TUBERCULOUS FISTULA BY INFECTION.
A certain number of cases of anal fistula in middle-aged, highly-nourished men come under my observation, and I have been struck with the fact their wives had either died of, or were suffering from, consumption. Four such cases in one year have I observed, and I have been constrained to ask myself the question, whether these cases do not represent a class by themselves? The frequent coincidence deserves at least some attention. I would not be too hasty in generalizing, but any one who sees much of fistula may, I think, readily verify the fact for themselves. I imagine that the fistula represents, in such cases, an infection from a consumptive wife communicated to the husband in the intimate relations of married life.
I commend the subject to the consideration of my colleagues. I imagine, further, that the infected husbands, had they been prone to phthisis of the tuberculous variety, would in all probability have developed genuine consumption, but not being so prone, they simply maintain a tuberculous sore-the fistula-in-ano-much as one observes obstinate tuberculous sores on parts exposed to mechanical infection from cuts and the like, as, for instance, on the hands, whereof numerous cases are on record in general medical literature. I take it that the infection is truly tuberculous in the bacillary sense, but the soil is not fit; the constitutional power is too great to allow of the development of general tuberculosis.
That this kind of locally limited tuberculous infection does actually exist, I am satisfied. One sees this also exemplified at rare intervals in syphilis. In certain very obstinate cases of Hunterian chancres that becomes very usually penetrating, with a distinct resistance to specific treatment that is otherwise usually successful, and that promptly, I have of late been led to assume the existence of a tuberculous mother soil, and have treated the two pathological states simultaneously, and -at any rate they begin forthwith to mend! I will relate a very instructive case in point.