TUBERCULOSIS. 



223 



the infection, in these cases at any rate, frequently takes place by the ali- 

 mentary canal. The age at which these tubercular glands were found is 

 very significant ; during the first year of life there were 4 cases ; from 1 to 

 2j years, 33 j from 3 to 5J years, 29 ; from 6 to yj years, 12 ; from 8 to 10 

 years, 13 ; and from 11 to 15 years 9 cases. In 14 cases these glands only 

 were affected. 



Bolitz (Inaugural Dissertation, Kiel) gives similar figures, but on a more 

 extensive scale. 



Out of 2,576 children whose bodies were submitted to 6. fast mortem ex- 

 amination in Kiel during the years 1873-1889, there were 424 cases of 

 tuberculosis, or 16.4 per cent, of the whole mortality. 



The following shows the percentages of the whole of the deaths from 

 tuberculosis at each of the diiterent ages : — 



Up to 2-3 years old 33.0 per cent. 

 .. 3-4 >. „ 29.6 „ 

 » 4~S >> I, 31-8 „ 

 .. S-io .. .. 34-3 .. 

 ., lo-iS .. .. 30-1 .. 



Here, again, as where the lung is attacked, we must look 

 upon the bacillus as the exciting cause, but tissue weakness 

 as the predisposing cause. These conditions may be summed 

 up as follows : — 



[a) The presence of the bacillus tuberculosis in such a 

 position and for such a length of time that it obtains a coign 

 of vantage, so to speak, from which to attack the tissues of 

 the body. 



{b) Some weak point in the epithelial surface " made by 

 disease, or due to irritation or bad food," by which the organ- 

 isms may attack the deeper tissues in sufficient numbers to 

 ensure their being able to hold their own in the struggle for 

 supremacy that ensues. 



(c) The comparatively low vitality of these deeper tissues 

 brought about by imperfect nutrition or irritation ; the cells 

 of which they are composed being no longer able to deal 

 successfully with any large number of bacilli that can under 

 ordinary circumstances find their way thus far. 



As regards the possibility of the bacillus tuberculosis being 

 present in the intestinal canal, it should be remembered that 

 the class of patients amongst whom abdominal tuberculosis is 

 most rife, consists of infants, which during the first year of 

 their life, and sometimes for a longer period, are suckled at 

 the breast ; after this, however, the diet is extremely mixed, 

 and as a rule it is extremely unsuitable ; but it is in by far the 



