TUBERCULOSIS.
In the various articles dealing with the treatment of the different local manifestations of disease caused by the tubercle bacillus the principles and details of treatment have been already fully dealt with, especially under Phthisis, Peritonitis (Tuberculous), Mesenteric Gland Disease, Caries, Meningitis, Lupus. etc.
Great advance has been made in both the treatment and prevention of the ravages of tuberculosis in all its forms during late years by a clearer conception of the views promulgated by henry MacCormac of Belfast, who first forcibly pointed out the value of the open-air treatment which is now recognised as the basis of the sanatorium and climatic methods afterwards systematised at Gobersdorf by Brehmer. The mortality has been further reduced by the overfeeding and suralimentation methods, and in suitable cases by Vaccine therapy.
The universal acceptance of these methods has tended to place the value of drugs upon a lower plane than they formerly occupied, but in selected cases the efficacy of many drugs in turning the scale against the bacillus when already handicapped by open-air treatment cannot be ignored.
has attracted great attention during the last decade, and possibly it is owing to a clearer conception of the communicability of the disease that the death-rate from tuberculosis has been reduced so markedly. As stated under Phthisis, the weight of evidence is decidedly against the route of ingress being by the respiratory passages. Much advance is made by a recognition of the fact that no matter how tubercle bacilli gain an entrance into the blood, they are liable to be filtered out by the fine capillaries of the lung, and their presence in this organ is consequently no evidence that they had been inhaled.
In his Cavendish Lecture (tooS) the writer has shown that living tubercle bacilli introduced into the stomach of the guinea-pig are to be found in a few hours (4) in the lung substance, and fine carbon particles administered at the same time are filtered out by the pulmonary organs so effectively as to colour the lung black. That the bacilli can pass
rapidly through the intact intestinal mucosa without producing any local lesion is now almost universally accepted. The histological dif ferences between the mesenteric glands of young and old animals is a factor of greatest interest in the problem of infection. Vanstenherghe and Grysez maintain that when carbon in fine division is introduced into the stomach of a very young animal it is arrested in its progress to the thoracic duct by the fine reticulum of the mesenteric lymphatic glands. This supports von Behring's theory that adult pulmonary tuberculosis is the result of an infection of these glands received in early life, the bacilli remaining long quiescent and imprisoned in the abdomen.
Cahnette's experiments for inducing artificial anthracosis in animals have demonstrated that when carbon particles are inhaled for a consider able period they accumulate in the throat, are swallowed ith the saliva, and enter the stomach and bowel, from which they find their way to the lung by the thoracic duct. By ligaturing the cesophagus of the animal, this observer found that the carbon was prevented from reaching the lung. These facts go a long way to prove the contention that pulmonary tuber culosis is not contracted by inhalatiOn, W..t--173„: the ingestion of bacilli which penetrate the intestinal mucosa. The importance of this cannot be exaggerated when we come to consider the prophylaxis of pulmonary and other forms of human tuberculosis. By a blind adherence to the inhalation theory the part played by the unprotected state of the intestinal surface has been minimised, and, indeed, denied by Koch, whilst an infected milk supply has been permitted to inflict its ravages upon the human race. Elsewhere the writer has stated that he was enabled to stamp out out breaks of bovine tuberculosis in a colony of Industrial School children by sterilising the milk supply, and to thoroughly protect this community from the bovine form of tuberculosis by rigidly persisting in the sterilisation.