No. 6. DEPARTMENT OP AGRICULTURE. 137 



The few reports we have from America indicate that infection 

 through tlie intestine is umch less frequent than in England. 



Northrup reports that among liT) autopsies, in only three was the 

 primary lesion found in the intestinal tract. In thirty-four cases, 

 however, the disease was so general and far advanced that he was 

 unable to determine the mode of invasion. 



Holt among 111) tuberculous children examined postmortem found 

 the intestines atiected forty times and mesenteric glands thirty-eight 

 times, but in no case did he consider the intestine as the route of in- 

 vasion. 



Bovaird, in 1899, published the records of seventy-five autop- 

 sies on tuberculous children. In sixty cases infection had taken 

 place through the respiratory tract; in eight the bronchial and mes- 

 enteric glands were equally involved, and in seven the records were 

 incomplete. He has recently added the record of fifty cases, among 

 which two cases of primary intestinal infectioii occurred. The num 

 ber of indeterminate cases is not given. 



German statistics, as far as I have been able to obtain them, do 

 not sustain Koch's position, although they indicate that primary 

 intestinal tuberculosis is not so common in that country as io Eng- 

 land, which we would hardly expect, considering the precautions pre- 

 scribed in Germany and the lack of regulations in England. 



However, intestinal involvement in children appears to be quite 

 frequent in most parts of Germany; and as many of the reports 

 do not clearly indicate the primary seat of invasion, we are justi- 

 fied in believing that a fair proportion of these cases are due to in- 

 testinal infection. For example, the statement given by Koch and 

 attributed to Baginsky — that among 933 cases of tuberculosis in 

 children he never found tuberculosis of the intestine without simul- 

 taneous disease of the lungs and bronchial glands — is entirely in- 

 definite as to the primary seat of the disease, and as quoted furnishes 

 no ground whatever for Koch to stand on. 



Against the figures given by Koch — which are confined tO' his own 

 experience — the reports of Baginsky, and a series of cases attributed 

 to Biedert, we have the statement of Professor Hueppe that "the 

 number of these cases (primary intestinal tuberculosis) occurring in 

 children is by no means so small as Koch alleged. The number of 

 cases may be fairly reckoned as between 25 and 35 per cent, of all 

 deaths of children from tuberculosis." 



Among fourteen children who died from other diseases, and in 

 whom the existence of tuberculosis was not recognized before death 

 Kossel found tuberculosis of the bronchial glands ten times and of 

 the mesenteric glands four times. In twenty-two children who died 

 of tuberculosis he found the disease confined to the intestinal tract 

 in only one case. 

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