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Study of tuberculosis of the tonsils and cervical lymph glands in children

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Date
1913
Author
Mitchell, P. A.
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Abstract
 
 
In recent years the results of investigations conducted by the British and German Commissions and many individual investigators have proved beyond doubt the communicability of the bovine virus from animal to man. For this purpose these investigators rightly employed material obtained from a marge number of non-selected cases of human tuberculosis of varied types. This 'modus operand! ' enabled them to determine in a special way the extent and nature of bovine infection in man, but has failed to supply us with any idea of its actual responsibility and importance in the commoner varieties of surgical tuberculosis affecting children. If, then, man derives a certain percentage of infection from bovines, it is reasonable to expect that where human tuberculosis is of frequent occurrence the bovine disease will also be rife and that raw mi lie formed an important article of diet. There is no doubt that bovines are affected with the disease to about the same extent as man. It is not remarkable that a causal relationship between the two does exist, when it is recalled how their raw milk is used by us as an important article of food - one of the few animal products used by civilised man in the uncooked state - and, further, it constitutes the chief nourishment of the large majority of children. Although I hope to show that bovine tuberculosis is a problem which demands the closest attention of our Government and dairy-farmers, it cannot be doubted that its chief importance depends upon its relation to tuberculosis in children. The only way to obtain definite statistical evidence as to the frequency of bovine infection in children was to undertake the examination of a large series of non-selected cases. Tuberculous cervical glands in children - a very frequent disease in our city - seemed to me a suitable field for an immediate attack, one which had received little attention, and a field in which it was reasonable to expect a considerable percentage of bovine infection. Accordingly, about the end of the year 1910 I undertook the study of a consecutive series of cases of cervical adenitis occurring in children with the object of determining the type of baciiius active in each case. The material for this study has come to my hand without selection through the kindness of Mr. Harold J. Stiles and Mr. C. Palfour Paul. Almost without exception the material has been removed at operations at the Royal Hospital for Sick Children, Edinburgh. In a few instances, it was obtained from operations in private practice. I have received it in sterile gauze from the operating theatre and have been, in all cases, able to guarantee freedom from contamination with other tuberculous material. I have carefully recorded in each case a clinical history in regard to the age, duration of the disease, present condition of the patients, family history of tubercle, previous history, mode of feeding in infancy, and a short account of each operation, in the hope that , from such clinical data , I might be able to detect some feature or features of distinction between the cases in which bovine and human types of tubercle bacilli were found. Since the results of investigations on the relationship between primary tuberculosis of the faucial tonsils and the development of tuberculous cervical adenitis, so far reported have been too fragmentary to be worked into satisfactory statistical evidence, I have made the histologic and experimental inoculation of the faucial tonsils removed from children with tuberculous cervical glands an important part of the research. For purposes of comparison I have also studied in a similar way hypertrophied faucial tonsils removed from children in whom clinically there was no evidence of cervical lymphatic tuberculosis. I have endeavoured in every suitable case to establish the relationship between the incidence of tuberculous cervical glands and the drinking of tuberculous cow’s milk. One only expected to be able to trace the disease to the milk, when after the onset of symptoms pointing to infection by way of the mouth, the cow or cows from which the milk had been obtained were still available for examination. I have investigated 72 cases of tuberculous cervical glands in children and 8 cases in adults: the faucial tonsils removed from 64 children with tuberculous cervical glands and hypertrophied faucial tonsils removed from 90 children with no clinical evidence of cervical lymphatic tuberculosis.
 
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http://hdl.handle.net/1842/35362
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