THE following case of streptococcal infection presents features of such unusual type that the history appears worth recording :-HISTORY .-May 20, 1934.-R.
W., a healthy boy aged 10 years, attended his private doctor complaining of pain in the left axilla. On examination soft, tender, discrete glands were palpable in the axilla. Further examination revealed an almost healed septic focus on the middle finger of the left hand, said to have been of a fortnight's duration. T h e axillary adenitis was treated by hot fomentations, but two days later the child developed a temperature of 1 0 4 ~ F., a rapid pulse, and a scarlatiniform rash. An injection of 10 C.C. of concentrated streptococcal serum was given, and with this the temperature and pulse returned to normal, but the swelling in the axilla became fluctuant and was opened for drainage of pus. T h e wound so made failed to heal, and became a chronic sinus with considerable daily discharge which showed no signs of ceasing.
September, 1934.-Enlarged glands were palpated in the region of the clavicle. November, 1934.-The boy was admitted to one of the London hospitals, a diagnosis of tuberculous axillary adenitis having been made.
November 12, 1934.-A block resection of the axillary glands was carried out. T h e operation was easy, and, " as all the infected tissue appeared to have been removed, the wound was closed without drainage ", A few days later, however, the sutures began to cut out ; on removal, the wound broke down completely, and an active ulceration of the edges of the wound, which spread rapidly into the surrounding skin, commenced. This was accompanied by a copious, purulent discharge.
T h e glands removed were reported on by the Clinical Research Association as follows : " The glands show a well-developed granulomatous hyperplasia with suppuration into several centres. The change is in no way specific, but a simple, chronic suppurative one. There is no evidence of malignancy."
No further special investigation to establish the diagnosis of tuberculous infection was made, but in February, 1935, the boy was admitted to the Lord Mayor Treloar Hospital, being sent in as a case of "tuberculous ulceration of the axilla, secondary to tuberculous