Vol. 60, 1909 - University of North Carolina at Chapel Hill

ORIGINAL COMMUNICATIONS, 77
tions are given intravenously or through of bacterial products, serums or attenuated
lumbar puncture. In New York City there cultures of the tubercle bacillus, the results
are usually fifteen to thirty cases following so far obtained do not warrant the conevery
Fourth of Juh'. Most of them are elusion that the problem is destined to be
caused by infection through blank-cartridge solved in this way, although this view by
wounds. Recovery sometimes follows from no means lessens the necessity of continued
the ordinary symptomatic treatment or endeavor until every conceivable method
without treatment at all, so that the statistics for the production of protective or curative
of cures of the disease by the injection of substances has been tried,
antitoxic serum must be very carefully Koch's tuberculins, which are doubtless
sifted before they can be accepted the best of these substances as yet prepared,
The power of tetanus antitoxin to neu- have not met generally with the success
tralize the poison Ijefore it has affected the that was hoped for: and notwithstanding
tissue ceils is marvelous and certain, but the fact that in selected cases, and in the
after the cells have been injured it is slight hands of experts, a number of persons have
and uncertain. The curative treatment in been apparently cured or greatly benefited
man, therefore, has not been followed by by several periods of treatment, in private
very satisfactory results, owing to the fact practice the dangers of tuberculin have
that the disease is generally too far advanc- been considered, by most physicians, to be
ed before it is recognized and treatment greater than its benefits. It is also probably
commenced. Still in the less acute cases safe to assert, in spite of much conflicting
of tetanus it seems to have arrested the testimony on the subject, that there are no
progress of the disease. serums at present obtainable which have
Tuberculosis.—In all its various manifes- any decided value. Tuberculin, however,
tations in man and animals this disease is has proved to be of inestimable value as an
now admitted to be caused by (^a«7//« /w/^(V- aid to the diagnosis of obscure cases of
miosis, discovered by Koch in lS,S()-2. Its tuberculosis in man, and particularly in
common modes of infection are through the cattle.
respiratory tract by inhaling the dried and One of the most remarkable features of
powdered sputum of consumptives, and modern preventive medicine is the universal
through the intestines by drinking the milk interest that has been aroused in the cruof
tuberculous cows, less often by eating sade against consumption. The practical
infected meat. Infection may more rarely results already obtained in places where
occur through inoculation by wounds of the active sanitary measures have been adopted,
skin, and still more rarely through the guarantees the belief that in this direction
sexual organs. In a very few instances it the hopes of even the most enthusiastic bid
has been supposed to have been transmitted fair to be realized. A positive decrease in
directly from parent to child. the prevalence as well as in the mortality
Either at the beginning of the infection of the disease has been effected in many of
or at any stage in its progress other micro the larger cities of this country and elseorganisms
may become associated with the where. This has been the case especially
tubercle bacillus in mixed infection, and in Xew York and severallcities of Germany
their deleterious effects may even predomi- and Great Britain, where the mortality from
nate in importance. Tuberculosis of the tuberculosis has apparently been reduced
glands, bones or joints frequently become .50 per cent, during the last twenty years,
spontaneously arrested. The same is prob- In combatting the disease our main vveapably
true also in from ten to twenty per ons are: First, education of the public in
cent, of cases of pulmonary tuberculosis, personal hygiene, particularly the poorer
Natural cure or arrest is, liowever, tlie ex- classes who do not appreciate the chief
ception rather than the rule in the majority dangers of infection, and in school and facuf
cases where the lesions have advanced tory hygiene; secon'd, the compulsory notifar
enough for detection: nor is it likely fication and registration of all cases of
that any permanent immunity is present in tuberculosis, by organized boards of health,
arrested cases. It is well known that many —the importance of this again relates espersons
readily become infected a second pecially to the very poor and improvident
time. At the same time it should l)e noted, from whom, after all, comes the greatest
as Koch believes, that even and perhaps menace to the community, and who should
chiefly in the very worst cases, as in miliary be under constant control in order that the
tuberculosis, a tendency to immunity is danger may be reduced to a minimum; and
often exhibited; but the immunization pro- third, theestablishment in suitable locations,
cess, if it be such, comes too late to prevent by the State or municipality, of Sanatoria
the fatal termination. for the training and treatment of incipient
Regarding the preventive or curative cases, and of special hospitals for the care
treatment of tuberculosis by the injection and isolation of chronic or incurable cases.