The following observations mtay throw some light upon the condition described as epituberculous infiltration or epituberculosis, a condition which probably is not different from that formerly described as tuberculous splenopneumonia, Friuhinfiltrat, or tuberculose inflammatoire.It is difficult to define exactly the term epituberculous infiltration for it is used to denote a variable clinical picture, of which the underlying pathology is not known through lack of opportunity for post-mortem study. It was first used in 1920 by Eliasberg and Neuland to describe a benign clinical syndrome in a tuberculous child, of which 'the chief features were an extensive dense consolidation of the lung revealed by percussion, auscultation, and X-ray examination; a harsh cough without sputum; an absence of severe constitutional symptoms; an absence of an initial acute illness; a slow disappearance of the consolidation, without signs of softening or cavitation; a complete recovery without fibrosis or bronchiectasis. The nature of the lesion is considered by many to be an allergic reaction around a small primary tuberculous focus, but this has been deduced by speculation and not proved by pathological investigation. The argument that has been advanced in favour of this theory is that, were the wholc lesion a caseous tuberculous process or gelatinous pneumonia, the illness would be more severe, the course of it less benign, and the result less satisfactory.The three cases to be described had that combination of an extensive solid lesion of the lung, with relatively slight symptoms of illness, which justifies their being regarded as examples of children suffering from epituberculous infiltration of the lung. They were presumably tuberculous children, the skin tuberculin reaction being positive, and in two there was a definite history of contact. From none of them were tubercle bacilli recovered in the sputum or stomach washings. In the third a further inve,stigation was pursued by exploring the lung lesion and examining the material obtained in the aperture of the explorirng needle. This was done twice at an interval of four weeks, and in two sites. On both occasions tubercle bacilli were present in the material. This placed the tuberculous nature of the process in this case beyond doubt and the evidence suggests that the whole lesion in so-called epituberculous infiltration is a caseous tuberculous process, yet producing no severe constitutional symptoms.
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