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July 14, 1917


JAMA. 1917;LXIX(2):102-104. doi:10.1001/jama.1917.02590290024007

Phlyctenular keratoconjunctivitis has always impressed me as a distinct ocular evidence of a systemic dyscrasia; in other words, these nodular exudates indicate a weakened, anemic constitution. The impoverished patient requires more than general tonics, something more definite and specific in the line of treatment. As an increased heart beat would be suggestive of some abnormality, so I take this eye condition to be a symptom of some abnormal constitutional condition. As interstitial keratitis is a manifestation of inherited syphilis, these nodular lymphoid infiltrates are evidences of a strumous diathesis or tuberculosis — if not tuberculosis, then something very similar, bearing in its symptomatology a striking resemblance to tuberculosis. These nodular exudates are warnings, and not outspoken evidences of tuberculosis. The absolute certainty, as clinical evidence of it, must remain unanswered for the present. The proof is not sufficient to warrant such an assertion, yet in the large percentage of these

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