The demonstration of the tubercle bacillus in the pulmonary tuberculosis of childhood.

The diagnosis of pulmonary tuberculosis in children is notoriously difficult to establish, and this is in great part due to the rarity with which the tubercle bacillus is found. In the adult reliance is placed on the discovery of the bacillus in the sputum, and, unless this is done, the diagnosis must always remain in some doubt. The presence of the tubercle bacillus, if it can be demonstrated by any one of a variety of methods, clinches the diagnosis and can leave little doubt in the mind of even the most sceptical. Hence the finding of the bacillus must ever be a point of great importance, not only so that the diagnosis may be placed beyond doubt but in order that adequate treatment may be obtained; for the tuberculosis officer, armed with the fact that the bacillus has been seen, is able not only to provide more prolonged sanatorium treatment, but is better able to prevail on contacts to subject to examination. In the child, however, the obtaining of sputum for examination has always been a difficulty and there are many devices which have been introduced to overcome this. In 1898 Mernierl made the first attempt to demonstrate the tubercle bacillus in swallowed sputum by means of stomach lavage, and this has within recent years become the favourite method. A high percentage of positive results has been reported by this method. Poulsen2 obtained fiftythree positives out of 110 tuberculous children and Wallgren' examined the fasting stomach contents in thirty-seven children with erythema nodosum and positive Mantoux reactions, and was able to demonstrate the bacillus in seventeen instances, while Armand-Delille4 reports 30 per cent. positive results in 110 tuberculous children. In 1904 Leonard Findlay' suggested attempting to obtain the sputum while it was in the pharynx and before it had been swallowed, and recently Nalbant6 and Mishulow and her coworkers7 have affirmed that repeated examination of the faeces will yield as high a percentage of positives as will stomach lavage.