(f) Raw’s communication (British Med. Journ., 1903) concerning 300 cases of tabes mesenterica, not one of which was found to have developed in a child nursed exclusively at the breast, but rather in those who had been nourished for a considerable time on cow’s milk.
11. It is probable that in thickly populated countries practically every person is at some time or other infected with tuberculosis. Aside from the quantity and quality of the Tb. virus, the outcome of the tubercular infection is dependent to a high degree on the physiological state of the infected individual and on accidental conditions of infection. (Intercurrent pathological factors; endogenous and exogenous conditions of infection.)
12. Not a single unexceptionable case has been brought forward to show that under the conditions of life usually present in civilized lands, an adult person has ever contracted pulmonary, bronchial, tracheal, or laryngeal tuberculosis without having previously been infected and thus rendered oversensitive to the tubercular poison.
13. Against the action of tubercle bacilli entering the intestinal apparatus, healthy, full-grown persons apparently possess sufficient protection in the character of the mucous surfaces and the anti-bacterial action of the digestive juices. It has, too, still to be proved that healthy, full-grown persons become ill with tuberculosis as a result of eating food (milk, butter, meat) derived from tuberculous cattle.
14. Very probably adult persons frequently acquire intestinal tuberculosis through food containing tubercle bacilli, if the epithelial covering of the intestinal mucosa is defective, or if perhaps there exist ulcers which extend down to the parenchyma of the wall of the alimentary tract. (Exanthematic diseases, typhoid, dysentery, carcinoma, etc.)
15. Whether adult persons in whom the conditions are favorable for an intestinal infection with Tb. will develop primary tubercular lesions in the intestinal wall, or in the mesenteric glands and the peritoneum, will depend mainly on the circumstance whether or not, owing to a previous infection, they have become oversensitive to tuberculin. Individuals oversensitive to tuberculin are inclined to develop lesions at the point of entry of the tubercular virus, if opportunity is given for the introduction of the virus by means of leucocytic wandering cells. This opportunity is lacking in the virile infecting period at such places where the lymphatic receptive apparatus is destroyed [verödet]. (Mucous surfaces of the faucial ring of consumptives?)
16. In order to explain the mode of origin of cheesy pneumonias and tubercular broncho-pneumonias it is necessary at autopsy to regard most carefully the possible direct extension of the infection from cheesy mediastinal and bronchial glands to the bronchi and their branches, before thinking of aerogenous or hæmatogenous pathogenesis. (Compare [Ribbert] Sievers, “Marburg Dissertation,” Aug. 14, 1902.)
17. Critical analysis of several statistical statements which seek to show that alveolar pulmonary tuberculosis is referable directly to inhaled tubercle bacilli; especially the statement of Knopf (New York) cited by Mitulescu (Zeitschrift für Hygiene, 1903), that in Lansing, Mich., twenty employés of a library became consumptive through handling Tb. laden books.[5] Probability of the correctness of my assumption that Knopf was misled by unscientific communications from Lansing. Proof that Mitulescu again misunderstood Knopf.
18. It has not yet been proved that persons cutaneously infected with human or bovine Tb. have as a result of this developed phthisis. (My own observations on cases of infection on the hand in persons working with tubercle bacilli of various origins.)
19. Justification of the statement by Virchow in his “Phymatie, Tuberculose und Granulie,” that “the history of phthisis is concerned much more with cheesy hepatization than with tubercles” (Virchow’s “Tuberkel,” Begriff).