Clinical Remarks ON PULMONARY TUBERCULOSIS IN INFANCY AND CHILDHOOD
Authors: R. A. Young
Journal: BMJ (1908)

THE early diagnosis of intrathoracic tuberculosis In infants and yong children is often a matter of extreme difficulty.Too often the condition is hardly suspected until general miliary infection occurs, or until wide- spread changes in the lung texture render it only too obvious.The reasons for this difficulty are not far to seek.The non-appearance of sputum, the number and variety of affections of the respiratory apparatus to which children, especially those brought up In the unhealthy conditions incidental to town life, are liable, and the greater proportionate size to which the lesions have to attain in order to render their presence demonstrable by physical examination are all factors.Again, the fact that the manifestations of the disease are often whered in or accelerated by some acute infectious disorder, such as measles or whoopingcough, is one to, bear in mind, sinoe the sequence may divert attention from the grave nature of the rospiratory condition and the ill-health of the child may be attributed erroneously to the debilitating after-effects of the primary disease.On the other band, many caees are labelled as pulmonary tuberculosis on very Insufficient grounds, such as the association of anaemia and malaise with a chronic couglj and night sweats.Again, certain cases ehowing suggrstive signs may clear up completely, so that it is important in doubtful cases to make more than one examination of the chest or to confirm the diagnosis by some of the newer bacteriological methods, which, however, are not always available and are not invariably desirable.It is difficult to form an accurate estimate of the incidence of pulmonary tuberculosis in Infancy and childhood, and the most widely divergent statements are current in this regard.The chief reason for this diversity of opinion is the confusion of nomenclature which exists.since by some authors the term " pulmonary tuberculosis " is taken to include tuberculosis of the traeheo-bronchial lymphatic glands, which is admittedly very common) while by others, itis restricted to those cases of destructive disease of the lung similar to the types of-pulmonary tuberculosis in the adult, which are by universal consent comparatively rare.For this reason statistical observations, unless carefully compiled and analyse, serve but to increase the con- fusion.Recently, however, the methodical examination of groups of school-children-.in-this and other countries has afforded-some.interesting fdgures.Grancher and -his assistants,rorking among the schoolchildren of certai-n diE- triets of-Pais, found.that 141 out of 896 examined showed evidences of glandular or-pulmonaryr tuberculosise-that is# about 14 per cente;.ani ..in,a subsequent investigation of 4,226 childreu they obtained identieal results, but theycertainly includledascases olbrouehial-gland tuberealosis many which were ot very doubtul-nature, Dr.-J.E. $quire and Dr. Annie Gowdey, after careful examination of 1,670 children in certain of the schools of the London County Council, foun4 only 8 with signs of pulmonary tuberculoss-that.ie+-OA47 ,pen.cent., or if 14 other cases with doubtful Big1w be -addedk, the., percentage becomes 1.3 per cent.. Theee atatetics agree fairly closely with those of Leubuscher, who found about a cases In 1,200 to 1,400 school childrent X Germanyu Statistics derived fr,om pot-mortem examinatioao,onthe other hand, although they show theoincidence of tuberclosis in chi-ldren dying In certain general hospitals, fail to afford Information as to the general incidence-eof the condition among the living, and cannot strictlybe4taken even as giving the general mortality, since they are often derived from hospitals for infectious diseases, or -from other special' sources.They serve, howeve; to indicate the distribution of tuberculous 4 lesions In the body.Barthez and RilHet some fifty years.ago found such lesions in 33 per cent. of the cases