TUBERCULOUS BRONCHO-PNEUMONIA. —This form is much more common in adults and children than is commonly supposed. At Jefferson Medical College Hospital, where I saw many children and adolescents, I made inquiries as to the antecedents of many of the cases, and found that there could be separated a group of cases of recurrent broncho-pneu monia which was almost invariably tuber culous, and probably had been such from the outset. I have also seen many cases of recurrent fever and cough in young peo ple, without physical signs other than of seeming bronchitis which I am sure are tuberculous and explain the numerous cases of healed and "latent" tuberculosis reported from the dead-house. Indeed, so far from feeling that I am called upon to establish the correctness of the sus picion of tuberculosis in cases in which this arises I am beginning to feel that the burden of proof rests on the side of ex clusion. When a case is far advanced, microscopical examination of the spu tum showing lung-fibre or tubercle bacilli clinches the diagnosis. Unfortunately, these signs are not available early and the diagnosis is often exceedingly difficult and doubtful. The points on which more or less reliance may be placed are as fol low: 1. The course of the fever, which is usually remittent in simple broncho pneumonia and often hectic or irregular in tuberculosis, though I have seen it sus tainedly high and falling by crisis in cases undoubtedly tuberculous. Some
times the temperature is of the inverse type. 2. The duration of the case, which is more prolonged in tuberculosis, pass ing into a chronic or subacute course, though death at times occurs early. These cases form the group of rapid con sumption in young adults, though not rarely recovery or arrest takes place. 3. The antecedents; that is, the personal and family history of the patient. He redity plays a marked influence; so too do causes affecting the health of the parents, even though they themselves do not become tuberculous. Broncho-pneu monia following typhoid fever in a young adult is almost invariably tuberculous; and frequently does tuberculosis super vene upon the catarrhal pneumonia of measles and of influenza. 4. The phys ical signs are likely to be more pro nounced in tuberculosis. There is some apical impairment. Crepitant and sub crepitant riles in the middle of a lung are more common. Sibilant tiles in isolation are characteristic. As the case proceeds, the signs of breaking-down be come evident.