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Title: Tuberculosis in childhood : the sources and channels of infection, with special reference to the tonsils
Author: Kingsford, Leslie
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1903
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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. Cases of skin infection, inoculation of wounds, or of the eyes, usually remain local, and are neither of frequent occurrence, nor of great importance in childhood. It only remains for me to express my indebtedness to Dr Coutts, under whose care was the case of congenital tuberculosis, for permission to use the notes of the case, and to Drs Clive Riviere and 0. K. Williamson, the then Pathologists of the respective Hospitals mentioned at the commencement of this paper, for allowing me to use the Post mortem records of those Hospitals.
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Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available