INFANTILE TUBERCULOSIS The tuberculosis of infants deserves especial consideration, as it generally differs in its pathology, clinical course, and prognosis from other forms of the disease. For this reason we consider it separately.
is very frequent in infancy. The difficulties of diagnosis and the lack of autopsies render statistics of doubtful value as to its frequency. Among 532 autopsies of infants, I have met with tuberculosis 36 times as follows: From the above table we see that tuberculosis is uncommon during the first few months of life. Generally more time is required to cause death. The second quarter of the first year contains a greater number, and the second half year shows nearly 17 per cent. of tuber culous cases. My figures are rather below the average, e.g., 10 per cent. the percentage of tuberculosis given by Finkelstein for the first year. This is due to the peculiar nature of my material, which includes many premature babies, cases of sepsis, etc. [These figures cannot be regarded as showing the frequency of tuberculosis in infancy, as it is now known that tuberculosis may be present, especially in the cervical, bronchial, or mesenteric lymph-nodes and not manifest itself macroscopically or even microscopically. The only exact test is the biological one, namely, injecting the suspected material into guinea-pigs. It is certain that the above figures would be still larger if such latent cases were included.—II.] this connection we must refer to what has been written above. However we must emphasize the fact that the infant is very susceptible to infection immediately after birth. Frequently we can trace the source of the infection to a parent or to the nurse. Milk does not play an important role in the genesis of the disease as it is generally cooked previous to being used.
Pathological characteristic of tuberculosis of infancy is the rapid generalization of the disease. I have never seen a case come to autopsy where the tuberculosis was localized in one organ. In the early stages there occurs a dissemination by means of the blood, due to the breaking down of a primary lesion which involves the intima of a vessel, or to a focus rupturing into a neighboring blood vessel.
The type of tuberculosis is miLary, submiliary, or nodular, such as we find in the monkey. The latter is due to the rapid growth and early confluence of the miliary tubercles. The tissue of the infant is evidently an excellent culture medium for the bacilli. There is also a striking lack of reactive changes surrounding the lesions. The lungs and the bronchial lymph-nodes are regularly the most involved. The former besides showing miliary and nodular tuberculosis are often the seat of an acute tuberculous pneumonia. The conglomerate tubercles often break down and form cavities, which are by no means exceptional (7 in 20 cases, Geipel). In fact we may find true sequcstnu lying within the cavities.
The bronchial lymph-nodes and spleen arc also regularly involved. The liver, mesenteric lymph-nodes, and intestines are very frequently affected. The tonsils (7 in 17 cases), stomach, meninges, bones, etc., are not rarely the seat of tuberculosis.
Symptoms.—The symptoms of the tuberculosis of infants are manifold and variable. They present nothing characteristic of the disease. The general appearance of an infant suffering from tubercu losis is that of a mild marasmus. One of the first symptoms is that the child ceases to gain in weight. On the other hand, we do not always find a marked emaciation; on the contrary, some children, especially those in the first months of life, remain fairly well nourished. Indeed we must remember that, under appropriate diet, the infant afflicted with tuberculosis may even gain. This I have repeatedly seen demon strated in nursing infants. When they begin to have persistent fever and cavities develop in the lung we find a sudden loss of weight. Not rarely, however, the disease takes a rapid course and the children die before they have lost materially in weight.