| dc.description.abstract | In conclusion, to summarise my results, I found that out of a total of 307 cases, 213 were
of respiratory origin, through the lungs or the
middle ear; 53 were due to the ingestion of tuber -l' culous material; 6 were due either to respiration
or to ingestion, having been infected through the
mouth or pharynx; i was a case of placental infection; 1 possibly of uterine infection; and the
remaining 33 cases of doubtful origin. Thus,
though infection by air is by far the most frequent method, infection by ingestion is a matter
of very real and urgent importance, especially
amongst children between the ages of 6 months and
3 years, during which period 30 cases, or 56% of
all the abdominal cases occurred. It is in these
years also, that the proportion between the thorac=ic and abdominal cases is most nearly approximate,
and this, in spite of the numerous predisposing
influences, such as measles and whooping -cough,
which favour thoracic infection. According to
the Registrar General's Reports for the decade 1881-
1890, the total average annual deaths in England of
children under 5 years was 201,000, and the average
annual number for the same age certified as having
died from some form of tuberculosis, was 13,900,
or 6.9% of the total number. Of course this does
not include the large number of cases which, though
suffering from tuberculosis, were carried off by
some concomitant disease, or by accident, before
the tuberculosis had gained sufficient hold on the
system. When we come however, to consider how
difficult of diagnosis tuberculosis in infancy so
frequently is, even by experienced physicians, and
how often it is found at post mortems when least
expected, we shall not require very much argument
to convince us that death statistics, so far as
they relate to tuberculosis in childhood, are utterly misleading, unless based upon post mortem evidence. Recognising this fact, Dr Landouzyl made
careful calculations regarding the tuberculosis mortality in infancy in Paris, and came to the conclusion that in the year 1885, out of 12,264 deaths
under the age of 2, 2,162 instead of 442 as returned on the death certificates, had died from tuberculosis. Of course, his method of calculation was
a rough one, but his result is likely to be much
nearer the truth than the original estimate.
Landouzy's statistics will apply equally well to
the urban population in England, some reduction
being made when the rural mortality is included.
Let us suppose then, making allowance for this reduction and for some exaggeration in his statistics
that 1 in 8, instead of 1 in 5 of all the deaths
under 5 years, is due to tubercle; this will mean
an annual tuberculosis mortality for that period
of 25,000 instead of 13,900 as certified. Now by
examination of Table II. it will be seen that 40
out of 227 cases under 5 years, or 17.5% were infected through the intestines or mesenteric glands;
and this percentage is slightly below those of
other English observers. This will give in round
figures 4,400 as the annual number of deaths in
England under the age of 5, resulting from the ingestion of tuberculous material. These startling
figures bring to our notice again, the question of cows' milk and Professor Koch's statements. About
two months after the Tuberculosis Congress of 1901,
a Royal Commission was appointed to investigate the
relations between Human and Bovine Tuberculosis in
general, and the importance of tuberculous milk
and meat more particularly. Its report, when the
investigations are concluded, will be awaited by
medical men at home and abroad, with impatience
and keen interest. Should it consider the case
against milk proven, we shall expect the Government)
to carry out such means for safeguarding the population, as the Commission may suggest; and on the
other hand, should its conclusions be similar to
Professor Koch's, a stigma will be removed from
cows' milk, and a great weight lifted from the mind
of the thinking public. Whatever, therefore, the
report of the Commission may be, the results can
only be beneficial, and the question of the causation of Tuberculosis much simplified. | en |
