," Fortschritte 

 der Meditin, 1883) found the bacillus of tuberculosis in three cases 

 of lupus affecting the face, ears, and legs. In examinations made 

 of eleven cases of lupus by Cornil and Leloir, and four by Koch 

 for the especial purpose of showing the identity of lupus and tuber- 

 culosis, the bacillus was found in every instance. In the artificial 

 tuberculosis of animals produced by implantation of lupus tissue, 

 the bacillus of tuberculosis was shown to exist by Pagenstecher, 

 Pfeiffer, Koch, and Doutrelepont. 



2. Primary Tuberculosis of Iris. 



Griffith (British Medical Journal, Dec. 21, 1889) has related a 

 case of primary tuberculosis of the iris which occurred in a seven 

 months' old female child. The eye had been affected for one month ; 

 there was an enlarged gland in the neck on the same side, but there 

 were no other physical signs of tubercle. No history of heredity. 



