256 MILK AND ITS HYGIENIC RELATIONS 



' Where other investigators have reported non-selected cases 

 the percentages come close to these figures. 



' On the whole, bovine infection causes somewhat less than 

 10 per cent, of the total deaths in young children.' 



Mitchell (2) examined eighty consecutive cases of tuberculous 

 cervical glands in children. Of these eighty children forty-two 

 resided in Edinburgh and thirty-eight came from the neighbouring 

 country districts. The bovine bacillus was present in 88 per cent, 

 of the cases and the human bacillus in 12 per cent. Mitchell 

 states that ' without exception the cases were those of children 

 twelve years of age and under. The maximum incidence occurred 

 during the second year of life. This is not surprising when it 

 is recalled that the large majority of children of this age are nourished 

 in whole or in part on cows' milk. I found that in my series of 

 cases 84 per cent, of the children of two years and under had been 

 fed with unsterilised cows' milk since birth. Whatever may be 

 the case in other countries the mode of feeding children in Britain, 

 especially Scotland, is such as to favour bovine infection.' 



The method of feeding of children showing lesions due to bovine 

 tubercle bacilli, has been investigated by Fraser. Out of seventy 

 cases of tuberculosis of bones or joints thirty-eight cases had a 

 clear history of feeding on cows' milk, and the bacteriological 

 results suggested infection by bacilli of bovine origin. In nineteen 

 of the cases the children were breast-fed, and the evidence was 

 in favour of infection with bacilli of human origin. In thirteen 

 cases the evidence was either incomplete or showed apparent 

 contradiction between the bacteriological findings and the history. 



The question of infection in children by the ingestion of bovine 

 tubercle bacilli in milk was thoroughly discussed at the conference 

 on tuberculosis which took place in Edinburgh in 1914, at which 

 conference some of the results above described were given by the 

 authors concerned. 



Stiles, in dealing with the question, reviewed some of the work 

 of the observers already mentioned, and urged the necessity for 

 attention being directed towards the stamping out of bovine 

 tuberculosis. He considers that if measures were energetically 

 carried through, the amount of surgical tuberculosis in children 

 would rapidly diminish. He adds : ' I maintain, however, that 

 until such legislation has been in force for some time it is the duty 

 of the medical profession to insist on the boiling of all milk given 

 to children. Professor von Pirquet, one of the greatest authorities 

 on tuberculosis in Vienna, states that practically all the surgical 

 tuberculosis which is met with in children in that city is due to 

 the human bacillus. This statement would at first sight appear 

 to throw doubt upon the reliability of the Edinburgh investigations, 

 but when Professor von Pirquet assures us that the whole of the 

 milk of Vienna is boiled we can quite understand why surgical 

 tuberculosis in that city is never of bovine origin.' 



