132 ANNUAL REPORT OF THE Off. Doc. 



of children from three months to thirteen jears of age, seen at au- 

 topsy, foniid seven which were tuberculous. One of the most recent 

 studies of tliis subject is Ilia I of Fricdmann, who examined the ton- 

 sils obtai^ied from niucty-onc childreu at autopsy, and fifty-four 

 cases removed by operation, all but one of the latter under five years 

 of age. Of the ninety-one cases, in three there was tuberculosis, 

 probably iiot primary: in five there was tuberculosis, probably prim- 

 ary, with secondary involvement of lymphatic glands, intestine, and 

 bone; in one the (onsile showed many tubercles, giant cells, and 

 tubercle bacilli, the rest of the body being free; in seven (two with 

 and five without tuberculosis in other parts of the body) the tonsils 

 coutained typiciil giant cells, but no bacilli could be demonstrated; 

 in three giant cells attributed to other causes were found; in eleven, 

 which showed extensive tuberculosis of other parts of the body, the 

 tonsils were free, but showed scars; in four the tonsils were free, 

 there being tuberculosis of the internal organs; in three bacilli were 

 demonstrated in smear preparations, though no tubercles were found. 

 In the remaining fifty-four cases tuberculosis w'as not found in any 

 part of the body. Only one of the operative cases showed primary 

 tuberculosis. 



When we remember the frequency with which children are fed, 

 and the ease with which particles of food lodge in the tonsils, we 

 cannot but think that Friedmann is reasonable in his conclusion 

 t.'iat tuberculosis of the tonsils is quite common in children, and 

 that the infection takes jjlace directly from food, and not through 

 the lymph, blood, or by inhalation. 



Numerous authors who have studied this question give corrobora- 

 tive facts, lack of time preventing further citations. Those given 

 are sufficient, I think, to show the fallacy of looking exclusively to 

 the intestine for the proof of a food infection. I beg to call attention 

 to the specimen showing ulceration of the tonsils which I have here, 

 taken from one of four pigs which were infected by feeding, ten meals 

 containing pure cultures of tubercle bacilli being given. All the 

 animals contracted general tuberculosis, most marked in the lungs, 

 and ending in death. Three of the four presented lesions of the ton- 

 sils similar to those shown, while in only one could any lesion of the 

 intestine be found. In the tonsils of the fourth pig, which showed no 

 macroscopic lesions, many tubercle bacilli and areas of caseation 

 were found. In three of the four pigs the cervical and mediastinal 

 glands were markedly involved, and tubercle bacilli were readily 

 demonstrated in smear preparations made from the cut surface of the 

 salivary glands in the remaining one. 



A similar observation was made by Koch, who, however, seems to 

 have entirely overlooked the importance of it. He says: "These 

 animals had without exception severe tuberculous disease, especially 



