infants and young children is to be condemned as a means of immunization against tuberculosis. The use of an attenuated organism such as B.C.G. is a more rational approach. Wallis rightly points out that calcification in the abdominal glands, while evidence of a tuberculous infection, is not necessarily evidence of complete healing; but, although he says that isoniazid, for example, is not necessary in treatment, it is always possible that it may become necessary. Tuberculous mesenteric adenitis is usually benign, and all will agree, therefore, that the routine giving of tuberculostatic drugs is both unnecessary and unwise. In view of the difficulty sometimes encountered in making a diagnosis the family doctor may well wonder whether he should have the abdomen x-rayed. This would entail considerable time and expense, and a simplF tuberculin test is the real prerequisite to the diagnosis. If this is negative, no tuberculous calcification in the mesenteric glands will be found. Only those children reacting positively will need to have an x-ray examination. It would be interesting to know the findings of Russian paediatricians on the symptomatology of intra-abdominal calcification, for all infants in the U.S.S.R. are given B.C.G. orally at intervals, and there must be many thousands of children who now have calcified mesenteric glands. Whether the pain is caused by pressure or by the drag of the calcified glands on the mesentery is not clear. Certainly such glands are found by chance in many children being x-rayed for some other condition -an intravenous pyelogram, for example-in whom there have been no abdominal symptoms at all. Clearly not all cases with these symptoms and calcified glands are necessarily suffering from active tuberculous adenitis. The other symptoms described in this condition-for example, vomiting, sweating, lassitude, and loss of weight-are likely to be connected with some activity of the tuberculous process, and it is in children with such symptoms who also have fever and a raised sedimentation rate that the use of isoniazid may have to be considered. The association of pain and vomiting with slight fever must often raise the question of appendicitis. In any doubtful case laparotomy should always be undertaken. A radiograph of the abdomen showing calcification is no guarantee that acute appendicitis is not present, and it would be most unwise to wait for 48 hours to see the result of a tuberculin test. Of the physical signs of tuberculous mesenteric adenitis, local tenderness and palpable masses are the most frequent, but both are more commonly due to constipation than to tuberculosis; radiographs must therefore be taken and calcification confirmed before the diagnosis can be accepted with certainty. If the diagnosis is still seriously entertained in the absence of any visible calcification, a negative tuberculin test will exclude the condition.
