Sessional_Paper_1904 — Page 385

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II. Children over 2 and under. 5 years of age.

(1.) Acute Tuberculosis,..

(2.) Tubercular Pneumonia,

(3.) Tubercular Peritonitis,

Total,

27

11

40

When one considers the number of post-mortem examinations, it is rather surprising to find so few cases of tuberculosis amongst young children. By far the majority of the cases resolve themselves into acute generalised miliary tuber- culosis or tubercular pneumonia. In several of these cases an affection of the meninges was also found. What appears to be the most usual method of produc- · tion in these cases, at least in those where the disease is disseminated throughout the body, is the primary affection of certain lymphatic glands in the mediastinum, especially the bronchial glauds. In young children I have repeatedly found the presence of caseating foci in these glands, the bacillary infection of the general system would appear to take place, as HAUSHALTER believes, through the lymphatic system.

Further, only 2 cases of tubercular enteritis and a similar number of tuber- -cular peritonitis have been found. So far as the cases of tubercular enteritis are concerned, only one could be regarded as primary. The other case showed the pre- sence of tubercular lesions in the lungs.

Such a result, obtained after the performance of over 800 post-mortems is of great interest from the point of view of inrasion of tubercular injection through the small intestine. Up to the recent meeting of the British Congress on Tuberculosis in London, held in July, 1901, the opinion was widely diffused that the tubercle bacillus most frequently gained an entrance into the body through the tonsils and the lower part of the small intestine. Such were the conclusions arrived at by Drs. SYDNEY MARTIN and WOODHEAD, who conducted experiments on tuberculosis when engaged in the work of the Tuberculosis Commission in London. In their opinion, invasion of tubercle bacilli could take place without leaving any trace of a pathological condition in either of these situations. That such an invasion of bacteria can take place through the unbroken skin or mucous membrane is by no means an established pathological fact. On the other hand there is much reason

to doubt the occurrence of such an infection under natural conditions.

Although the intestinal canal is the seat of election of a large number of diseases as dysentery, typhoid fever, cholera, etc., yet the general result of all observations and experiments force the conclusion, that under healthy and natural conditions the intestinal canal resists the invasion of micro-organisms. From all sides, the danger attached to infection through the intestine in certain diseases" has been greatly exaggerated. The investigations of NoCAD and KAUFMANN, (Sem: Med. 1895), Lewin (Beitr z. Inhalations therapie, 1865) and others, endea- vouring to show the sieve like structure of the intestine and the penetration of micro-organisms through its walls and their appearance in the thoracic duct have been completely refuted by searching investigations made by M. NEisser (Zeit, f. Hyg. 1896) and OPITZ (Zeit. f. Hyg. 1898) who demonstrated that notwith- standing the administration of large doses of micro-organisms to the intestine, the chyle and the mesenteric glands were always foun I sterile. This is all the more remarkable owing to the fact that there is no other part of the body which is so closely and permanently in contact with a rich bacterial flora.

When we come to look at the subject from the point of view of Tuberculosis, again we find the occurrence of primary infection of the intestine one of the rarest

-occurrences.

The results of my post-mortem examinations show this, the occurrence of a single or about 0.1% of the total number of necropsies held.

These results of mine are not isolated, but are of the greatest importance in regard to the present day view of the paths of infection in tuberculosis and the possible. danger incurred through the agency of infected food. In the Charité in Berlin where an enormous number of post-mortem examinations are held, only fire cases of primary intestinal tuberculosis were found in 5 years. Again, BAGINSKI did not find a single case amongst 933 autopsies, and BIEDERT only 16 times in 3.104 examinations, GROSSER in Tubingen only found 1 case in 1,407 autopsies on tubercular subjects.