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Two cases of miliary tuberculosis that were diagnosed clinically as lymphocytic leukemia are presented. Both cases had evidence of chronic tuberculosis which was of 43 years’ duration in Case 1 and of 28 years’ duration in Case 2. Both patients had granulocytopenia and anemia. Autopsy findings revealed no evidence of leukemic infiltration, but a diffuse miliary tuberculosis, involving all of the hematopoietic tissues, existed in both Cases.

A series of 63 patients (divided into 2 groups) with chronic polyresistant very extensive pulmonary tuberculosis often complicated by associated pathology were treated with Rifampicin (RMP) under supervision in a sanatorium. In group 1 (26 cases) RMP had to be used alone as the last therapeutic chance. At the end of the 1st and 2nd year the sputum was negative in 14 of 26 patients (55%) and in 10 of 20 patients (50%), respectively. Five patients died. In group 2 (37 cases, including 10 with associated pneumoconiosis) RMP could be and was combined with another drug; ethambutol (EMB) in most cases. The sputum was negative in 28 of 37 cases (75 %) after 6 months and in 14 of 22 cases (68 %) after 9 months. Only 1 patient died. As expected, the radiological results in both groups were poor because of extensive fibrosis accompanying oldstanding lesions and associated respiratory pathology including pneumoconiosis. Our findings contribute in an objective way to our notion as to what can be expected of RMP in the treatment of the type of case in question. It is stressed that better results could be obtained by the use of three-drug combinations consisting of RMP, EMB and another drug.

THORACOPLASTY for pulmonary tuberculosis, at Rutland State Sanatorium, began in 1927. By January 1, 1947, 362 patients had received that form of treatment. This is a review of the work done and of the results obtained in those twenty years. Indications The clinical indications have changed very little, if at all, throughout the whole period. The general rules established by Alexander‡ remain: "... those patients are chosen for operation who have moderately or far advanced chronic tuberculosis, with or without hemoptysis; whose lesions are of the fibroulcerative type, with or without cavitation or empyema, and are principally confined to one . . .

SummaryAerogenic tuberculous infection of mice with small numbers of tubercle bacilli resulted in chronic tuberculosis which persisted in some of the animals for over a year. The lesions produced by this infection contained a constant number (“steady state”) of culturable units of tubercle bacilli after 8 weeks, but there was enlargement and coalescence of the lesions because of an increased number of foam cell macrophages. In conse-sequence, there was an increased involvement of normal lung tissue. Thirty-six to 52 weeks after infection, the number of culturable units of tubercle bacilli had increased beyond that of the steady state; deaths continued to occur during this period.

A simple technique for the visualisation of the bronchial arteries in vivo is described and examples shown. In eight cases of fibrocystic disease in children, the bronchial arteries were found to be both dilated and tortuous radiographically. No abnormalities were noted of origin or general course. As pointed out by other investigators, the bronchial arteries are found to enlarge in emphysema, bronchiectasis, chronic tuberculosis, infarction and primary lung tumours. All of our cases had emphysematous changes of both lungs and a varying number suffered from bronchiectasis, chronic pneumonitis, and fibrotic changes. These stimuli or yet undetermined stimuli or defects in fibrocystic disease may cause the bronchial arteries to enlarge in this disease.

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Dextrose (30 gms. in 250 c.c. water) given per os with acetyl salicylic acid (1 gm.) in a case of chronic tuberculosis was followed within 2 1/2 hours by a fall in rectal temperature from 38.03° C. to 36.02° C. In numerous observations upon this and other “labile” individuals under like conditions acetyl salicylic acid (1 gm. with 250 c.c.) never has produced a fall of temperature exceeding 1.1° C. in the same length of time.This observaton has led to an investigation of the action of dextrose upon the heat regulation.The preceding table shows the effects of dextrose given per os upon the temperature of three individuals, one of whom was in normal health. (Readings were taken at half hourly intervals but the curves are uniform enough for the first and last reading to suffice.)Calorimetric Observations.-In each of the above experiments also the heat production has been determined by the indirect method, using the Benedict Respiration Chamber at the New Haven Hospital. As would be expected, the CO2 excretio...

The subject of purpura in this paper is treated from the standpoint of the relationship it bears to tuberculosis. Several writers within the last two centuries have made observations on this phenomenon, endeavoring to find its cause and effect, and to discover the relation purpura has to other diseases with which it is associated. Mackenzie1 says : The great variety of supposed causes or associated conditions is sufficiently striking. Still more so is the fact that in one-third of 200 cases no explanation was offered for the purpura, though in several of the cases a necropsy was made. It will thus be seen how extremely complex is the pathology of purpura. All we can do in the present state of our knowledge is to accumulate further information and to exhaust every means—histological, bacteriological and chemical—in the investigation of cases. Osler 2 also maintains "that purpura is obscure, and is

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In human pathology, the association of generalized amyloidosis with chronic tuberculosis is a well known fact. Thus, in many cases, amyloidosis has been considered an immunopathy induced by tuberculosis. In our material, necropsies of aged persons, suffering from senile mental deterioration and affected by amyloidosis, often revealed signs of lingering pulmonary and lymphonodular tuberculosis. Systematic clinical investigations of senile patients endorsed these observations, demonstrating a rather frequent occurrence of acid-fast bacilli in smears and cultures of sputa and gastric washings. Also, a causal connection between tuberculosis and amyloidosis was shown in a series of experimentally infected guinea pigs. These studies indicate the possibility of an immunobiologic connection between amyloidosis in aged persons and lingering tuberculosis.

No disease has received more attention in the literature than tuberculosis, especially pulmonary tuberculosis, yet the subject is by no means exhausted. There is a type of pulmonary tuberculosis infrequently met with in children which is often overlooked, unless constantly kept in mind. The most frequent form of tuberculosis in children, aside from tuberculous meningitis and miliary tuberculosis, is tuberculous pneumonia, either of the lobar pneumonic or bronchopneumonic type. Chronic tuberculosis as met with in adults is almost unknown in infants and children under 2 years of age. With the aid of the roentgen ray more cases of the chronic and subacute forms are being discovered. (Reuben,1Dunn,2Eisler,3and Wesler and Bass,4speak of such cases.) The type of tuberculosis to which I wish to call attention may be defined as a diffuse or parenchymatous process involving that portion of the lung immediately adjacent to

I have been studying the problems related to the pathology, diagnosis and treatment of chronic renal tuberculosis for more than a quarter of a century and, in preparing this paper, have gathered together the experience gained during these last thirty years. I have reviewed my records of the last fifteen years with considerable care and have used the data gathered in more than 300 cases. The recognition of tuberculosis of the kidney as a surgical condition has been a development of comparatively recent years. Under the influence of some of the leaders of French urology, the surgical treatment of renal tuberculosis was somewhat delayed; but at the present time chronic surgical tuberculosis limited to one kidney is universally considered as belonging in the realm of surgical therapeutic endeavor. With the development of the cystoscope and more accurate methods of diagnosis, together with the accumulated experience of clinical observation of the

The following work was undertaken for the purpose of producing an experimental chronic insufficiency of the adrenal glands. It was then our intention to study this experimental insufficiency in relation to the other glands of internal secretion, and to compare it with the clinical picture of Addison's disease. Thus far all experimental work has resulted only in an acute insufficiency of the adrenal function. Excision of the glands is followed by death in two or three days. It was accordingly necessary to devise some means of slowly but progressively injuring the function of the glands. For this purpose it was decided to try the injection of tuberculin over long periods. Tuberculin was selected because of the evidence presented by certain workers in this field that chronic tuberculosis causes a sclerosis and atrophy of the adrenal glands. Bernard and Bigard1have found, in the adrenals of the tuberculous, a

To the Editor.— Reference was recently made to chronic otitis media, from which was recovered a culture of Escherichia coli (217:826, 1971), attributed to a urinary source. In a chronic tuberculosis service of years ago, chronic otitis media (painless) was common in patients with long-standing pulmonary cavitary disease. Recovery of tubercle bacilli might be difficult, but other organisms, especially E coli , were plentiful. While bacteremia may be implicated, a simple lack of fastidiousness would be adequate to explain this colonization.

Geotrichosis, an infection rarely mentioned in the United States, is probably commoner than realized. Europe and certain South American countries have been aware of the fungus Geotrichum for many years and have reported its varying types of pathogenesis. There is increasing evidence that it will be found oftener in the United States when clinicians and laboratories become aware of its characteristics. In France, Brumpt, 1 in an excellent summary of Geotrichum infections, listed 20 species reported by various writers. Reeves, 2 in the southern United States, reported 79 cases of bronchomycoses, two of which were geotrichosis. He stated that in geotrichosis the chest roentgenogram resembles that of chronic tuberculosis, with heavy studding along the bronchi and frequent cavitation. Kunstadter and Milzer 3 consider Geotrichum of sufficient importance to include Geotrichum extract with routine skin tests for detection of mycotic infections. One of the most detailed discussions of this disease is

For the purpose of the present paper it does not especially concern us which or how many of the different tissues which together constitute a joint are affected, and I shall not attempt to discuss methods of treatment based on anatomic differentiation of the location of the lesion. It may, however, be stated that in the great majority of cases the initial lesion, so far as the joint is concerned, is in the bone; but in the purely conservative treatment the management of these cases differs hardly any from that of those which are primarily synovial. Underlying the treatment of all forms of chronic tuberculosis, of whatever tissue or wherever situated, is the gospel of rest and food. This is founded upon the fact, learned in the first place by experience, and confirmed later by the results of biologic investigations, that there is in living tissues an inherent antagonism to