THE MEDICAL ASPECT OF TUBERCULOSIS.

Star (Christchurch), Issue 5498, 25 February 1896, Page 4

THE MEDICAL ASPECT OF TUBERCULOSIS.

At the medical congress on Feb. 5, 'Hie jusiness of the day consisted of a general lisoussion of the subject of tuberculosis. Dr Springthorpe (Melbourne), who had been asked to deal with the medical aspect of the question, said: A disease like tuber- < cular disease— whichj according to Hirschberger, kills one-fourth of .all ohildren j dying under one year old, is responsible, according to Eansome, for one-half of all deaths during marriageable ages, is ; common, according to M'Laohlan and j others, among the aged, and causes in all some 16 per cent of the total mortality m I civilised lands— merits special attention at a medical congress. (Applause.) Nor have we in Australasia any relative immunity from this universal scourge. Dr M'Laurin's statistics show that it is the greatest single cause of death throughout Australasia, and that it is already as common in our large cities as in their European compeers. Our peculiarities, as Drs Colquhoun, Corswell, and others have shown, are simply its comparative rarity in the young and frequency in the aged, and its later and slower affection of the middle-aged. , It represents a great advance to be able to maintain thatthe disease is not possible in the absence of the tubercle bacillus. Gradually we are becoming acquainted •with THE LIFE HISTORY QF. THIS EXTRAORDINARY GERM. We have long known that it resists freezing, boiling and putrefying, and hfifye lately recognised that it is not an essential parasite in :•'• ' "^arm-blooded animals, but, under favourable circumstances, may pass a saprophytic existence in polluted environment. As to its frequency in man> the appalling, death record may be taken aa an incomplete illustration. Equally suggestive is its prevalence amongst the bovines; German and English statistics show; a tubercular infection of from 15 to 20 per cent of the cattle slaughtered, and such Australian records as are valuable prove that our stock are affected in at least equal proportion. And as rfegaxds the extent of , intermediate .contamination of dwellings, buildings, conveyances, subsoil, &c, we have sufficient cause in the. myriads of bacilli coughed up daily with tubercular sputum, estimated at the John Hopkin University nt hundreds and thousands of millions per patient— some no doubt dead, as Pf eiffer haa shown, but many still living and virulent. The actual result, is seen inthe prevalence of the disease wherever people congregate together and take nb care of the infected sputum. Unfortunately in most cases, at least of advanced phthisis, the infection is not simple, but mixed. Antecedent to tubercular infection frequently cpnies invasion by the influenza ba<all__ — the pneumococcus — the systematic weakness produced by zymotic and other diseases, and side by side with the tubercle bacillus itself are found a large variety of pyococci, who now find a suitable nidus for their growth. It is to these indeed that, following good authorities as well asrecordingmy own experience and opinion, I venture to think are to be attributed most of the septic phenomena whioh cast such a cloud over advancing phthisis— e.g., the hectic, the emaciation, the sweats, the profuse, sputum, the "streptococcus curve," &c. And the recognition of this mixed infection is not only valuable pathologica_y_.it is essential to a satisfactory therapeusis. Next to its recognition the important point regarding the bacilliary factor in tubercular disease is the understanding of the means of entrance and of exit. It is beyond qnestion that environment maybe polluted, by tubercuhu* discharges, and that one serious source of tubercular invasion lies- in such polluted environment. Air and earth thus polluted are certainly frequent and extensive agents in THE SPREAD OF TUBERCULAR DISEASE., . Stop this avenue of invasion, and how much subsequent disease might not be prevented? We shall see shortly how lamentably this is neglected. Equally, if not more important is the great question of tubercular meat and milk. We have' already seen the prevalence of the disease in slaughtered animals. As regards dairy stock, statistics prove that it is far more common amongst aged milkers than ,in other classes of stock, with a greater tendency also to generalisation, and thus to transmission through meat and iinilk. Systematic and, skilled inspection of the food and milk supply thus stands out as among the most important of the hygienic functions of a Government. (Applause.) It is to the credit of English medicine that it has persistently advocated the second factor- in tubercular disease — the constitutional weakness, itsfelf a disease, upon which depends not oijly successful invasion, but rate and extent ,of spread. For the healthy human being possesses a resisting power which renders him, practically immune against the bacillus so long as he remains healthy ; and though . the disease cannot start without the bacillus, it cannot spread without the susceptibility. In what this vulnerability really consists it is impossible to say. It is a bacterio-chemical question affecting the strength of cells and serum in the struggle for existence with THE INVADING MICROBE. But for the full understanding of the tubercular question the English constitutional factor is as essential as the Continental germ factor. We require the union of the two. But whatever its inherent nature, we find clinically that it varies indefinitely in degree, and that the practical difficulty is to discover in what part of the scale the individual case is to .be placed, a difficulty which at present is often insuperable, for there is absolutely no necessary relation between progress and extent. The fact is that the constitutional factor not only varies in different individuals, from nothing to infinity, but that it varies in the same individual according to the state of the constitutional health. Herein comes the value of the inflammatory origin of phthisis, once so much insisted upon; and hereon also hinges the possibility of re-infection at any subsequent time. It is perhaps possible also to subdivide this vulnerability into a local vulnerability of mucous membranes, produced by catarrh germs, &c, and permitting invasion and a general vulnerability of tissue which allows of extension after invasion has been accomplished, and of course it is this vulnerability and not the bacillus that is the usually inherited factor. Such being the tubercular situation gene-