420 TUBERCLE [ June , 1935

become caseous, break down, and affect the smaller air passages. Cough alone cannot be depended upon for diagnosis, since as a part of a nervous reflex it may be produced in so many conditions; nor does it indicate intensity of disease or its progress. Even hmmoptysis, though frequently a sign of activity of the pathological process, is not neces- sarily of serious import. Pleurisy is nearly always a secondary infection, probably connected with movement of bacilli in lymphatics from distant tubercles, or from tubercles in the subjacent parenehyma. The general conclusion of tim writer is that consti- tutional symptoms are an accurate measure of tuberculous activity, but that if they are lacking, as is often the case in the proliferative type of disease, it is so unsatisfactory to estimate it by the irregularly occurring symptoms associated with the growth and spread of tubercles, that other measures should be resorted to.

FRAENKEL, E.M. Pulmonary Tuber- culosis in Asthma Cases. .Brit. lfed. Journ., 1934, ii, 518.

Conflicting views as to the relation between asthma and tuberculosis are held in this country, as well as abroad, some authorities believing these two conditions to be mutually exclusive, and others of equal standing insisting that the majority of asthma cases are

o f tuberculous origin. The writer has made a detailed examination, by clinical and X-ray methods, for any signs of active or healed tuberculosis in the lungs of 369 asthma cases seen by him between the years 1930 and 1932. All these cases were referred to him with the diagnosis of bronchial as thma by medical men, among whom were specialists in pulmonary diseases. Sixteen of these patients had active tuberculosis ( four with tubercle bacilli in the sputum, four with cavities but without demonstrable bacilli ; and eight with active tuberculosis both clinically and radiographically). Of the 16, only one case had been sent with the diagnosis of asthma and tuberculosis. In 26 other cases definite X-ray evidence was found of productive cirrhotic inac. t ire tuberculosis, and 20 further cases

showed healed lesions. The writer points out tile obvious epidemiological importance of tuberculosis undiagnosed on account of the concurrent symptoms of asthma. Two instances o[ this are given: in one the wife of the undia- gnosed patient developed tuberculosis of the eyes ; and in the other two children had tuberculous meningitis and pul- monary tuberculosis. A case is also recorded here in which a rapidly progressive exudative tuberculosis de- veloped in a patient who possessed a sensitisation to sodium salicylate witl~ typical asthma and who had previously been completely free from tuberculosis. The asthmatic picture still persisted. In yet another case a medical man who had had as thma practically all his life became infected with tuberculosis while working in the tuberculosis department of a hospital. The infection led. to cavity formation and after treatment at Davos was followed by healing. Inves- tigation of this case is still being carried on. An " in f luenza" infection or a catarrh of the apex is often shown in the history of a patient, and in some such cases there is found an inactive tuberculosis, which can only be demon- strated by X-rays. The writer points out, in conclusion, that an active and open tuberculosis can be concealed for a long time under the guise of a bronchial as thma with both eosinophilia and skin reactions against specific proteins.

REICHLE, It. S., and FROST, T. T. Tuberculosis of the ~Iajor Bronchi. Amer. Journ. Path., 1934, lO, 651.

Tuberculosis of the major bronchi is of special interest in that it may often lead to bronchieetasis, the rigidity and size of the diseased bronchi impeding collapse of the lung and interfering with the natural healing of eavi~es. The material for this study was obtained from 37 routine unseleeted eases of pul- monary tuberculosis, mostly chronic phthisis (tertiary isolated pulmonary tuberculosis of Eanke's classification), but also cases of childhood tuberculosis (primary pulmonary tuberculosis with generalisation) and of miliary tubercu- losis. The writers summarise their find- ings as follows. They classify tubercu- losis of the major bronchi according to