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

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

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ORIGINAL COMMUNICATIONS, 77<br />

tions are given intravenously or through <strong>of</strong> bacterial products, serums or <strong>at</strong>tenu<strong>at</strong>ed<br />

lumbar puncture. In New York City there cultures <strong>of</strong> the tubercle bacillus, the results<br />

are usually fifteen to thirty cases following so far obtained do not warrant the conevery<br />

Fourth <strong>of</strong> Juh'. Most <strong>of</strong> them are elusion th<strong>at</strong> the problem is destined to be<br />

caused by infection through blank-cartridge solved in this way, although this view by<br />

wounds. Recovery sometimes follows from no means lessens the necessity <strong>of</strong> continued<br />

the ordinary symptom<strong>at</strong>ic tre<strong>at</strong>ment or endeavor until every conceivable method<br />

without tre<strong>at</strong>ment <strong>at</strong> all, so th<strong>at</strong> the st<strong>at</strong>istics for the production <strong>of</strong> protective or cur<strong>at</strong>ive<br />

<strong>of</strong> cures <strong>of</strong> the disease by the injection <strong>of</strong> substances has been tried,<br />

antitoxic serum must be very carefully Koch's tuberculins, which are doubtless<br />

sifted before they can be accepted the best <strong>of</strong> these substances as yet prepared,<br />

The power <strong>of</strong> tetanus antitoxin to neu- have not met generally with the success<br />

tralize the poison Ijefore it has affected the th<strong>at</strong> was hoped for: and notwithstanding<br />

tissue ceils is marvelous and certain, but the fact th<strong>at</strong> in selected cases, and in the<br />

after the cells have been injured it is slight hands <strong>of</strong> experts, a number <strong>of</strong> persons have<br />

and uncertain. The cur<strong>at</strong>ive tre<strong>at</strong>ment in been apparently cured or gre<strong>at</strong>ly benefited<br />

man, therefore, has not been followed by by several periods <strong>of</strong> tre<strong>at</strong>ment, in priv<strong>at</strong>e<br />

very s<strong>at</strong>isfactory results, owing to the fact practice the dangers <strong>of</strong> tuberculin have<br />

th<strong>at</strong> the disease is generally too far advanc- been considered, by most physicians, to be<br />

ed before it is recognized and tre<strong>at</strong>ment gre<strong>at</strong>er than its benefits. It is also probably<br />

commenced. Still in the less acute cases safe to assert, in spite <strong>of</strong> much conflicting<br />

<strong>of</strong> tetanus it seems to have arrested the testimony on the subject, th<strong>at</strong> there are no<br />

progress <strong>of</strong> the disease. serums <strong>at</strong> present obtainable which have<br />

Tuberculosis.—In all its various manifes- any decided value. Tuberculin, however,<br />

t<strong>at</strong>ions in man and animals this disease is has proved to be <strong>of</strong> inestimable value as an<br />

now admitted to be caused by (^a«7//« /w/^(V- aid to the diagnosis <strong>of</strong> obscure cases <strong>of</strong><br />

miosis, discovered by Koch in lS,S()-2. Its tuberculosis in man, and particularly in<br />

common modes <strong>of</strong> infection are through the c<strong>at</strong>tle.<br />

respir<strong>at</strong>ory tract by inhaling the dried and One <strong>of</strong> the most remarkable fe<strong>at</strong>ures <strong>of</strong><br />

powdered sputum <strong>of</strong> consumptives, and modern preventive medicine is the universal<br />

through the intestines by drinking the milk interest th<strong>at</strong> has been aroused in the cru<strong>of</strong><br />

tuberculous cows, less <strong>of</strong>ten by e<strong>at</strong>ing sade against consumption. The practical<br />

infected me<strong>at</strong>. Infection may more rarely results already obtained in places where<br />

occur through inocul<strong>at</strong>ion by wounds <strong>of</strong> the active sanitary measures have been adopted,<br />

skin, and still more rarely through the guarantees the belief th<strong>at</strong> in this direction<br />

sexual organs. In a very few instances it the hopes <strong>of</strong> even the most enthusiastic bid<br />

has been supposed to have been transmitted fair to be realized. A positive decrease in<br />

directly from parent to child. the prevalence as well as in the mortality<br />

Either <strong>at</strong> the beginning <strong>of</strong> the infection <strong>of</strong> the disease has been effected in many <strong>of</strong><br />

or <strong>at</strong> any stage in its progress other micro the larger cities <strong>of</strong> this country and elseorganisms<br />

may become associ<strong>at</strong>ed with the where. This has been the case especially<br />

tubercle bacillus in mixed infection, and in Xew York and severallcities <strong>of</strong> Germany<br />

their deleterious effects may even predomi- and Gre<strong>at</strong> Britain, where the mortality from<br />

n<strong>at</strong>e in importance. Tuberculosis <strong>of</strong> the tuberculosis has apparently been reduced<br />

glands, bones or joints frequently become .50 per cent, during the last twenty years,<br />

spontaneously arrested. The same is prob- In comb<strong>at</strong>ting the disease our main vveapably<br />

true also in from ten to twenty per ons are: First, educ<strong>at</strong>ion <strong>of</strong> the public in<br />

cent, <strong>of</strong> cases <strong>of</strong> pulmonary tuberculosis, personal hygiene, particularly the poorer<br />

N<strong>at</strong>ural cure or arrest is, liowever, tlie ex- classes who do not appreci<strong>at</strong>e the chief<br />

ception r<strong>at</strong>her than the rule in the majority dangers <strong>of</strong> infection, and in school and facuf<br />

cases where the lesions have advanced tory hygiene; secon'd, the compulsory notifar<br />

enough for detection: nor is it likely fic<strong>at</strong>ion and registr<strong>at</strong>ion <strong>of</strong> all cases <strong>of</strong><br />

th<strong>at</strong> any permanent immunity is present in tuberculosis, by organized boards <strong>of</strong> health,<br />

arrested cases. It is well known th<strong>at</strong> many —the importance <strong>of</strong> this again rel<strong>at</strong>es espersons<br />

readily become infected a second pecially to the very poor and improvident<br />

time. At the same time it should l)e noted, from whom, after all, comes the gre<strong>at</strong>est<br />

as Koch believes, th<strong>at</strong> even and perhaps menace to the community, and who should<br />

chiefly in the very worst cases, as in miliary be under constant control in order th<strong>at</strong> the<br />

tuberculosis, a tendency to immunity is danger may be reduced to a minimum; and<br />

<strong>of</strong>ten exhibited; but the immuniz<strong>at</strong>ion pro- third, theestablishment in suitable loc<strong>at</strong>ions,<br />

cess, if it be such, comes too l<strong>at</strong>e to prevent by the St<strong>at</strong>e or municipality, <strong>of</strong> San<strong>at</strong>oria<br />

the f<strong>at</strong>al termin<strong>at</strong>ion. for the training and tre<strong>at</strong>ment <strong>of</strong> incipient<br />

Regarding the preventive or cur<strong>at</strong>ive cases, and <strong>of</strong> special hospitals for the care<br />

tre<strong>at</strong>ment <strong>of</strong> tuberculosis by the injection and isol<strong>at</strong>ion <strong>of</strong> chronic or incurable cases.

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