342 UNIVERSITY OF COLORADO STUDIES 



and know not what conclusions to draw from their exaniinationB. 

 All cases of tuberculosis giving the diazo reaction continuously for 

 some days may be considered in the third stage of the disease. Such 

 cases will not be permanently benefited by change of climate. 



On an average between 20 and 30 per cent, of consumptives 

 give the reaction (Clemens). The prognostic value of the reaction 

 in this disease can be gathered from the fact that in 100 of Clemens' 

 fatal cases 87 of them gave this test. Michaelis states that the great 

 majority of consumptives who show a marked diazo for several days 

 die within half a year. In 88 cases, which he had collected since 

 1896, 63 gave a positive, 25 a negative reaction. Of the 63 diazo 

 cases, 50 died in the hospital, 5 left unimproved," 2 were transferred, 

 and 6 improved. Of the 25 cases without diazo, 20 improved, 1 left 

 cured, 2 died, and 2 did not improve. 



The absence of the reaction in one of my cases of tuberculous 

 meningitis and miliary tuburculosis should be emphasized because 

 of the assistance it would render in making an early differential 

 diagnosis between these diseases and typhoid fever, were it always 

 absent in the former. Anyone with a large experience will admit 

 that even a master medical mind stands in doubt in many cases in 

 differentiating between typhoid fever so protean in character, with 

 such variable temperature-curves, and tuburculous meningitis and 

 miliary tuberculosis. In the above case it was impossible to make a 

 diagnosis till the development of the brain symptoms. I made a 

 Widal test, and with a dilution of 1 to 10 there was characteristic 

 clumping, while with 1 to 30 the agglutination was not typical. 

 Daily diazo tests were made, but the reaction was never found — a 

 fact which had weight in eliminating typhoid fever. Post-mortem 

 proved it to be a case of tuberculous meningitis and miliary tuber- 

 culosis. Simon says in his Clinical Diagnosis : "Since the reaction 

 is obtained not later than the twenty-second day of the disease, and 

 is usually present as early as the fifth or sixth day in typhoid fever, 

 and while it generally does not appear earlier than the beginning of 

 the third week, and then persists almost to the end in acute tuber- 

 culosis, its occurrence may be of decided value in diagnosis in many 

 instances." 



