It is the same with affections of the skin and mucous membranes. Infections of the skin with staphylococci lead to the formation of fur uncles, to abscesses and to inflammation and suppuration of the glands involved, but they do not produce that peculiarly stubborn scrofulous catarrh, tending toward a state of hyperplasia and ulceration. We may observe in a poorly nourished child afflicted with chronic intertrigo great many skin affections in conjunction with suppuration, but no changes characteristic of scrofula. Hence it is quite an arbitrary as sumption to confound the scrofulous diseases of the skin and mucous membranes with infections by bacteria and especially the pus cocci.
To explain this we must again resort to predisposition, a peculiar but unproven anatomical condition. But even granting such a pecu liar anatomical condition, and such a singular disposition on the part of the tissues, there still remains to be explained the theory why it is that in these individuals with such peculiar disposition, bacteria of abso lutely different biological effectiveness, as tubercle bacilli and pus cocci, produce at once the same anatomical changes, which they otherwise never do as a rule.
It must not be inferred that tubercle bacilli are not present, because pus is produced, or because they cannot be found. Heubner in his text book, teaches as follows: The peripheral appearance of scrofula is imme diately succeeded by an infection of the glands with tubercle bacilli, and it is inconceivable, why these catarrhs should only furnish the oppor tunity for the entrance of tubercle bacilli, nor is it quite clear, why this occurs just here, and not in other inflammatory conditions of the same organs. Moreover, it must be emphasized that nearly all scrofulous
children and even those who do not yet show any glandular swelling, react with tuberculin and also possess in their serum the power to agglu tinate tubercle bacilli.
Finally, we regularly find as Heubner says, in necropsies of such cases of purely scrofulous catarrhs, tuberculosis of the bronchial glands. It is more sensible therefore, because of the close connection existing between scrofula and tuberculosis, to ascribe even these peripheral affections to the latter, insead of to something else which nobody has seen nor proven.
It has also been observed in children, with pronounced tubercu losis, that typical scrofula suddenly appears. It has been mentioned above that latent cases of tuberculosis, can, by biological investigations, be detected even in very young suckling babies, and we must repeat the assertion, that when scrofula later develops it is nothing else but evidence of the already existing infection.
Therefore, it appears to me correct, to believe strongly that these scrofulous catarrhs also are tuberculous in nature.