INTESTINAL TUBERCULOSIS Intestinal tuberculosis has been the subject of many theories and of great divergence of opinion. It is a disease, however, which by this time should be pretty thoroughly understood on aecount of our knowl edge of the caustive agent and its pathogenic action and on account of our clinical and pathological studies.
It is not possible. in this place, to discuss even the chief features of this question and for a more extended reference the recent publica tion, of Leslie, Finkelstein, Ibrahim and L. Furst should be consulted.
In the present article questions which are the subject of contro versy will be avoided as far as possible. Numerous statistics show that primary tuberculosis of the intestinal tract, including the niucous membranes of the mouth and lymphatic glands of the throat is rela tively rare in childhood. Filrst could collect only one hundred and sixty cases from the. literature, which is a vely small number in com parison to the vast amount of tuberculosis in the first years of life. Cases are far more connnon in which infection of the intestines occurs secondarily from swallowing sputum containi»g tubercle bacilli.
The possibility of the so-called food tuberculosis should be borne in mind, since we possess animal experiments of striki»g value on this subject as well as significant observations in Man.
Notwithstanding the many opportunities for infection which occur in the use of food containing tubercle bacilli, the number of infections occurring in any such manner is remarkably small. Such infection may occur through the milk of tuberculous cows, dried human and bovine sputa, from a tuberculous nurse, etc.
Weleminsky elaims the reason of the rarity of intestinal tuber culosis is that the tuberele bacilli present in the mouth penetrate the submaxillary and cervical lymph-nodes and thence pass into the lungs. Others believe that the action of the normal intestinal juices destroys the tubercle bacilli.
Koch and his adherents make the astonishing statement that bovine bacilli are harmless for the child, while, on the other hand, Behring and his followers assert that tuberculosis of later life has its origin in an intestinal infection acquired in early infancy and remaining latent for years. In any case, this question is unsettled and far front clear.
Milk unquestionably often contains virulent tubercle bacilli and is an important carrier of infection and open to suspicion as a means of producing the disease through the intestines.
The presence of tubercle baeilli in the seeretion in the lacteal glands of phthisieal wet-nurses has not been proven. At least, infections from this source are not recognized, which is not remarkable since consump tive patients are usually forbidden to nurse and especial attention is given to this condition in the engagement of a wet-nurse. Mothers suffering from acute tuberculosis expose the). children to so much danger of infection in other ways that, in comparison to these, infection through the food seems relat:vely very improbable. In regard to the danger from the use of cow's inilk or milk products (butter and cheese) con taining the bovine tubercle bacilli, statistics have shown (Ttiedert, Ganghofner, v. Starck) that there is no relation between the frequency of pleuropneumonia in definite districts and the frequency of human tuberculosis, still less between the latter and food tuberculosis. The pathologico-anatomical studies in the various Institutes are very different; the percentage of the involvement of primary intestinal tuberculosis in relation to that of infantile tuberculosis in general varies from 1.7 to 37 per cent. after equally careful search and the most thorough autopsy technique.
A single etiological possibility- is rarely present, and it is difficult to exclude with certainty all other sourees of infeetion; as Schlossmann has properly emphasized, a more thorough investigation in almost every ease shows the possibility of infeetion through tuberculous patients in the neighborhood of the child.