426 
Tuherciilosis  in  igzo. 
Am.  Jour.  Pharm, 
June,  1920. 
Compulsory  declaration  of  tuberculosis  seems  to  have  been  post- 
poned to  the  day  when  the  declaration  will  ensure  care  and  assistance 
for  the  tuberculous  and  his  family.  Until  this  can  be  realized,  noti- 
fication serves  merely  to  pile  up  statistics.  E.  Sergent  has  recently 
presented  evidence  that  even  tubercle  bacilli  in  the  sputum  do  not 
necessarily  prove  that  the  lesions  are  in  process  of  evolution,  and 
also  that  the  absence  of  tubercle  bacilli  is  not  unfailing  testimony 
as  to  the  non-activity  of  the  lesions.  Radiography  throws  no  light 
on  the  age  and  evolution  of  the  lesions,  but  a  low  arterial  pressure 
is  the  rule  in  progressing  cases.  A  rise  in  temperature  after  mus- 
cular exercise  does  not  necessarily  mean  tuberculosis,  as  unstable 
temperature  may  be  observed  under  various  other  conditions,  diges- 
tive, cardiac,  etc.  They  agree  with  Sergent's  dictum  that  there  is 
absolutely  no  certain  sign  which  tells  whether  tuberculous  process 
in  a  well  appearing  person  is  progressing  or  not.  He  may  have  had 
hemoptysis  on  one  occasion  or  a  disquieting  pleurisy,  but  has  been 
in  apparent  health  since.  Repeated  examination,  the  fixity  of  the 
stethoscopic  and  radioscopic  findings,  the  character  of  the  physical 
signs,  the  attenuation  of  the  myotonic  reaction,  the  disappearance 
of  the  tenderness  of  the  apex,  the  normal  blood  pressure,  the  in- 
tensity of  the  tuberculin  reaction,  stability  of  the  temperature,  and 
the  repeatedly  verified  absence  of  tubercle  bacilli  from  the  sputum, 
form  a  bundle  of  proofs  on  which  the  diagnosis  can  be  based.  The 
whole  secret  lies  in  repeating  the  examinations  and  comparing  the 
findings.  About  25  per  cent,  of  the  tuberculous  show  Roentgen  shad- 
ows in  the  fissures  between  the  lobes,  but  few  physicians  ever  examine 
for  these  localisations  scissurales,  and  yet  they  are  an  important  factor 
in  recurring  pleurisy.  The  stethoscope  reveals  small  and  inconstant 
foci  of  dry  rattling,  or  friction  rales,  which,  associated  with  inter- 
costal neuralgia  and  cough,  aid  in  detecting  these  frequent  and 
benign  tuberculous  lesions. 
Roger  demonstrated  ten  years  ago  that  the  absence  of  albumin 
from  the  sputum  excluded  tuberculosis.  A  positive  albumin  reac- 
tion is  found  in  many  other  diseases,  but  Krongold  has  recently 
published  evidence  to  the  effect  that  the  presence  of  peptone  in 
the  sputum  is  a  reliable  sign  of  tuberculosis,  as  the  tubercle  bacilli 
belong  to  the  small  group  of  microorganisms  which  by  their  pro- 
teolytic ferments  split  albumin  into  albumoses  and  peptones.  Jous- 
set  insists  that  tuberculosis,  as  we  know  it,  is  merely  the  nodular 
form  of  infection  by  the  tubercle  bacillus.    The  latter  may  induce 
