Tuberculosis. 481 



To these may be added the cutaneous forms of tuberculosis 

 (tuberculosis verrucosa cutis), which occur on the hands of per- 

 sons (butchers, tanners, coachmen, cooks, etc.), who handle in- 

 fected products of animals. These have been described by Riehl 

 and Paltauf, Senn, and a number of surgeons and dermatologists 

 and the relation of the occupation to the seat of the disease is con- 

 clu.sive as to the source of the infection. It is the exact counter- 

 part of the verrucosa necrogenica of the hands of persons working 

 in the dissecting rooms of medical schools, and the source of in- 

 fection is equally well established in both cases. 



A strong argument for the appreciable influence of the bovine 

 bacillus upon man (acting directly or indirectly through the pig) 

 is that the relative death rate of Jews from tuberculosis is mate- 

 rially less than that of other races. It is constantly claimed that 

 orthodox Jews who eat only kosher (rabbi inspected) beef and no 

 pork, suffer lea.st of all the population from tuberculosis. Dr. 

 Gerster, judging by the burial returns of the United Synagogue 

 and the English Registrar General's returns, concludes that only 

 about half the relative proportion of Hebrews suffer from con- 

 sumption as do other races in the same country. Some remarka- 

 ble facts come out in the report of the Royal Commission on 

 tuberculosis in England. In England and Wales the disease had 

 decreased 39.1 per cent, in thirty-five years, but this decrease has 

 been mainly in pulmonary cases, while the abdominal forms de- 

 crea.sed only 8.5 per cent. Sir Richard Thorne, indeed say.s, that 

 in children of the first year there had been an actual encrease of 

 27.7 per cent. Northrup and Still, on the contrary, present sta- 

 tistics showing that in children the pulmonary form of tubercu- 

 losis is the most common (Brit. Med. Jour. 1898), If in the face 

 of this there has been a very material encrease of the abdominal 

 form, coincident with the notorious encrease of the disease in 

 dairy cows and of the bottle-feeding of infants, may we not en- 

 quire how much of this is due to the greater prevalence of bottle- 

 feeding and the infected cow's milk? It is not for a moment 

 supposed that the majority of infections in children come from 

 the cow. The question is whether this encrease in the minority 

 is not in measure chargeable on the cow. The impaired nutrition 

 resulting in some instances from the use of cow's milk cannot 

 well be charged with a marked encrease of cases in which the 

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