« ForrigeFortsæt »
in exceptional cases, be cultivated on bovine milk theory. Sir Richard Douglas Powell, one tissues. The experiments are so difficult to of the most cautious and scientific of living carry out that many have failed, and have physicians, in his evidence before the royal positively refused to believe in the successful commission, stated that he had not met with results of others. Variolation of the cow is any cases in his experience which would connevertheless a fact, and so marked is the effect nect consumption in man with the use of milk of cultivating the small-pox virus upon a soil and meat from tubercular animals. Dr. Goodwhich is foreign to it, that the highly infectious hart, consulting physician to the Evelina disease in man becomes transformed in cattle Hospital for Children, was of the same opinion. into a mild disease which is not infectious. I certainly am not prepared to attribute tuberThe effect of a foreign soil is also illustrated in culosis in children to a bovine origin, especially the result of inoculating sheep-pox in man. as the experiments of Nocard and others have This highly infectious disease of sheep, when shown that when the milk of the tubercular grafted on human tissues, is also transformed cow is mixed with the milk of healthy cows it iuto a mild non-infectious disorder.
is no longer virulent to experimental animals. We can take it for granted that in excep- In order to accept the theory that tuberculosis tional cases human tubercular virus can be in children is due to cow's milk, we should experimentally grafted on cattle, and we have have to believe that in every instance the milk good reason to believe that in exceptional supply had been obtained direct from the udder cases bovine bacilli may invade the human of a tuberculous animal without being mixed tissues. I refer to those rare cases in which
with the milk of other cows. there has been accidental inoculation. Veteri- I consider, nevertheless, that milk from cows nary surgeons, butchers, and others whose
suffering from any diseased condition of the occupation brings them into contact with udder or teats is unwholesome, and I maintain diseased cattle, do suffer from tubercular that when we pay for pure milk we are entitled nodules in the skin, which contain tubercle to have it. We want the doctrine of absolute bacilli, undergo caseation, and disappear. I cleanliness to reach our dairies, both public am convinced that human infection with the and private.
On account should any bovine variety of tubercle can only be quite 6 waster or “piner,” or cow suffering from exceptional : if it were not so, the inhabitants any disease affecting the milk, be admitted of every country in the world in which bovine into the herd. Registration and inspection of tuberculosis is prevalent would be decimated dairies are of great importance, but with or by tubercular disease. Tubercle bacilli occur without Government inspectors I think the with frequency in milk, cream, butter, cheese, public might to a great extent protect themand I have already given you some idea of the selves. It would be a distinct advantage to quantity of meat derived from animals with adopt the Danish system of co-operation. In more or less tuberculosis.
towns like Brisbane small dairymen should
combine to form large model dairies. They TUBERCULOSIS IN CHILDREN.
should invite inspection of their premises and I would next draw your attention to the farms. They would find it to their own adtheory that tuberculosis in children is neces- vantage to employ a veterinary inspector. The sarily due to infection from the milk of tuber- public would be willing to pay a higher price cular cows.
Those who advocate this view if they had a guarantee that the cows were appear to have entirely lost sight of the oppor- healthy and that every precaution had been tunities for inoculation from a human source. taken in the collection, in the transit, and in Tuberculosis of the digestive tract may result the delivery of the milk. A great deal has from swallowing sputum when there is con- been said upon the necessity of boiling milk, current disease of the lungs, and in many
other Except in time of epidemics it is not a practice ways. There are obviously many paths by likely to be generally adopted. Pure fresh which a child
be infected by the mouth inilk is an ideal food, and the boiling of milk with bacilli from a human source. A tuber- alters its composition. It is then very uncular mother may take little or no precaution palatable to many people, and is not only in nursing her children, and the habit of tast- unsuitable, but in many cases dangerous, for ing food before giving it to an infant suggests infants. Neither Dr. Powell nor Dr. Goodhart a channel of infection. Various objects, con- were prepared to recommend the boiling of all taminated by consumptive sputum, may find milk. From their evidence we may gather their way to the mouth of a child. London that they had other causes of consumption in physicians, who have had enormous experience their minds. They insisted upon the fact that with patients suffering from consumption, of tuberculosis of the bowels is almost unknown all ages, are by no means ready to accept the in very young children, and it is not very
common even in children from five to ten years effect. It is sometimes argued that though an old. Dr. Goodhart laid great stress upon the animal may be in prime condition, if there is fact that tuberculosis in children was very a single tuberculous nodule the carcase ought common when there was a distinct family to be destroyed. In my opinion there would history of tubercle, and it was quite common be no justification for the wholesale destruction also to find children becoming tuberculous of such valuable food. Compulsory destruction after measles, bronchial-pneumonia, whooping- of every animal with the slightest indication of cough, and intestinal catarrh.
tuberculosis would ruin the farming industry. I would draw attention to the fact that No Government would face the question of negro children in the West Indies suffer from compensation for every case of tuberculosis, tubercle, and they have very little milk, and however slight the lesion.
Such a this, owing to the tropical climate, is almost would involve the destruction of an enormous always boiled. Tuberculosis in children in proportion of the cattle of the United Kingdom, England is largely a disease of the poor.
and create a meat and milk famine. To secure Though it attacks all classes, it is extremely perfectly healthy cows, thus saving much loss common among the London poor and in all our and ensuring the supply of pure and wholeover-crowded towns. The disease among the some milk, will be a splendid work for veteripoor is attributable more to the want of milk nary surgeons and breeders of stock to than to the possible occurrence of a few stray
undertake, and one to which they should bacilli. Plenty of milk, good nourishing food,
direct all their energy. It can be confidently better hygienic surroundings, will with cer
asserted that there can be no better recommentainty diminish the number of tubercular
dation of Queensland meat than a very high children in England. As the slums are re
standard of health in Queensland cattle, and moved from our over-crowded cities, and when the percentage of tuberculosis in cattle in the problem of the better housing of the poor Queensland would appear to be extremely low. has been solved, we may confidently expect to
I find in the reports of the Board of Agrisee a steady diminution of consumption. In
culture out of 21,768 cattle slaughtered the Brisbane and other growing towns in Queens- proportion of tubercle was 1•1 per cent. land it should be the care of the Government, In another report of 27,905 slaughtered, the of municipal authorities, and the public that percentage of tubercle was :9 per cent. But as the insanitary conditions which we have in- I have already pointed out, it is difficult to herited in the old country should never be arrive at a correct estimate from the published allowed to arise.
returns. FLESH OF TUBERCULOUS ANIMALS.
SO-CALLED CANCER As regards any danger from consuming the It is absolutely necessary to differentiate in flesh of animals with tuberculosis, I believe it every instance the disease known as actinomy. is practically nil. There has not been a single cosis. I have already referred to the use of the case recorded of tuberculosis contracted by word “cancer" in the reports of the meat eating tuberculous meat. Jews have a very inspectors. I regret to find that this popular thorough system of meat inspecton, and yet term is still made use of. Probably those who they are by no means free from tuberculosis. use it little realise how damaging it is to the In the course of my travels in the West Indies meat industry of the State. Last year there I found that the negroes were very liable to was a correspondence in the Times in which it consumption, and Dr. Williams, of Demerara, was suggested that the increase of cancer in pointed out to the royal commission that the England was due to eating the flesh of Hindoo coolies also suffered very severely. cancerous animals imported from the colonies. Yet Hindoos eat very little meat of any kind, I took an early opportunity of pointing out the and the negroes eat meat in very
quan- absurdity of suggesting any connection between tities, and then it is beef or salt pork imported so-called cancer in cattle and cancer in the from America and well cooked before it is human subject. Many years ago I published eaten. They, however, take very
little care to an exhaustive report upon actinomycosis, protect themselves from chills, and they live which is prevalent in England. I pointed out for the most part in small and badly-ventilated that various manifestations of this disease were buildings. We are justified in concluding that known to farmers and breeders as “cancer of if the carcase is well nourished the meat is the tongue, cancer of the jaw,' cancerous perfectly wholesome, in spite of the existence polypus, osteosarcoma,” and various other of local deposits of tubercle in the viscera and misleading names. Every one of the cases glands which should, of course, be condemned. which came under my observation was shown The views of extremists cannot be carried into to be
manifestation of actinomycosis, a
local inflammatory affection associated with the bacillus; and the cultures, though differing at presence of a characteristic fungus known as first, after passage through animals strongly the streptothrix actinomyces. The disease has resemble those of tubercle.
In guinea pigs no relation whatever to cancer in the human the lesions are similar to those set up by the subject. It is this disease which is met with butter bacillus, and in rabbits they are very in Queensland, and it is most unfortunate that difficult to distinguish from true tubercle, owing the public should be alarmed by any reference to the formation of giant cells and epitheloid to cancer. I trust that in all future reports of cells and caseation. Another grass bacillus is the meat inspectors that the popular term similar in staining reactions to the tubercle “cancer" will be left out altogether, and that bacillus, but it is rather thicker and has a the scientific name for every disease will be special tendency to form threads. It produces given. Actinomycosis, though common in in guinea pigs lesions similar to those caused cattle, occurs also, though rarely, in man, and, by the butter bacillus. Another pseudo-tubercle as in the case of tuberculosis, it has been bacillus has been isolated from manure and suggested that the disease is derived from from the excrement of cows and other herbivora. cattle. It is, in my opinion, a distinct variety. Other bacilli of this class have been found by I do not accept the theory that men and Fraenkel and Pappenheim in pulmonary gananimals infect each other with actinomycosis, grene and other morbid conditions of the lungs, but I believe that they contract the disease and by Moeller in nasal and pharyngeal mucus. quite independently, and that the microorganism is derived from some source in com
PREVENTION OF CONSUMPTION. And, further, the flesh in these cases is With regard to the prevention of conperfectly wholesome, and only the tongue, or sumption, this must be left principally to the other part affected, need be destroyed.
sanitary inspector and the medical officer of health. We must not concentrate all our
energies upon the destruction of tubercular We have not only to distinguish actinomycosis sputum, but give much more attention to those from tuberculosis, but we must in future pay insanitary conditions which are responsible for close attention to distinguishing the tubercle the causation of tuberculosis. This is a matter bacillus from some recently discovered and which in Brisbane can be safely left in the closely allied bacilli. There is no doubt that the hands of the energetic Commissioner of Health. reports of the discovery of tubercle bacilli to Dr. Ham has before him a career of great an alarming extent in milk and milk products, usefulness in this city; but if he were to do and in the dust of rooms inhabited by consump- nothing more than what he has already tive patients, will have to be modified. After achieved he would deserve to be remembered the first discovery of the tubercle bacillus, all with gratitude by the public of Brisbane. I rod-like organisms with the same tinctorial refer more particularly to the institution of a characters were pronounced to be tubercle Queensland branch of the London Sanitary bacilli, with the exception of the leprosy bacillus Institute-the recognised authority for granting and a bacillus found in certain secretions, certificates qualifying persons as sanitary inFurther investigation of some of these bacilli spectors. This will have a far-reaching effect have given very striking results. The first in obtaining and maintaining a high state of discoveries in this direction were made by Petri sanitation in this town. I regard the trained and Rabinowitch, who succeeded in showing sanitary inspector as the most formidable that there was a bacillus in butter with all the opponent of diseases such
as diphtheria, general characteristics of the tubercle bacillus, typhoid, cholera, plague, and yellow fever, and further, the inoculation of this bacillus in which flourish wherever insanitary conditions guinea pigs produced lesions, which to the prevail. If only sanitary inspectors could, naked eye and under the microscope were very
without let or hindrance, carry out their duties easily mistaken for tuberculosis. Korn and under the direction of one central authority, we others have describcd other forms in butter and should soon hear of a reduced death-rate and milk not materially differing from one another, far greater immunity from epidemic diseases. and Moeller regards them as varieties of the so- The work of sanitary inspectors is one which called grass
bacillus obtained from grasses and ought to be more fully appreciated by the dust. The latter was first obtained from public, and, instead of hindrances, facilities Timothy grass, and is known as the Timothy should be put in their way when carrying out bacillus. It cannot possibly be distinguished duties which involve the general health of the microscopically from the tubercle bacillus. It is community and the saving of many human lives. granular, and exhibits branching and club-like As regards the relation between tuberculosis swellings; it stains exactly like the tubercle and insanitary conditions, we have some
evidence forthcoming from the study of the disease in animals. Tuberculosis, for instance, is peculiarly liable to occur among birds and animals kept in captivity ; poultry and guineafowls, and ostriches and emus and other birds in zoological gardens, develop tuberculosis ; monkeys in captivity, pheasants in preserves, and rabbits in overcrowded warrens sometimes die in great numbers. These examples point to the conclusion that confinement, overcrowding, defective ventilation, heredity, and breeding in and in are powerful factors in rendering the tissues prone to tubercle and a fitting soil for the invasion of the bacilli. We must also remember the danger of damp houses and the effect of a cold and foggy climate. In addition to general insanitary conditions, I desire to draw particular attention to the influence of alcoholism. This was brought most forcibly before the London Congress in an exhaustive paper by Dr. Brouardel. The influence of previous diseases has been urged by Dr. Goodhart; and special trade occupations which involve inhalation of dust of various kinds must not be overlooked. I trust that much weight will be given to these matters by the Queensland Society for the prevention of consumption.
CONSUMPTION NOT INFECTIOUS BUT INOCULABLE.
In conclusion, I would like to draw attention to the theory upon which so much stress has of late been laid, viz., that consumption is infectious. I feel very strongly that this is most misleading, and I think we ought to do all we can to allay the public anxiety which has arisen from the belief that consumption can be caught like scarlet fever. To compare it also to typhoid fever is a great mistake. In typhoid epidemics at home, in India, and recently in South Africa, we know that those in health and out of health fell victims to the disease when they took the poison in food or water. Tuberculosis is not infectious, but it is an inoculable disease. In the Brompton Hospital, in London, it has been found that among nurses, porters, physicians, surgeons, in fact among all those who have been in connection with it, the mortality from consumption is within the average of ordinary mortality. If tuberculosis were an infectious disease, and readily conveyed from person to person, the marriage of individuals who become, or are consumptive, would be a fruitful source of direct infection. We should hear constantly of instances in which married people had infected each other with tuberculosis. There is a great difference between natural infection and experimental inoculation, and to this we should attach the greatest importance.
It cannot be too widely known how virulent is the sputum of consumptive patients when inoculated in susceptible animals, and the habit of spitting in public places, and railway carriages, and other conveyances, should be prohibited. It is a disgusting habit, but there is no need to create a panic or raise an outcry for legislation, making spitting in public places a matter to be dealt with in the police court. The sputum of consumptive persons should be disinfected. A good deal of attention has been drawn to the danger of sputum when dried and raised in dust. The virulence is greater when the sputum is moist, and when it has not been exposed to sunlight. That the virus of tubercle is scattered far and wide, and is a danger to all, is not a theory which is supported by experiment or experience. For example, sputum dried and disinfected by the powerful action of the Australian sun, will be rendered inert. Dr. Ransom maintains that in a well-ventilated room sputum is harmless. Tuberculous sputum kept in the ventilating shaft of a hospital proved virulent to rodents, but similar sputum in a well-ventilated and well-lighted room became absolutely harmless. It is no doubt owing to this exaggerated idea of infection that there have been such extreme proposals as the New Zealand Act excluding tubercular immigrants. It is probably due to the same cause that there
I should like to say a few words on the subject of heredity. Heredity is of two kinds. There is hereditary pre-disposition and hereditary transmission. Inherited susceptibility renders many liable to the development of -tuberculous disease. Family history plays a very important part in tuberculosis. Sir Richard Powell stated to the commission that, in his experience, 48 per cent. of the cases in hospital suffering from tuberculosis had a previous history of hereditary tuberculosis. Dr. Klein and Mr. Victor Horsley are convinced that there is direct transmission of the virus of tubercle in some cases, and that it may exist for many years in a latent form. In connection with the question of heredity, some interesting observations have been recorded upon tuberculosis in birds. According to Dr. Baumgarten, a male bird on a poultry farm developed tuberculosis. All the chickens reared from this parent were tubercular. There was no evidence of infection with either human or bovine tubercle. An identical case occurred on another farm, and these instances have been quoted in support of the theory of direct transmission of the virus from the parent. Tuberculosis is not .a common disease in calves, and it seems probable that those cases which do occur are mostly, if not entirely, the result of hereditary transmission.
is some prejudice in Queensland against the present. These will hardly be sufficient on building of sanatoria for consumptives. There which to call it a positive reaction, yet we have is not a shadow of foundation for the theory no doubt that provided the culture be good, that there is danger to the inhabitants of a these clumps have some significance. They township if a sanatorium is erected in the may be interpreted in one of two ways-(a) neighbourhood. I trust there will be no oppo- either that the patient is in the early days of sition to erecting sanatoria for the poor
and for an attack of typhoid, or (b) that he has had paying patients. Bright sunshine, invigorating typhoid previously, some of the anti-toxin
air and cheerful surroundings are conditions which he then formed remaining in his blood which compensate in some measure for sepa- and exerting a feeble clumping action. In a ration from family and friends, alleviate the few
cases patients suffering with chronic sufferings, and give hope in many cases of diseases have given this very feeble clumping permanent recovery.
reaction, and we have not been able to deti
nitely trace a past history of typhoid, but as CONCLUSIOX.
frequently the disease is mild and goes by In the remarks I have made to-night I have other names, the question is by no means touched upon many controversial points, and I settled by the patient's statement. Our have endeavoured to indicate the lines upon grounds for saying that even slight clumping which further research is required. I trust has some significance is that we have watched that those engaged in scientific inquiries in the action of blood of numberless diseases on Queensland will help to throw light on these the typhoid bacilli, and, with the exception of a points. The report of the new Royal Com- few cases noted elsewhere, there has been no mission now sitting in London will be awaited sign of clumping after an hour or more. with interest, but in the meantime there is no
It is impossible to write down what extent uncertainty as to the course to be adopted by of clumping constitutes “positive;” different those responsible for the public health. What
observers might look at the same reaction ever the result of that inquiry may be as regards (provided it is not marked) and yet have the relation of bovine to human tuberculosis, different views as to the result. As a rule, in we know that there are many factors in the our experience, the bacilli, if they are going production of this disease.
to clump, will at least commence to do so within The removal of insanitary conditions by the twenty minutes; in those cases where they do co-operation of the public with sanitary officials
not, the clumping, if it does appear later will secure for Brisbane the enviable position
on, is never very marked and not of great of being conspicuous among all the great cities
diagnostic value. It is not necessary for all of the Commonwealth, on account of its low the bacilli to be clumped; even in marked death rate and practical immunity from all reactions it is common to see some free and epidemic diseases.
actively mobile. Preceding the clumping there
is always a diminution of motility, but too THE WIDAL REACTION.
much stress should not be laid on this alone,
as without the addition of blood the bacilli tend ITS PRACTICAL WORKING AT SYDNEY
to become much slower in their movements HOSPITAL.
after ten minutes or so. The intensity of the
reaction is not always in accordance with the J. L. T. Isbister, M.B., C.M. (Adel.), late Resident
severity of the disease. Pathologist;
Day of the disease on which the reaction appears. C. Y. Bowker, M.B., Ch.M. (Syd.), Medical Superin
This is impossible to fix, since it varies so inuch. tendent and late Resident Pathologist; and
This we can say, however, that it is not usually H. Skipton Stacy, M.D., Ch.M. (Syd.), late Resident
present in the first week. We frequently get Pathologist.
it about the eighth day, but never well marked
till at least a few days later. The longer the ONE of the most common beliefs about the patient has been ill the more marked the rewidal reaction is that if the result is not action, and it is not at all uncommon for the “positive” it must be undoubtedly nega. clumping to have taken place before it can be tive." Now this is far from being the case. examined under the microscope. On the other There are a certain number of reactions which hand, there are a few cases of typhoid which are on the borderland between the two, and it fail to give it throughout their course, but is with these that judgment and great experi- show it during the relapse. This has happened ence of the reaction are necessary.
For in several cases, and makes one wonder whether instance, after the lapse of, say, 50 or 60 the relapse is in any way due to the deficiency minutes, there may be a few small clumps of the anti-toxin in the blood. Unfortunately