340 SCIENCE PROGRESS 



scarlet fever is frequently conveyed by milk ; that of diphtheria 

 sometimes ; that of measles {Morbilli) perhaps occasionally and 

 of German measles (Roteln) seldom. It is open to question if 

 chicken-pox can be conveyed by milk. Typhoid, it is well 

 known, is not infrequently attributable to the contamination of 

 milk with infected water. 



Diphtheria is by no means uncommon in babies but more 

 frequently occurs as a nasal discharge than in its dangerous 

 membranous form ; in the nasal form of the disease, bacilli are 

 detected on bacteriological examination but there are no 

 symptoms other than the discharge. Tuberculosis affects 

 children of this age far less commonly than later in life and in 

 cases which I have seen there has commonly been an obvious 

 source of infection in a mother or attendant suffering from 

 pulmonary tuberculosis, often in an active form. 



By far the commonest form of tubercle in children is that 

 involving infection of the glands of the neck ; but if postmortem 

 evidence be a fair guide, tubercle in the bifurcation gland — the 

 gland situated just below the bifurcation of the trachea into 

 the two main bronchi — is more common still, there being no 

 invasion of glands in the neck in many cases. Frequently the 

 bifurcation gland is the oldest focus found ; more frequently still 

 the gland is caseous, i.e. shows degeneration as the result of the 

 prolonged activity of tubercle bacilli. 



Next in order may be placed tubercle in the abdominal 

 glands, particularly the mesenteric glands — the glands which 

 lie in the goffered, fan-shaped membrane by which the small 

 intestine is attached to the hinder body-wall — which are the 

 first to receive the lymph flowing from the gut. 



Tubercle of the peritoneum is not uncommon. 



Tubercle occurs frequently in bones — caries of the spine 

 being an outstanding example. 



Tubercle of joints, particularly the knee and hip, is common 

 but it is to be noted that tubercle of the joints really begins not 

 in the joint but in the part of the bone which is growing most 

 actively, namely the epiphyseal end — either the upper or lower — 

 of the shaft of the bone ; it spreads thence to the joint. 



A suggestive hypothesis bearing on the incidence of bone 

 lesions in children is that these parts are, as it were, so busily 

 occupied with the work of growth and so highly specialised in 

 this connexion that they possess but little power of resisting 



