HUMAN AND BOVINE TUBERCULOSIS.

Lyttelton Times, Volume CXX, Issue 14981, 29 April 1909, Page 9

HUMAN AND BOVINE TUBERCULOSIS.

<>. (By Dr NATHAN RAW, Liverpool.) (" British Medical Journal.")

In the year 1903 I made a communication to the " British Medical Journal," in which I stated that tubercle bacilli of bovine origin had been isolated from lesions in the human body. At almost each successive meeting of the British Medical Association I have had the opportunity of putting forth my views on the relationship between human and bovine tuberculosis, and the part played by infected milk in the production of tuberculosis in the human body. In 1903 I expressed the view that the two forms of tubercle were different varieties of a common species, and that the doctrine of the unity of tubercle could not be maintained. The result of a very extensive study both clinical and pathological, since that time has only served to strengthen my views, although, of course, I have not been able to produce absolute scientific proof, since tho human body can never be used for- purposes of experiment.

To summarise the case very briefly, Koch enunciated the view in 1901 that human and bovine tuberculosis were different diseases, and that bovine tuberculosis could not be conveyed to the human. The most elaborate and exhaustive experiments conducted by different observers throughout the whole of tho world have oidy served to show that the great master was wrong in his contention that bovine tuberculosis could not be conveyed to the human. On the other hand, they have successfully shown beyond all reasonable doubt that tuberculosis must be classified according to its origin, and that human and bovine tuberculosis must be considered as of different varieties. I will not enter here into tho description and result of innumerable experiments whieh have been made with a view to solving this intricate problem. In my opinion, they have settled the broad question of the difference between tho two forms, and have also settled for all time the more important fact that tubercle bacilli of "the bovine type are able to. set up numerous lesions in the human body. Hitherto it has been assumed that all tubercle bacilli recovered from the human body are necessarily of human origin, but this is certainly not so, and the Royal Commissions havo shown that from 12'per cent to 20 per cent of tuberculous lesions in the human body are produced by bacilli of the bovine type. I would venture to suggest that in children, during the milk-drinking period, even a larger percentage or tuberculous lesion's will ultimately prove to be of bovine origin. The theory which I placed before you in 1903, and which further observation only tends to. confirm, is briefly as follows": v

" That tuberculous lesions affecting the human body must be divided into two great groups according to their origin, and that the true example of human infection is pulmonary tuberculosis."

In other words, man is susceptible to both forms of the disease. Bacilli of typhus humanus produce pulmonary tuberculosis, tuberculous laryngitis and secondary intestinal ulceration. Bacilli of typhus bovinus produce tuberculosis of (1) mesenteric glands; (2) peritoneum ; (3) lymph glands; (4) bones and joints; (6) meninges; (6) lupus;. (7)| genito-urinary apparatus; (8) middle ear. and acute miliary tuberculosis. Post-mortem examinations of cases of pulmonary tuberculosis are remarkable in this respect, that the tuberculous process in tho great majority of cases is strictly limited to the lungs, and the most careful search will fail to discover any other deposit of tubercle; In a small proportion of cases the larynx is extensively involved, and when this is the case there is invariably extensive secondary ulceration of the intestines. We must look upon the lungs, then, as the natural habitat of tubercle bacilli of the human type, producing what is called "consumption," a disease which has been unfortunately for thousands of years in our midst, and which will only be stamped out by education, improved dwellings and destruction of sputum, as well as by the advances of sanitary science. I was impressed last year in Vienna, when attending the pathological department of the hospital, by the fact that deaths from phthisis pulmonalis wore not examined, as there was nothing to observe' excepting the lungs and intestines. Now, if all tuberculous lesions were caused by one identical bacillus, why should tho be so constantly affected in one form of the disease and other parts of the body in another form, the lungs in the latter form being generally exempt" I maintain that phthisis pulmonalis is in a class by itself, that it is caused by the typus humanus, and it does not attack the other viscera, and that practically all other tuberculous lesions are tho result of infection, generally in infancy, through the digestive intes-

tinal tract by milk and other food products containing bovine bacilli. ' The spaco at my disposal will not permit mo to discuss tho clinical distribution of tubercle, but having postulated my theory, I would like to say a few words with regard to the more important question of its bearing upon treatment. From a long and extensive experience, I am a firm believer in treatment by tuberculin, but different forms of the disease require different varieties of tuberculin.'

I havo long ago come to the conclusion that ordinary cases of phthisis pulmonalis are not benefited by Koch's tuberculin (either old or new), which is, as you know, prepared from human tubercle bapilli. von Behring and Romer have done splendid work in the immunisation of cattle against bovine tuberculoses, but they have come to the conclusion that it is impossible to' produce even a slow immunity by injecting small doses of tubercle bacilli of the bovine type, and that they can produce complete and lasting immunity by injecting cattle with bacilli of the human type. Working on the hypothesis that the human body is attacked by two varieties of tubercle, which may bo present in the body at the same and which, generally speaking, are antagonistic to each other, I have devoted my attention within the last few months to the preparation of tuberculins for the treatment of these different lesions. After a fairly complete experience, I have come to the conclusion that Koch's tuberculin R. has little ot no healing effect in phthisis pulmonalis, and when we remember that it is manufactured from human tubercle, if my theory is correct it is exactly what we would expect. Consequently, I have prepared from one oi my own pure cultures from bovine sources a special tuberculin for tho treatment of phthisis pulmonalis. The tuberculin was made from a typical culture of Perlsucht, and was very carefully sterilised and standardised. Several guinea-pigs were inoculated, but without any bad effect. Working on these lines I am at presest treating over seventy cases of surgical or bovino tuberculosis in the. wards of Mill Road Infirrriary with Koch's tuberculin R., commencing with very small doses and slowly increasing up to a maximum dose of l-100mg. The results, without any accessory treatment, have been beyond all my anticipations. Enlarged glands, joints, and lupus have been immensely improved, whilst discharging sinuses have cleared. up. and in two cases the symptoms of tuberculous meningitis associated with tuberculous peritonitis entirely disap-. peared. On the other hand I nave treated twenty-five cases of early phthisis, six of which were associated with hoemoptysis, andall of which showed tubercle bacilli in

the sputum, with distinctive physical signal at one apex, with the tuberculin prepared from a pure culture of bovine, tubercle (kindly supplied to me by Professor Calmette, of Lille). These cases are still under treatment, but up to the present many of them have shown marked improvement, with total disappearance of physical signs. It is too soon yet to speak of the final results of treatment, but I hope to publish them after one year. '..' With a view to produce immunity against human tubercle in children, especially in those who have been exposed to infection from a consumptive father or mother, I have lately been' working with the serum of tuberculous /

cattle. I have purchased several dairy cows suffering front tuberculosis of the udder, and have obtained, ' with the kind co-operation of Professor H. E. Annett, a large amount of the serum of these cows. This serum has been very carefully sterilised and injected into guinea-pigs without any ill effects. I believe that the serum of a. cow which lias suffered from bovine tuberculosis will confer such immunity when injected into a'child as. will suffice tc •protect him against an attack of human tuberculosis. Considering the laTge number of children who are attacked by phthisis as the direct result of contact with a consumptive parent, a protective./serum would be an immense step in the direction of stamping out consumption. In any case, the serum is quite harmless, and will only be used with the full consent of, those parents whose children have boon exposed to infection. I have lately been using small prophylactic, doses' of bovine tuberculin in tho cases of children, whose parents have died of phthisis, with the object of producing an immunity against pulmonary tuberculosis. So far eleven children havo been inoculated without the slightest reaction, but ot course it is too soon yet to consider results. From this series of cases of phthisis pulmonalis, .the results of, which I. shall publish in the course of another twelve months, I am convinced that the tuberculin prepared from bovine sources has a most marked and curative effect in tuberculous affections of the lung, but my, experience teaches Jne that,'first, tho patient must have a certain amount of natural resistance to the organism. If this is not present at. tho time of observation, endeavours must be made by feeding and general tonics to raise the resistance somewhat /before the tuberculin treatment is commenced. If it is found" impossible with the aid of pure air, nutritious food, blood tonics, etc., to improve the resisting power, ■ I have come to the conclusion that tuberculin it6olf will not be of much avail. At present lam quite certain that every early case of phthisis under suitable conditions should be inoculated with bovine tuberculin.