THE EHRLICH DIAZO REACTION 341 



ill the hospital but a few days. Had they remained longer it is quite 

 possible that in many cases reported as negative the reaction would 

 have been found. In some of the positive cases there were intervals 

 of considerable length during which diazo was absent. The test was 

 almost never found in patients with slight lesions and slow course, 

 but nearly always in those with advanced lesions and rapid course. 



In several cases of the acute forms of the disease the presence of 

 the reaction was responsible for a grave prognosis, notwithstanding 

 the fact that the signs were very meagre and symptoms were prac- 

 tically absent. A striking illustration of this fact was the case 

 of Mr. S., who came to the hospital with the diagnosis of dyspepsia. 

 He had neither cough nor expectoration, but had a slight evening 

 rise of temperature, with loss of weight and strength. On physical 

 examination there were slight signs of infiltration of the right apex. 

 The urine showed a good diazo. Dr. Dock, who had not examined 

 the patient, but had seen him and noted his cachectic appearance, 

 immediately predicted tuberculosis with a bad prognosis. Ammo- 

 nium chloride and iodide of potassium were given to produce 

 expectoration, and eleven days after admission tubercle bacilli were 

 found in the sputum and several days later in the stools. The 

 patient failed very rapidly, developed a severe diarrhoea, and remained 

 in a typhoid state till death, which occured six weeks after admission 

 to the hospital. Daily diazo tests were made from the day of 

 admission till death, and, with the exception of five tests, were all 

 positive, though varying somewhat in intensity. 



In cases of pulmonary tuberculosis in which the diazo reaction 

 is found continuously for some days, I believe, with Michaelis, that 

 a grave prognosis should be made. This fact is of decided practical 

 interest and should influence us in advising patients about change of 

 climate. The amount of needless suffering which is caused, the 

 waste of large sums of money uselessly by poor people, the harm 

 done the climatic treatment of consumption by sending hopeless 

 cases to our Western resorts to die is something criminal. It is by no 

 means an easy matter to give advise in these cases. Many physicians 

 are not thoroughly familiar with the physical signs of this disease 



