November 12, 1908J 



NA TURE 



49 



efforts are being made by sanUary authorities all over the 

 civilised world to combat this disease. It was realised, 

 as never before, how widespread and serious are the 

 results of tuberculosis, and at the same time how keenly 

 alive, not only the medical profession, but health authori- 

 ties generally, have become to the importance of dealing 

 even in drastic fashion with the " white scourge." At the 

 end of each day a popular lecture on some aspect of the 

 question was given, these lectures being entrusted to Dr. 

 I'annwitz, on tuberculosis in its social aspects ; Dr. Theo- 

 dore Williams, on the history of the treatment of tuber- 

 culosis ; and Dr. Calmette, on the tuberculin ophthalmic 

 reaction, with which his name is now so intimately associ- 

 ated. This preliminary conference had a special interest 

 from the fact that it was authoritatively stated that Koch 

 had been somewhat misunderstood at the London" congress, 

 and that his position as regards the non-transmissibility of 

 bovine tuberculosis to the human subject was not so 

 directlv opposed to what may be called the popular view 

 as had been held to be the case. Needless to say, such an 

 expression of opinion was received with almost a sigh of 

 relief by those who are convinced of the possibility of such 

 conimunicability. So strongly was the congress impressed 

 with the necessity of ensuring a milk supply free from any 

 possible contamination by tubercle bacilli that on the last 

 day Prof. Heymans, of Ghent, moved, and it was passed 

 with acclamation, that a committee to inquire into the 

 conditions under which milk may become so contaminated 

 be appointed, and that it report at the conference to be 

 held in Brussels in 1910. This committee is thoroughly 

 international, and representative of both the medical and 

 veterinary professions. 



During the Philadelphia week large numbers of those 

 specially interested travelled to Washington to inspect the 

 excellent museum that had been brought together by an 

 energetic organising committee under Dr. H. J. Beyer. 

 No such complete, interesting, and instructive exhibition 

 had ever been brought together before, partly because no 

 such material had hitherto been available. It is open to 

 question whether medals and prizes constitute a desirable 

 means of stimulating exhibitors, but in this instance, 

 although we hope that this distribution of prizes will not 

 form a regular feature of these exhibitions, our American 

 cousins may claim that the success that has attended their 

 efforts justifies the means emploved. In the matter of 

 prizes, especially monev prizes, Great Britain comes out 

 well ; Brompton Hospital, represented by Dr. Theodore 

 Williams, Dr. Lathom, and Dr. M. S. Patterson, takes a 

 prize of one thousand dollars offered for the best exhibit 

 of a hospital for the treatment of advanced cases of pul- 

 monary tuberculosis, whilst the one thousand dollar prize 

 offered for the best exhibit of an existing sanatorium 

 for the treatment of tuberculosis amongst the working 

 classes was divided between the Brompton Hospital 

 .Sanatorium at Frimley and the Whitehaven Sanatorium at 

 Whitehaven, Pa. 



.Another prize, part of which came to our side of the 

 Atlantic, was that offered for the best evidence of effective 

 work in the prevention of tuberculosis since the last con- 

 gress held in Paris three vears ago, the Women's National 

 Health Association of Ireland and the committee on 

 tuberculosis of the New York Sanitary Organisation 

 -Society dividing both the honours and the money. Other 

 nrizes were the first gold medal, awarded to Great Britain, 

 for the best p.ithological exhibit, and a silver medal to 

 Dr. Sims Woodhead and Mr. William Henman for plans, 

 with elaborate details and descriptions, of a sanatorium. 

 These are given as examples of the range of subjects for 

 which prizes were aw.Trded ; but others were an exhibit of 

 the best laws and ordinances in force on June i, iqoS, for 

 the prevention of phthisis, for which the State of 

 Wisconsin was awarded a gold medal. New York Citv 

 taking a simil.nr award for the best set of laws and 

 ordinances for the prevention of phthisis shown by any 

 municipality in the world, whilst the awards gained by 

 the National Swedish .Anti-Tuberculosis Association further 

 illustrate the eclectic chnricter of the exhibits. This 

 association gained two gold medals, one for having the 

 largest number of any orgrmisatlon in the world which is 



NO. 2037, vor,. 7o] 



fighting phthisis, and a second for exhibiting the best 

 plans tor raising money with which 'to wage the crusade 

 against tuberculosis. .Again, Dr. D. Sarason, of Berlin, 

 received a gold medal for models and plans showing new 

 and interesting principles in house construction in its 

 relation to the prevention of tuberculosis. These are simply 

 examples of a large number, but they serve to indicate 

 the lines on which the organising committee got together 

 a good museum — by making a definite demand, a demand 

 which in most cases was promptly met . from many 

 quarters. Certain of the visitors before seeing the exhibi- 

 tions scarcely seemed to realise that many of the schemes 

 and plans described in connection with the various 

 American " municipalities were anything more than paper 

 plans, but the working plans, models, and statistics soon 

 made it clear that a large amount of very valuable work 

 has been done and effective measures taken to stem the 

 tide of tuberculosis. 



Although a great deal of educational work was done 

 in the pathological, clinical, social, surgical, municipal, 

 veterinary, and other sections, there can be little doubt 

 that the centre of interest was the discussion in the com- 

 bined sections of bacteriology and tuberculosis of animals, 

 at which Prof. Koch maintained that the practical aspect 

 of the question was so important that he felt justified in 

 confining his attention to it. He was satisfied that the 

 tubercle bacilli in bovine tuberculosis were different from 

 those In human tuberculosis, and that although human 

 beings may be infected by the bovine tubercle bacilli, 

 serious disease rarely occurs as a result of such infection. 

 The human bacilli, on the other hand, play a far more 

 important role in the spread of tuberculosis. He did not 

 claim that the results announced at London were final. He 

 and Dr. Schultz then asked that their experiments should 

 be repeated. Many experiments had been carried on, but 

 he should still like to ask how far sources of error had 

 been eliminated. Animals must be free from spontaneous 

 tuberculosis, the early stages of which cannot be recog- 

 nised. 



Tuberculin, of course, had to be used in connection with 

 this work. Further, it was evident that experiments on 

 too small a series of animals could carry but little weight. 

 Then all animals must be protected from any external 

 infection, especially that of bovine origin, and it was, of 

 course, essential that different series of experiments should 

 be kept absolutely separate. All the infections should be 

 made by subcutaneous injection with early cultures that 

 had not passed through more than a single guinea-pig. 

 Me believed that doses of ten milligrams were most satis- 

 factory, and he was satisfied that it was a mistake to 

 use too large doses or to introduce the virus by intra- 

 venous or intraperitoneal injection. Of course, there 

 should be no contamination of the cultures. He and his 

 colleague had found that all bacilli from bovine source, 

 when injected into cattle, gave rise to progressive, and 

 ultimately generalised, lesions, but that tubercle bacilli of 

 human origin gave rise to localised and regressive lesions 

 only. He wished to point out, too, that as experiments 

 must necessarily extend over long periods, it was essential 

 during this time to eliminate the possibility of secondary 

 Infection. Finallv, they had to remember that mixed 

 infection by the human and bovine bacilli might occur. 



In regard to the experiments of the British comnii'is:on. 

 he pointed out that immense quantities of phlhi-iral 

 sputum had been given to calves and pigs, and that It was 

 possible that this sputuin had contained milk or butter in 

 which were bovine tubercle bacilli. 



The first case to which he referred was placed amongst 

 the positive results. To be of value, he considered that 

 the sputum should have been taken from one case only, 

 and that all possibility of infection by either milk or butter 

 should have been eliminated. He thought the British 

 Roval Commission failed in several respects, and that many 

 of ills opponents had not been sufficiently careful on certain 

 of these matters. He maintained that he had never held 

 that we were dealing with two distinct species, but that 

 we had to deal with two different types. 



Bearing this in mind, he considered that laboratorv 

 experiments, bearing on modification of the characters of 



