and indigestion, or a daily rise of temperature, with or without cough being present, especially if combined with any loss of flesh or strength, in the absence of any other manifest cause, even without tubercle bacilli being found in the sputum or physical signs as outlined above, tuberculosis should be suspected and its presence or absence verified by the use of tuberculin.Third: The presence of moist rales, when localized, are sufficiently indicative of pulmonary tuberculosis to make careful watching and repeated examinations imperative, but are not by any means pathognomonic of pulmonary tuberculosis unless persistent and accompanied by evidences of a mild toxemia.Fourth: A negative examination of the sputum for tubercle bacilli is of no value. In all suspicious cases many examinations should be made.Tubercle bacilli may be absent from the sputum of a tuberculous case because none of the tubercles are softening and communicating with a bronchial tube, or because there is such a profuse bronchial secretion that the bacilli are relatively too few to be demonstrated microscopically, though an inoculation of the same sputum into the abdominal cavity of a guinea pig might show their presence. Assistant Physician for Diseases of the Skin. A CASE OF MYCOSIS FUNGOIDES.Case I. Sister F., age sixty-two. Family history negative except that father died at about forty of some asthmatic trouble. Previous history negative.Present illness began twenty-three and a half years ago when a palm-sized red spot appeared on the outer side of the right thigh. This spot persisted a long time, how long patient cannot say as there were no subjective symptoms to call her attention to it. After its disappearance there was an interval of freedom.Two and a half years after the appearance of the first spot, or twenty-one years ago, a second spot appeared on the left ankle which was red, itching, scaling and painful. For a few weeks at its beginning this patch bore small blisters which were painful. When the blisters had attained the size of a pea they burst and with the bursting the pain ceased. This was the only time in the course of the whole disease when there was any vesiculation. The evolution of this second patch was very slow but it finally did disappear. From this time on patches which were red, scaling and slightly indurated and which pursued this same sluggish course appeared on various parts of the body. Gradually the evolution of the patches became slower and slower until for the last eight or nine years none have disappeared. Gradually also the induration of the patches became more and more marked until the skin was much thickened and very scaly. Eight years ago a reddened patch appeared on the left knee. For five years it was merely red and scaly with an unbroken skin beneath the scales. Three years ago it was noticed for the first time that the skin was broken. Thenceforward the ulcération progressed steadily both in extent and depth. Its edges became rolled up and much elevated above the surrounding skin. About a year ago tumo...
The case herewith reported presents features of such unusual interest that it seems to us worthy of record. The patient was a young child under our observation in the ward on three different occasions. Each time she was discharged as well. We have, however, been able to observe the evolution and involution of each attack from start to finish. The salient characteristics of the various attacks have been the same.
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