THE ROYAL COMMISSION ON TUBERCULOSIS 509 



out very clearly the results of their observations. Emmett Holt, 

 of New York, has made a special study of this question and two 

 passages may be quoted from his book, Diseases of Infancy and 

 Childhood, since they serve admirably to illustrate the attitude 

 of expert physicians and pathologists on this question. 



" Much stress has been laid upon tuberculous milk as 

 a means by which children are affected. There is little patho- 

 logical support to be found for the view that children often 

 contract the disease in this way. In 119 autopsies upon 

 tubercular children, chiefly infants, there was not found one in 

 which the most advanced and therefore presumably the primary 

 lesion was in the intestines or stomach. In 127 autopsies, also 

 upon tubercular infants, Northrup found the most advanced 

 lesions in the intestines in but a single case. While infection 

 from milk is possible, it is certainly extremely infrequent. In 

 my own autopsies, intestinal lesions have been found only in 

 marked cases of generalised tuberculosis." 



" Near a large American city was a fancy stock farm of 

 registered Jersey cows, which supplied milk for table-use and 

 infant-feeding to a large number of families in the wealthiest 

 part of the city for a period of over ten years. At the end of 

 that time the tuberculosis test was used for the first time and 

 45 per cent, of the cows were found to be tuberculous and 

 were killed by order of the State Board of Health. 



"The diagnosis was confirmed by autopsies upon thejanimals 

 in every case. An investigation was instituted among the 

 children who had been fed upon this milk but in only one case 

 of many hundreds could it be learned that tuberculosis had 

 developed and in this instance it was by no means established 

 that the milk had been the source of infection. 



" It should be stated that this was before the days of sterilising 

 milk for infant-feeding. Besides the families who took the milk 

 in the manner mentioned, the employes at the farm were accus- 

 tomed to drink the skimmed milk in large quantities daily as a 

 beverage. Many of them continued to do this for years and yet 

 not one of them developed tuberculosis." 



The attitude of the Royal Commissioners may be illustrated 

 by two quotations. It is significant that these hopelessly incon- 

 sistent statements occur within a few lines of one another. 

 One is on page 27 of the Second Interim Report ; the other is on 

 page 28. It should be explained that the paragraph on page 28 

 refers to organs which had been removed post mortem from 

 children who had died from tuberculosis. 



