From time to time the news of some great discovery rushes over the land like a mighty wave; but never before has the intelligence of a great achievement been received with such universal delight. There is hardly a man, woman or child that does not bewail the loss of some dear relative taken away by Tuberculosis, the most terrible of all foes. More terrible because it stealthily creeps into the system and takes a firm hold before its presence can even be surmised.
Now the appearance of a deliverer is hailed as would the advent of the Messiah.
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The other forms of Tuberculosis.
The first communication
BY DR. MAX BIRNBAUM.
TRANSLATED FROM THE GERMAN BY DR. FR. BRENDECKE.
With an Appendix being Prof. Koch's First Communication on the Subject, translated from the
DEUTSCHE MEDICINISCHE WOCHENSCHRIFT
and explanatory notes by the author.
MILWAUKEE, WIS., H. E. HAFERKORN, PUBLISHER. 1891.
COPYRIGHT 1890, BY H. E. HAFERKORN.
PRESS OF THE HARTMANN PRINTING CO., 126 Reed St., MILWAUKEE, WIS.
Consumption is curable. From time to time the news of some great discovery rushes over the land like a mighty wave; but never before has the intelligence of a great achievement been received with such universal delight. There is hardly a man, woman or child that does not bewail the loss of some dear relative taken away by Tuberculosis, the most terrible of all foes. More terrible because it stealthily creeps into the system and takes a firm hold before its presence can even be surmised.
Now the appearance of a deliverer is hailed as would the advent of the Messiah. Koch, formerly a poor and obscure student, being especially interested in bacteriology has plodded and worked for years. Even in the year 1882 he has made known to the world the evil spirit in describing the tubercle-bacillus as the specific generator of tuberculosis. We then knew the enemy but had no weapon to fight him. Now Koch has also manufactured the sword with which to combat the evil genius. The experimental tests thus far have not tended to lessen the merits of Koch's remedy. Added applications have resulted in additional success. The investigations are not yet complete; only meager particulars have thus far been given to the public from authorized sources. To guard against misleading representations the translator has undertaken to give to the American public only what has actually been achieved. He felt himself called upon to do this not only because he has followed the progress of Koch's labors with the keenest interest, but also because he himself has worked and labored on this field for many years.
Justly has a vast excitement taken hold of all classes of the people, an excitement that has caused all other contemporary events to fall back. The search for an actual remedy for that exceedingly ravaging disease, tuberculosis, has at last been crowned with success, and even the most uneducated will be able to estimate the significance of this event.
We need but consider, that pulmonary consumption, the most frequent form of tuberculosis, annually demands over 30,000 victims in the cities of the German Empire over 15,000 inhabitants, and out of every 100 deceased 12–13 have fallen prey to this sickness.
The number of sufferers from pulmonary consumption can not nearly be determined, it certainly exceeds all other diseases by far. In the case of many people we can only infer from their appearance and hereditary tendencies, before visible signs can be discovered, that they will succumb to this terrible disease.
And this disease is now curable. Millions of people who have considered themselves doomed, will be given back to life; their regained strength will greatly increase the national wealth. In short, we look forward to an era, such as was not dreamt of even by the most vivid imagination only a few years back. But rather than be carried too far by our enthusiasm, let us study Koch's new method to cure, as far as we are now enabled to pass judgement on it.
First of all we must explain: What is tuberculosis? What relation does it bear to pulmonary consumption?
Pulmonary consumption is only one form of tuberculosis, by far the most frequent. This is the reason why pulmonary consumption, pulmonary tuberculosis, consumption and tuberculosis are used as synonymous terms.
Tuberculosis is the general expression. By that we understand a disease which is generated by a certain kind of organism belonging to the class of bacteria. These organisms are the tubercle bacilli, which were discovered by Koch in the year 1882.
Now these tubercle bacilli settle most frequently in the lungs and here cause serious derangements of the lung tissue. Pulmonary consumption is the result.
But the tubercle bacilli will also settle in any other portions of the body and cause tuberculosis.
Frequently the tubercle bacilli nestle in the larynx and the result is laryngeal consumption.
They may infect the mucous lining of the tongue and nasal passages and cause the rarely occurring diseases—tuberculosis of the tongue and nose.
More frequently tuberculosis of the intestines results, the well-known intestinal consumption.
The spreading of tuberculosis in the brain is of especial importance on account of the importance of this organ. Very frequently small children are attacked by tuberculosis of the cerebral membranes, a disease that has heretofore unexceptionally resulted in death.
Much oftener than is generally supposed the kidneys are the seat of tuberculosis; and also the suprarenal capsules, whose functions are as yet entirely unknown, have in postmortem examinations been found to be tubercularly degenerated.
In the diseases of the bones and joints tuberculosis forms an important part. Those infinitely small and weak tubercle-bacilli have the power to destroy the hard and firm substance of the bones, to soften it and change it to pus. Whole portions of bone may disappear in this way.
Tuberculosis can also destroy parts of the skin. In this case it is called Lupus.
Finally tuberculosis is found in the generative organs. Tubercular derangements are frequently met with in the testicles of men, less often in the ovaries of women.
The well known children's disease Scrofula is considered a preceding stage of tuberculosis by many physicians. This much is certain that Scrofula inclines to tuberculosis.
Let us study the several forms of tuberculosis after this general synopsis; we will begin with pulmonary consumption.
Even before the discovery of the tubercle-bacillus by Koch, different scientists had claimed that pulmonary consumption was caused by the immigration of bacteria into the lungs, and several of them had found bacteria of that kind. But it remained for Koch to bring light upon the conjectures of other scientists, and he established the fact, that the bacillus discovered by him was the real generator of pulmonary consumption. Millions of these bacilli exist in the lungs of the diseased, and millions of them are thrown out with the sputum.
If we take a very small quantity of this thrown out matter and examine it with a microscope, we will find a greater or smaller number of these tubercle bacilli. Of course the preparation to be microscopically examined must previously be colored with some coloring matter, otherwise it is very difficult, well nigh impossible, to detect the infinitely small bacilli. The method of coloring now generally in use consists in discoloring the preparation after the coloring has been completed, it is found that the bacilli tenaciously cling to the coloring matter, and in this way it is easy to recognize the tubercle-bacilli under the microscope.
These bacilli are infinitely minute, they are 2⁄1000 to 8⁄1000 millimeters long, and about 5⁄100000 millimeters in width. Therefore it is absolutely impossible to recognize them with the naked eye. Generally they are somewhat bent, sometimes slightly nicked at one end.
The temperature of boiling water destroys the vitality of the bacilli under all circumstances. Even a temperature of 70° C. is able to lessen the efficacy of the bacilli. Unhappily this temperature is too high to be applied against the tubercle-bacilli in the human body without causing the most serious injury to it. Nevertheless it has been tried, we will speak of this later on.
Then the drugs that kill the bacteria, such as Carbolic Acid, Alcohol, Iodoformether, Ether, Sublimate, Thymol, destroy the tubercle-bacilli so slowly and only in such high concentrations that their application is impossible without endangering the patient. Therefore the prospects of directly destroying the bacilli in the human body had to be given up as impossible.
We are now confronted with two questions:
1. In what manner does the tubercle-bacillus enter into the human organism?
2. Under what conditions is the tubercle-bacillus able to generate pulmonary consumption after it has entered the human organism?
All investigations, both of earlier and later date have established the fact that the tubercle-bacillus is inhaled with the air, and then it is mainly the foul air which is accused. But foul air is especially found in such places where people congregate, as in rooms, barracks, factories, etc. As it is a fact that there are always several consumptives among a number of people, so in this case there will always be occasion to inhale the tubercle-bacilli that have been cast out by the consumptives. Therefore it is not the foul air in itself which generates pulmonary consumption, but the circumstance that in this connection there are always people present which are able to spread and scatter the bacilli.
Luckily the physical qualities of the tubercle-bacilli are such that they mostly adhere to the ground or floor and are rarely scattered in the air as dust; otherwise pulmonary consumption would be much more frequent than it is at present. Unfortunately the bacilli are very often spread through uncleanliness of the people, because they touch objects with their fingers to which the tubercle-bacilli chance to stick and then they touch their mouth or nose with these fingers. In this way bacilli can be taken into the system especially easily with the food. Children are particularly exposed to contamination, crawling about on the ground, on which, perhaps but recently, a consumptive has spit, and more so because they often have the habit to put all sorts of things and also the generally dirty fingers into their mouth.
On the other hand there are various obstacles in the way of tubercle-bacilli entering the lungs. The distance from the mouth to the lungs is long and narrow; all sorts of projections check the further penetration of the bacilli. The trachea and the air-passages of the lungs possess equipments arranged for the purpose of ejecting small foreign substances, thus also to throw out the bacilli. In short it is not too easy a matter for the bacilli to penetrate into the lungs.
And yet this happens only too often. For instance, in some people the passage from the mouth down may be a wide one, so that the bacilli can enter more easily; the protective arrangement by which foreign substances are removed may be deranged, it may be wanting in some place or its functionary qualifications may be bad; especially frequent this is the case after enfeebling diseases, which are associated with severe cough, as measles, whooping-cough, etc. This is the reason why pulmonary consumption is strikingly often observed to follow just these diseases.
But the tubercle-bacillus can also enter the body with the food, as stated before. The acid gastric juice is a protective agent which considerably lessens the danger of infection by tuberculosis.
It has not been definitely decided at the present time whether the drinking of milk from tuberculous cows brings with it the danger of tuberculosis for mankind. It will certainly be best to avoid such milk, especially when the cow's udder is found to be tuberculously diseased or when tubercle-bacilli can be traced in the milk.
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