Mycobacterium tuberculosis

“ In rare cases distribution by the blood is the principal method of extension, and immense numbers of small foci of disease are produced, the form of disease being known as acute miliary tuberculosis. Although the bacilli are distributed everywhere, certain organs, as the brain and muscles, are usually exempt, because in these the conditions are not favorable to further growth of the bacilli. Tuberculosis, although frequently a very acute disease, is usually one of the best types of a chronic disease and may last for many years. ”

“ As the results of tuberculin injection in the consumptive are something like an attack of grippe, and as tuberculin is not wholly devoid of danger to these patients, this test should be reserved to the last, and is only to be used by a physician.
Treatment.—There is no special remedy at our disposal which will destroy or even hinder the growth of the germs of tuberculosis in the lungs. Our endeavors must consist in improving the patient's strength, weight, and vital resistance to the germs by proper feeding, and by means of a constant out-of-door life. ”

“ In dead tubercular tissue living tubercle bacilli are often found. If the organisms so situated do not escape in some way from the body, they may find a nest for themselves there, and so set up fresh centers of tubercular disease. This fact clearly indicates that the treatment of tuberculosis by this new remedy must be continued for some time. From what is now known, it seems likely that about six weeks will be required to rid patients in the early stage of consumption of the symptoms of their disease. ”

“ The tubercular organism reacts in the same manner to dead as to living bacilli; the tuberculous animal has acquired immunity against reinfection or reintoxication by the tuberculous virus, which, however, in no way prevents the first inoculation from becoming generalized and setting up a tuberculosis of almost all the organs. ”

“ It may be months, years, or decades before the infection leads to manifest disease. This depends on the virulence of the virus, which is generally much greater in the virus of bovine tuberculosis than in that of human tuberculosis. It also depends on the number of bacilli introduced per stomach, and whether such introduction is single or oft repeated. In the human being months and years may elapse before the infection is followed by any sensitiveness to tuberculin injections in the usual dose. ”

“ The great advantage which this method possesses over all others arises from the fact that the course of a successful tubercular inoculation can be watched throughout by the experimenter until the pathological process has advanced so far that the whole organism—the neighboring lymphatic glands, the lungs, spleen, liver and kidneys—becomes tuberculous. A further point in favor of this method of inoculation is that spontaneous tuberculosis of the eye has never been observed in rabbits. ”

“ Of course, I presuppose that we understand by tuberculosis only those morbid conditions which are caused by the tubercle bacillus. In by far the majority of cases of tuberculosis the disease has its seat in the lungs, and has also begun there. From this fact it is justly concluded that the germs of the disease—i. e., the tubercle bacilli—must have got into the lungs by inhalation. As to the question where the inhaled tubercle bacilli have come from, there is also no doubt. On the contrary, we know with certainty that they get into the air with the sputum of consumptive patients. ”

“ Yet until recently consumption has not been recognized as a contagious disease, and the factor of predisposition, as determined by heredity, lack of proper air and exercise, failure of vital strength, impoverished blood, "weak lungs," etc., has been considered paramount. It is certainly true that a robust person may be placed in the most intimate contact with the germs of tuberculosis and throw them off or inclose them as inert foreign bodies in his tissues ”

“ The bacillus attacks every organ and tissue of the body, but some much more frequently than others. The commonest seats of tuberculous disease are the lungs, lymphatic glands, bones, serous membranes, mucous membranes, intestines and liver. Before the discovery of the bacillus its effects in different parts of the body received separate names and were classified as distinct diseases. For instance, tuberculosis of the lung was called "consumption" or "phthisis," of the bones and lymphatic glands "struma" or "scrofula," of the skin "lupus," or the intestinal glands "tabes mesenterica." ”

“ It must be remembered that the tubercle bacillus causes not merely disease of the lungs in children but also a large majority of the crippling diseases of the bones, joints, and spine, together with the whole group of strumous or scrofulous disorders, and a large group of intestinal diseases and of brain lesions, resulting in convulsions, paralysis, hydrocephalus, and death. The battle-ground of the future against tuberculosis is the home. ”

“ All these doubts and difficulties in connection with the diagnosis of tuberculosis in children serve to show that in a way this question may be called a negligible one, negligible, that is to say, as a menace to public health. It is important for the individual that a diagnosis be made, in order to do intensive work in upbuilding his resistance, but he is negligible as a distributor of infection. ”

“ These late infections may in isolated cases be referable to the inhalation of tubercle bacilli. They may, however, be due to already existing tubercular lesions, and so be regarded as auto-infections or metastases. Were we to inject into the tissue juices of a person not yet partially immunized against tuberculosis an amount of tubercle bacilli equal to that usually found in the lungs of consumptives, the person would die of an acute miliary tuberculosis, but he would never develop pulmonary consumption. ”

“ Pulmonary consumption is not hereditary in the strict sense of the word. Only an inclination to this [12] disease is transmitted. As the danger of contagion of those having such disposition is very great, so as a rule the disease makes its appearance sooner or later.
On the other hand it must be considered that the penetration only of the tubercle-bacilli into the body is not sufficient to generate tuberculosis. If they do not find the ground adapted to their nourishment and propagation they perish. ”

“ What has been all through these years regarded as the strongest proof of the hereditary transmission of tuberculosis—namely, the occurrence of the disease in several members of the same household—is, in the new light, simply the result of household infection—the breathing of air especially liable to contain the noxious germs, or their entrance in some other way into the bodies of persons especially sensitive to their presence. I do not mean to imply that under no conditions can the tubercle bacillus be transmitted from the mother to the child before its birth. ”

“ A thorough study of the history, thorough physical examination, examination of sputum (if any) give sufficient data for a reliable diagnosis in the vast majority of cases.
2. Cases, with uncertain symptoms or inconclusive physical signs, pointing to possible existence of tuberculous infection, may be treated as "suspicious" cases (without resorting to subcutaneous tuberculin test) , the treatment consisting of rearrangement of mode of life, diet, work, etc., that would tend to increase of general resistance of the patient. This can and should be done in the vast majority of suspicious cases. ”

“ In no case, however, was the growth of the virulent bacilli wholly suppressed.
In man the question of acquired immunity has been answered by many authorities, as far as the main considerations go, in the negative. A large number of well-observed facts demonstrates that a person who has suffered from localized tuberculosis of the lymph glands—scrofula so-called—or other form of local tuberculosis, can not count upon an immunity from pulmonary tuberculosis. ”

“ Any physician who fails to search for tubercle bacilli in the sputum, to establish phthisis in as early a stage as possible, commits gross negligence toward his patient, because his life may depend on this diagnosis and the specific treatment which has hurriedly been introduced on this basis. In doubtful cases the physician should gain certainty as to the existence or absence of tuberculosis through a trial injection. ”

“ In order to successfully treat the condition, early recognition, before much destruction of tissue has taken place, is imperative. Early diagnosis, by means of inoculation, means a successful cure in a large proportion of cases. Hump-backed children, from tuberculosis of the spine, and permanent lameness from hip-joint disease, are rapidly becoming misfortunes of the past. Not only the way in which tubercle bacilli act in various tissues, but the methods of their transmission, are now known, thanks to animal experimentation. ”

“ If the bacilli of bovine tuberculosis were able to infect human beings, many cases of tuberculosis caused by the consumption of alimenta containing tubercle bacilli could not but occur among the inhabitants of great cities, especially the children. And most medical men believe that this is actually the case.
In reality, however, it is not so. That a case of tuberculosis has been caused by alimenta can be assumed with certainty only when the intestine suffers first—i. e., when a so-called primary tuberculosis of the intestines is found. ”

“ The acute miliary tuberculosis in man, which can be clinically diagnosticated, is to be regarded as a provocative secondary infection, resulting from scrofula of the blood-vessels’ intima when, on the disintegration of cheesy intima tubercles, a great many tubercle bacilli are thrown into the circulation at once. ”

“ Neither lasting nor marked immunity in tuberculosis can be obtained by the inoculation of cultures of tubercle bacilli killed by heat, sunlight or other agency. Dead tubercle bacilli are poisonous and bring out a striking reaction of the organism, but this reaction does not confer immunity to subsequent inoculations of the living germ. ”

“ There is no doubt that the widespread popular interest and agitation against tuberculosis has overemphasized the importance of the tubercle bacillus, and the diagnosis and care of tuberculous patients. But equally or even more important is the prevention of the disease by sanitation, personal hygiene and increase of individual resistance to it. The bacilli, as Osler says, are ubiquitous, and practically every person is exposed at some time to infection. ”

“ We must destroy the bacillus; and we must render the organism of the individual resistant to infection. The disposition of the tubercle bacillus is theoretically extremely simple. Tuberculosis as an infectious disease is totally unlike certain others, as, for instance, diphtheria or scarlet fever. One can not be sure, after having been half an hour in the same room with a diphtheria patient, that he will not contract the disease. If, however, certain very elementary precautions are taken, one may live with a consumptive for months or years without jeopardizing his health. ”

“ The comparative immunity of the very young does not extend to all forms of tuberculous disease. On the contrary, tuberculosis of the bowels and mesenteric glands (tabes mesenterica) , tuberculous peritonitis and tuberculous meningitis are pre-eminently diseases of childhood. The tables at foot of page show in detail the relative incidence of pulmonary phthisis at different ages, and the steady diminution of the disease in England and Wales since 1850.
Occupation has a marked influence on the prevalence of pulmonary tuberculosis. ”

“ Finally the tuberculous tissue breaks down and liquefies, resulting in the formation of a cold abscess. In their struggle with the tissues, tubercle bacilli receive considerable support and assistance from any pyogenic organisms that may be present. A tuberculous infection may exhibit its aggressive qualities in a more serious manner by sending off detachments of bacilli, which are carried by the lymphatics to the nearest glands, or by the blood-stream to more distant, and it may be to all, parts of the body. When the infection is thus generalised, the condition is called general tuberculosis. ”

“ Perhaps others have had different experiences and have made observations that do not agree with this, for cases of tuberculosis have been reported cured through fasting. It is well to bear in mind that every case that is diagnosed pulmonary tuberculosis is not tuberculosis. Many supposed-to-be cases of tuberculosis, some of them so diagnosed by most reputable specialists, are nothing more than lung irritation due to the absorption of gas and acid from the digestive tract. When the indigestion is cured, the so-called tuberculosis disappears. ”

“ Let us now glance at the germ called the tubercle bacillus, the germ which induces and which alone can induce tuberculosis. It does not exist and thrive in the body of men or animals in health. Without the entrance of this particular germ into the human body from without, tuberculosis cannot develop in it. Without the transmission of this germ in some way or other in a living condition from the sick to the well, tuberculosis cannot spread. In the life-story of this tiny germ lie both the potency for mischief which we deplore and the secret of our release from its bondage. ”

“ Tubercle bacillus--Methods of infection--Inherited and acquired
predisposition--Relationship of tuberculosis to injury--Human and bovine tuberculosis--Action of the bacillus upon the tissues--Tuberculous granulation tissue--Natural cure--Recrudescence of the disease--THE TUBERCULOUS ABSCESS--Contents and wall of the abscess--Tuberculous sinuses. Tuberculosis occurs more frequently in some situations than in others; it is common, for example, in lymph glands, in bones and joints, in the peritoneum, the intestine, the kidney, prostate and testis, and in the skin and subcutaneous cellular tissue ”