It develops in many children suffering front tuberculosis, first appearing on one or the other favorite locality, as an isolated tuberculide. We often notice these areas of infection on the extremities of children brought into the hospital, suffering from tuberculous meningitis. In the course of meningitis due to other causes, we have never noticed these follicular eruptions.
Sometimes, the development of skin tuberculosis does not occur probably because the duration of the tuberculous disease is too short, and the condition of the skin for the sowing out of the eruption, too unfavorable.
At tinies a disseminated eruption covering the whole body occurs, particularly after infectious diseases. Measles niay be mentioned as the chief of these. On the fourteenth day of July, 1905, a child sixteen months old was presented for hospital treatment. Two weeks before the child had measles and tk-as running a somewhat chronic fever. It was now attacked by an exanthern, which proved to be a typical papular necrotic universal tuberculicle, following the measles. In the further course of the disease in this case, several quite typical follicular nodules u-ere observed, particularly in the face. These became rnuch inflamed
and softened in the centre front secondary infection with staphylo cocci. An injection of 0.0001 old tuberculin resulted in a slight rise of temperature; but did not produce local reaction.
Almost all authors agree that this form of tuberculide is not of toxic but of bacillary origin. It may be that the bacilli are present in very small numbers; or that they possess a weakened virulence, or they may be in a dying condition IDarier, Jadassohn, Zollikofer).
In the differential diagnosis, acute acne vulgaris has a certain similarity in appearance but differs from it as follows: acne vulgaris is always adherent to the follicles, that is to say, causes Et typical pustular formation, and in healing seldom leaves a scar.
When localized around the mouth or anus, miliary ulcerative skin tuberculosis must also be excluded; this form being often found in these situations, as well as in other locations, it is generally combined with tuberculosis of the lungs or intestines. This condition is characterized by a sharp-edged, small, shallow ulcer, quite in eontrast to follieulitis. These ulcers contain numerous tubereule bacilli.