TUBERCULAR MILK AND INFANTILE DISEASES 245 



a considerable amount of alimentary tuberculosis undoubtedly 

 occurs. This may be measured partly by the returns of the 

 Registrar-General, and partly by the results of special inquiry. 

 The Registrar-General's returns for the last thirty years have 

 shown a marked decrease in deaths due to phthisis, and a less 



(including Stang, Demme, Gosse, Ollivier, Law, Ebers, Bang, Von Ruck, 

 Nocard, Klebs, and Rievel) have recorded cases which appeared to show that 

 infection had been derived from milk. Carr, Guthrie, Still, Shennan, Holt, 

 Northrup, Bovaird, Kossel, and others have reported on the results of necropsies. 

 Broadly, it may be said that there are two conclusions to be drawn from these 

 post-mortem examinations, namely, (i.) tuberculosis is a common disease of 

 children ; and (ii.) the primary lesion is in more than half the cases in the lungs. 

 We may quote as illustration of this latter statement, the percentage returns in 

 the post-mortem examinations of tuberculous cases by Carr, Guthrie, and 

 Still as follows : — 



The frequency with which intestinal tuberculosis is met with in children 

 varies in different places. It is recorded as occurring in Tubingen in 14-7 per 

 cent, of the cases, in Kiel in 31 per cent. (Simmonds), and a later record gives 

 it at 41-3 per cent. (Bolz). In Munich, also, it has twice been estimated, once 

 at 31 per cent., and a second time at 38 per cent. Widerhofer, in an examina- 

 tion of 418 cases found the total cases of intestinal tuberculosis to be loi. 

 Shennan, working in Edinburgh, found 27-8 per cent, of alimentary tuberculosis ; 

 Batten in London found 13 per cent. ; and Northrup in New York met with 3 

 in 125 (2-4 per cent.) cases of infant death from tuberculosis. In many of these 

 inquiries, however, sufficient care has not been taken, in our opinion, to differ- 

 entiate between whether the intestinal tuberculosis was primary or secondary 

 in origin. Amongst 269 tuberculous children under twelve years of age whom 

 Dr Still examined post-mortem, he found it possible to detemiine the channel 

 of infection with some degree of certainty in 216 cases. In 138 (63-8 per cent.) 

 infection entered through the lung, in 63 (29-1 per cent.) primary infection 

 occurred in all probability through the intestine. Of children up to two years 

 of age he found 65 per cent, contracted infection through the lung, and 22 per 

 cent, through the intestine. In infants under one year of age apparently only 

 13 per cent, contracted tuberculosis through the intestine.* 



It is recognised that, owing to the great tendency to generalisation of 



1 Lancet, 1894, vol. i., p. 1177. 

 - Ibid., 1899, vol. i., p. 286. 



^ Brit. Med. Jour., 1899, vol. ii., p. 457. 

 * Practitioner, 1901 (July), p. 94. 



