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.
