Pulmonary Tuberculosis and Syphilis.

MEDICAL opinion is still strongly divided into two camps on the question of the incidence and extent of pulmonary syphilis. Some writers say that it is so rare that it can be counted as non-existent, while others call by this name a great many pulmonary conditions of indeterminate origin. It has been described as of three different forms: (I) Bronchitis in secondary syphilis; (2) Definite demonstrable gummata; and (3) A diffuse pulmonary fibrosis said to occur in the tertiary type. The final proof must always be the demonstration of the organism in the lesions or their products, but as in lung cases such proof is almost always missing, definite diagnosis can never be established as it can be in tuberculosis, and therefore opinion has been founded mainly on the anatomical distribution together with the clinical picture and the therapeutic proof. The post-mortem findings in various syphilitics have ranged from definite gummata to fibrosis, gummatouslike infiltrations and fibrotic cavities commonly found in conditions much more frequent than pulmonary syphilis. Later a film will be shown of a patient in whom no definite proof of either pulmonary tuberculosis or syphilis could be found, but in whom post-mortem definite syphilis of the lung was stated to be present by Professor R6ssell, of Berlin. Our steadily growing knowledge of pathology, combined with radiological findings during life, make it possible to say with a certain amount of dogmatism that there are lung lesions which appear to come within the category of gummata or gummatous sclerosis. Such lesions are, however, common to several other conditions, especially tuberculosis, so that while in a known case of syphilis some indeterminate lung condition may be by deduction considered to have such a lesion as a result of