Ingestion Tuberculosis. 



The development of the affection depends on the most varied 

 conditions, on the quantity of the introduced virus, condition of 

 the port of entry, general resistance, etc. 



Frequency of Tuberculous Infection Through the 

 Alimentary Tract. 



If the lesser virulence of the bovine type for man, as compared 

 to the human type, is left out of consideration, which fact is con- 

 sidered satisfactorily proven, the experiments of Ostermann, 

 Schroeder and Cotton show what great quantities of infectious ma- 

 terial are necessary in order to produce tuberculosis by ingestion. 



Schroeder and Cotton fed milk artificially infected with tuber- 

 cle bacilli, and proved that infected milk which invariably produced 

 tuberculosis when inoculated intraabdominally in 5 c. c. doses, 

 could be fed for 30 days without causing the disease in the ex- 

 perimental animals. 



The dilutions were prepared (1) by adding one platinum loopful of a cloudy sus- 

 pension of tubercle bacilli to 10 c. c. of milk. (2) by adding one loopful of the orig- 

 inal suspension to 10 c. c. of sterile water, and of this dilution one loopful was placed 

 into 10 c. c. of milk, (3) by adding one loopful of the original suspension to 100 c. c. of 

 sterile water and of this dilution one loopful was placed into 10 c. e. of milk. It was 

 not possible to produce ingestion tuberculosis with either the second or third dilution 

 during the period of the experiment, although the dilutions were not as high as they 

 occur in the milk of tuberculous animals (with the exception of tuberculosis of the 

 udder). 



Ostermann by comparing the average number of tubercle 

 bacilli in cow's milk with the minimal dose necessary for producing 

 ingestion tuberculosis in guinea pigs, rabbits and goats, came to 

 the conclusion that an alimentary infection is exceedingly rare. 



Nevertheless the danger of an alimentary infection with bovine 

 tubercle bacilli, even in high dilutions of the tuberculous material 

 in market milk, cannot be disregarded. 



The danger of infection to which small children are exposed 

 from the ingestion of food (without attempting to distinguish "bo- 

 vine tuberculosis" from "human tuberculosis") is best illustrated 

 by the clinical cases and also those cases of intestinal and mesen- 

 teric tuberculosis which are found on autopsy. 



Edens, from October 1, 1904, to September 30, 1905, found 

 12%, and from this time until September 30, 1906, 13.6% of the 

 bodies of children which he autopsied at the ages of 1 to 15 years, 

 affected with primary intestinal tuberculosis or tuberculosis of 

 the mesenteric lymph glands, whereas in man from 15 to 19 years 

 of age only 3.8% and 2.6%, respectively (all autopsies), showed 

 the disease. 



The intestinal tract of children appears therefore to be a 

 prominent port of entry for the tubercle bacillus, which is also 

 proven by the works of Orth, Henke, Chiechanowski, Hamburger, 

 Nebelthau, Lubarsch, Bruning, Fibiger and Jensen, Symes and 

 Fischer, Price and Jones, Kingsford, Harbitz, Ogyia, Edens, 

 Wagener and Heller, who demonstrated primary intestinal tuber- 



