12« ANNUAL, REPORT OP THE Off. DoC. 



sense that the lesions in dilterent localities seemed to have a "com- 

 mon simultaneous oi-iy,iu Iroiu some infective centre, or else that 

 there were several quite independent tuberculous centers in ditterent 

 parts of the body." In seventy-nine cases the primary lesion was in 

 the lung or bronchial glands; in twenty cases in the intestine or 

 mesenteric glands; in six cases it was impossible to tell whether the 

 respiratory or the digestive tract was hrst involved; in eleven cases 

 widely separated caseous foci were found, and the pj'imary lesion 

 could not be located; in four cases no centers could be found, the 

 lesions being generalized. 



Guthrie, at the Children's Hospital, Paddiugtou, London, ex- 

 amined seventy-seven cases, ile considered that in forty-two cases, 

 or 5-A.5 per cent., the primary lesion was in the respiratory tract; in 

 nineteen cases, or 24.6 per cent., it was in the ■' testiual tract. Of 

 the remaining sixteen cases the thoracic and abdominal organs were 

 equally affected in seven; in six the original nas unknown, and in 

 three otherwise accounted for. In only thirty-two cases could the 

 origin of the tuberculosis be traced with certainty to the glands, to 

 the thoracic seventen times, and the mesenteric fifteen times. 



Still, at the Great Ormond Street Hospital for Children, in 769 

 consecutive autopsies on children under twelve years of age, found 

 269 cases which showed tuberculous lesions. Of these 117 or 43.5 

 per cent., were children under two years of age; and 56.5 per cent. 

 — more than half the total number — were children under three years 

 of age. The origin of the disease was as follows: 



Lung 105 1 



Probably lung 33 |' 138=51.3 per ct. 



Intestine 53 i 



Probably intestine 10 r 63=23.4 per ct. 



Ear 9 j 



Probably ear 6f 1»= 5.5 per ct. 



Bones and joints 5 



Fauces 2^ B3=19.8 per ct. 



Uncertain 46 



In forty-three cases in which death was due to other causes, such 

 as diphtheria, heart disease, etc., the primary focus of infection could 

 be determined with great certainty, as the tuberculosis had not 

 become generalized. Among these the primary lesion was respira- 

 tory in twenty-six cases, or 60.4 per cent.; intestinal in sixteen, or 37.8 

 per cent.; and in the year three times. 



Dr. Shennan, of the Eoyal Hospital for Sick Children, in Edin- 

 burgh, found among 278 cases of tuberculosis 28.1 per cent, in which 

 infection had takc^i place by the intestinal tract, showing that the 

 high percentage in which this route of infection is observed is not 

 confined to London, where it might be supposed that conditions 

 were such as to favor it specially. 



