50 



NA TURE 



[November 12, 1908 



the bacilli, were merely of academic importance, and that 

 any question arising out of them was merely of theoretical 

 value. We had to deal with the properties of " fresh " 

 bacilli, and with these only. He believed that competent 

 investigators were in agreement that the human tubercle 

 bacillus differs from the bovine tubercle bacillus, that this 

 latter does not cause progressive tuberculosis in man, and 

 that, therefore, from the practical point of view, it might 

 be left out of consideration in our crusade against 

 tuberculosis. 



Prof. Theobald Smith, though agreeing with certain of 

 Dr. Koch's contentions, was by no means in accord with 

 him as to the sharp line of demarcation that he drew 

 between the human and bovine types of the tubercle 

 bacillus. He believed, moreover, that there was an actual 

 increase of virulence obtained by passage, and that a selec- 

 tive and protective action of the tissues probably comes into 

 play, and he was convinced that increased virulence did 

 not mean change of type. 



Prof. Sims Woodhead claimed that in no sense of the 

 word did the members of the British Royal Commission 

 regard themselves as Koch's opponents. He believed they 

 were all working to one end — the elucidation of a problem 

 which Prof. Koch had set before them, a problem he was 

 satisfied they -were all an.xious to solve, in great measure, 

 too, because of the respect in which they held their great 

 colleague, though even his great authority could not out- 

 weigh their own observations and conclusions. In regard 

 to the conditions laid down by Koch, the British Royal 

 Commission had exercised the greatest care to observe 

 each one. Their Government had been induced to spend 

 a very large sum in order to provide sufficient help, and 

 through the patriotic generosity of Lord Blyth a couple of 

 farms, a considerable distance from each other, which 

 could be completely isolated, and a central laboratory 

 between the two, to which material to be worked out 

 could be brought, thus doing away with any necessity for 

 any direct communication between the farms, had been 

 placed at their disposal. .As to animals, they were 

 fortunate in having near thom an island in which tubercu- 

 losis had never yet broken out among the cattle — Jersey — 

 and from which they had been able to obtain a very large 

 supply of bovines on which to carry out their very numerous 

 experiments. They had obtained the assistance of well 

 trained and enthusiastic experts in whom they had every 

 confidence, and the results they had obtained had been 

 set forth in their reports in the greatest detail, so that 

 those who questioned their opinion might see the data 

 on which they were founded, and he asked anyone who 

 read their report to go to the appendi.x to the report for 

 the details of any case in which they thought there 

 might be any doubt ; thry might then form their own 

 opinions. 



He asked them to accept all this as evidence that they, 

 the commissioners, and their Government were at one with 

 Prof. Koch in looking upon the question as an intensely 

 practical one. They felt that no stone should be left un- 

 turned to test the accuracy of statements of such enormous 

 importance, and from the experimental evidence they had 

 been able to obtain they were of opinion that conclusions 

 had been arrived at on quite insufficient data. Prof. Koch 

 had criticised a single one of their experiments. They 

 had taken the utmost care to eliminate the dangers that 

 Prof. Koch had pointed out ; but, allowing for a moment 

 that there were flaws in this experiment, one of the 

 earliest that they conducted, he would direct attention to 

 other cases, bearing on the same point, in which he believed 

 they would find no such opening for criticism. It could 

 not be a question of merely " academic " interest when 

 some 30 per cent, of the cases under five years of age 

 reported by the two commissions, the British and the 

 German, were of alimentary origin, for, as calculated by 

 Dr. Cabbett, this meant that about 7 per cent, of the cases 

 of tuberculosis probably resulted from infection from a 

 bovine source, and 7 per cent, of the cases, allowing a 

 little latitude on either side, could not be looked upon as 

 a negligible quantity. Prof. Koch had stated that the 

 alimentary cases were selected, but he should like to point 

 out that at first this was done for a short time because 

 Prof. Koch had been able to find so few cases in Germany. 

 Later they found this unnecessary. 

 NO. 2037, VOL. 79] 



In regard to the question of modification of tubercle 

 bacilli, he was not in a position to say more than had 

 appeared in the report of the commissioners, but he would 

 like to point out that the period after the infection at 

 which the disease manifested itself was so great that many 

 people could not bring themselves to believe that cause 

 and effect were in any way associated, and they scoffed 

 at the idea of tuberculosis being infective. Would not 

 this slow growth place similar difficulties in tracing the 

 modification eitlier of morphological characters or of 

 virulence of the tubercle bacilli? Was it not possible, 

 how'ever, that some of the conditions that regulated the 

 modification of the more rapidly growing bacilli should 

 obtain in the more slowly growing bacilli, allowing, of 

 course, for the much longer period necessary for these 

 modifications to come into effect? 



He thought that those who undertook the responsibility 

 of saying that there is no danger to the community, either 

 directly or through an increase of tuberculosis amongst 

 cattle, accepted a very grave responsibility indeed, and for 

 his part he was so impressed by the evidence that had 

 already been obtained, not only in England, America, and 

 Germany, but in France, Denmark, and elsewhere, that 

 he should be loath to countenance the relaxation of a single 

 regulation having for its object the extermination of bovine 

 tuberculosis. Indeed, he would go further, and say that 

 in the interests of the public health still more stringent 

 regulations might have to be put into force. 



The outcome of the various discussions may be summed 

 up in the statement that there can be no tuberculosis with- 

 out the tubercle bacillus, and that although under certain 

 conditions the human subject and the lower animals may 

 resist the invasion of this micro-organism, there are times 

 and conditions in which the vitality and resisting power 

 of the tissues are so greatly impaired that the tubercle 

 bacillus is able to invade the body and cause degenerative 

 lesions in the tissues, and tuberculosis is set up. It was 

 agreed that no hard and fast rule can be laid down for 

 every set of conditions under which the tubercle bacillus 

 is or may be present, but that every means should be 

 taken to kill the bacillus as it comes from any centre of 

 infection before it has had time or opportunity to infect 

 other organisms, and that at the same time all possible 

 means should be taken to raise the insusceptibility or 

 resisting power of any organisms that may be attacked. 

 In open and advanced cases of tuberculosis isolation of the 

 human being and slaughter of cattle are advisable. In 

 the case of cattle an affection of the milk gland should 

 be a sign for the destruction of the animal affected. The 

 sanatorium treatment should be looked upon as being 

 useful from three points of view ; — (1) as isolating the 

 patient temporarily ; (2) as giving opportunity of instruct- 

 ing the patient as to the best means of disinfecting sputa, 

 &c., which, under ordinary conditions, are a great source 

 of infection ; and (3) as commencing the treatment and 

 building up of the patient and educating him as to what, 

 in the interests of his own health, he may do and what 

 he may not. In this connection it may be pointed out 

 that Dr. M. S. Patterson's demonstration of the excellent 

 w-ork that is being done at Frimley was one of the most 

 valuable and instructive lessons given at the congress. He 

 showed that graduated labour seems to help to immunise 

 the patient, to build up his physical powers, to give him 

 confidence, and to improve his morale in so far that, 

 instead of allowing him to degenerate into a valetudinarian, 

 with thoughts only of his own ailments, he receives the 

 inspiration of the knowledge that he can still work and 

 earn his own living, and not only this, but that under 

 proper conditions work is a factor in his recovery. At 

 the present time, when we have promises of legislation 

 in the air, one cannot but feel that those who are re- 

 sponsible for legislation concerning tuberculosis cannot do 

 better than study carefully the results that have been 

 obtained abroad by men perhaps w^ith less experience than 

 ourselves, but also less hide-bound by precedent and tradi- 

 tion than are we. The announcement of the intention of 

 the Local Government Board to enforce compulsory notifi- 

 cation of phthisis amongst poor-law patients, for which 

 Dr. Newsholme said he had the authority of the Presi- 

 dent of the Local Government Board, was received with 

 loud applause at the opening meeting of the congress. 



