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FEMALES
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FEMALES . AGES. See also:Period. All Under 5 10— 15— 20— 25— 35— 45— 55— 65 Ages. ye a rs. 1851-186o 2774 1281 620 1293 3516 4288 4575 4178 3121 2383 1635 1861-187o 2483 947 477 1045 3112 3967 4378 3900 2850 2065 1239 1 871-188o 2028 750 375 846 2397 3140 3543 3401 2464 1777 1093 1881-1885 1738 553 350 749 2006 2596 3070 2927 2197 1541 995 1886-1890 1497 483 307 658 1626 2075 2552 2563 1936 1490 966 I 1891-1895 1303 421 260 561 1428 1740 2155 2305 1742 1294 800 ' 1896-1899 1141 334 201 410 1165 1547 1862 2096 1597 1242 787 1900-1904 1042 316 203 417 1002 1274 1593 1807 1481 1136 670 1903-1907 975 308 194 391 959 1194 1488 1643 1382 1075 666 1908 931 229 192 441 1270 1438 1761 1407 1156 945 654 In See also:English counties containing populations of See also:ioo,000 or over the highest rates were—in 1908—London, 1806; See also:Lancashire, 1848; See also:Northumberland, 1947; See also:Carnarvonshire, 2025; and See also:Carmarthen-See also:shire, 2328 per million living. Of the fifteen counties in See also:England and See also:Wales with the highest See also:tuberculosis mortalities, no fewer than seven are Welsh. See also:Cardiganshire, with 2270 for both sexes, has a See also:rate nearly See also:double that of England. According to the See also:United States See also:census of 1900, the See also:death-rate from tuberculosis in the See also:area chosen for See also:registration which embraced ten registration states, namely, See also:Connecticut, See also:Maine, See also:District of See also:Columbia, See also:Massachusetts, See also:Michigan, New See also:Hampshire, New See also:Jersey, New See also:York, Rhode See also:Island and See also:Vermont, and 153 registration cities outside these states, was: Number of Deaths from Death-rate per 100,000. Tuberculosis. 1890 48,236 245.4 1900 54,898 190.5 The returns of the mortality See also:statistics of the United States for the See also:year 1908 See also:cover an area of 17 states, the district of Columbia and 74 registration cities, representing an aggregate See also:population of' 45,028,767, or 51.8 % of the See also:total estimated population of the United States. Mortality from Tuberculosis in the United States in given areas. See also:Annual Tuberculosis Pulmonary Number Tuberculosis (all See also:Average, (all forms), See also:Phthisis, forms) per ioo,000 of the 1901-1905. 62,835. 55,251. population, 193.2.
1904 66,797 58,763 201.6
1905 65,352 56,770 193.6
1906 75,512 65,341 184.2
1907 176,650 66,374 183.6
1908 78,289 67,376 173.9
In the United States tuberculosis of the lungs forms from 86 to 87 % of all cases. The death-rate, as we see, is steadily decreasing. It is, however, difficult to estimate the ravages of the disease in that See also:country owing to the fact that rather less than See also:half the United States is still unprovided with an adequate See also:system of registration.
The following was the death-rate from tuberculosis (all forms) per ioo,000 of the population of the See also:chief cities of the United States during 1908:
New See also: The See also:children of consumptive parents had the " seeds " of the disease in them, and were thought to be doomed with more or less certainty. Great importance was therefore attached to heredity as a See also:factor in the incidence of tuberculosis. The See also:discovery that it is caused by a specific parasitic infection placed Heredity. the question in a different See also:light, and led to a more careful examination of the facts, which has resulted in a See also:general and increasing tendency to minimize or deny the influence of heredity. At the See also:Berlin See also:Congress on Tuberculosis in 1899 See also:Virchow pronounced his disbelief in the theory on pathological grounds. " I dispute this heredity absolutely," he said. " For a course of years I have been pointing out that if we ex-amine the bodies of infants newly See also:born, who have had no See also:life apart from the See also:mother, we find no tuberculosis in them. I am convinced that what looked like tuberculosis in the newly born was none of it tuberculosis. In my opinion there is no authenticated See also:case of tubercle having been found in a dissected newly-born See also:infant." Observations on animals similarly tend to disprove the existence of congenital tuberculosis (Nocard). The theory that the germs may remain latent in the offspring of tuberculous parents (See also:Baumgarten) is unsupported by See also:evidence. The occurrence of disease in such offspring is ascribed to infection by the parents, and this view is confirmed by the fact that the incidence in consumptive families is greater on See also:female children, who are more constantly exposed to See also:home infection, than on the male (See also:Squire). The statistical evidence, so far as it goes, points in the same direction. It is even denied that the children of consumptives are specially pre-disposed. Recognition of the communicability of tuberculosis has directed See also:attention to the influence of conditions in which See also:people live massed together in See also:close proximity. The pre- See also:Density of See also:valence of the disease in large centres of popula- and Otlon tion has already been noted, and the influence of and Over- Over- crowding. See also:aggregation is no doubt considerable; but it does not always hold See also:good. The See also:distribution in England and Wales does not correspond with density of population, and some purely rural districts have a very high mortality. Broadly, however, the rural counties have a See also:low mortality, and those containing large See also:urban populations a high one. In See also:France in the See also:department of the See also:Oise, in purely See also:industrial villages, the mortality from pulmonary phthisis is from 56 to 6r per Io,00o; in, a See also:village in which See also:part of the population worked in the See also:fields and part in factories the mortality was 46 per 10,000; and in purely agricultural villages it ranged from o to lo per I0,00o. The following table is taken from the Supplement to the Registrar-General's 65th See also:Report for England and Wales:diseases in relation to overcrowding, the same authority found that " while associated with overcrowding is a tendency of the population to See also:die from disease generally, this tendency is especially manifested in the case of phthisis, and is not manifested in the case of every disease." Other Conditions.—Poverty, insufficient See also:food and insanitary dwellings are always more or less associated with overcrowding, and it is difficult to distinguish the relative influence of these factors. An See also:analysis of 553 deaths _n See also:Edinburgh according to rentals in 1899 gave these results: under £1o, 230; from £IO to £20, 190; above £20, Io6 (Littlejohn); but the corresponding population is not stated. An investigation of selected houses in See also:Manchester gave some interesting results (Coates). The houses were divided into three classes: (I) infected and dirty; (2) infected but clean; (3) dirty but not infected; infected meaning occupied by a tuberculous See also:person. Dust was taken from all parts of the rooms and submitted to bacteriological tests. The conclusions may be summarized thus: The effects of overcrowding were not apparent; a large cubic space was found to be of little avail if the See also:ventilation was See also:bad; the beneficial effects of light and fresh See also:air were markedly shown even in the dirtiest houses; See also:ordinary cleanliness was found not sufficient to prevent See also:accumulation of infectious material in rooms occupied by a consumptive; no tuberculous dust was found in dirty houses in which there was no consumption. The upshot is to emphasize the importance of light and air, and to minimize that of See also:mere dirt. This is quite in keeping with earlier investigations, and particularly those of Dr Tatham on back-to-back houses. Darkness and stuffiness are the See also:friends of the tubercle bacillus. So much has the question of cleanliness, and of See also:housing in a sanitary district, to do with the prevalence of the disease, that the following table taken from the Report of the Registrar-General for See also:Ireland for the year 1909 shows the marked class incidence in all forms of tuberculosis. Distribution of Tuberculosis Mortality by Classes in Ireland, CDC). All forms of Pulmonary Other forms of Tuberculosis. Phthisis. Tuberculosis. Professional and See also:independent 1.41 0.64 0.77 class . See also:Middle class, See also:civil service and 1.82 I.30 0.52 smaller officials . . . . Large traders, business mana- I.59 1.04 0 55 See also:gers " . Clerks 2.92 2'33 0'59 Householders in 2nd-class 2.52 1.85 0.67 localities Artisans 2.94 2.23 0.71 See also:Petty shopkeepers and other 3'85 3'00 0.85 traders Domestic servants . . . I.31 1.04 0.27 See also:Coach and See also:car drivers, and 4'24 3.06 1.18 vanmen . . . . See also:Hawkers, porters and labourers 4'83 2'88 1'95 In relation to the last two classes the effect of exposure and also of alcoholic excess must be added to overcrowding and privation. The low rate noticeable for domestic servants must be ascribed to the better food and housing they enjoy while in situations. In See also:Hamburg the mortality was ro•7 per io,000 in those whose income See also:rose above 3500 marks, 39.3 where the income was 900 to 1200 marks, and 6o per Io,000 where the income See also:fell below that figure. It is now generally accepted that tubercle bacilli may enter the See also:body by various paths. At the See also:International Congress on Tuberculosis held in See also:Vienna in 1907 Weichselbaum summarized the channels of infection in pulmonary tuberculosis as follows: All occupied See also:Males. Occupied Males (London). Occupied Males Occupied Males (industrial districts). (agricultural districts). 1900—1902. 1890—1892. 1900—1902. 1890—1892. 1900—1902. 1890—1892. 1900—1902. 1890—1892. All Causes . . . 100 I19 I19 143 12I 156 72 86 Tuberculous Phthisis. See also:loo 122 156 183 I15 147 71 90 It will be noted that the rate in the agricultural districts is low compared to the industrial districts or purely urban district chosen. There is obviously a close relation between density of population and the prevalence of phthisis. Comparing phthisis with other (I) By inhalation directly into the bronchioles and pulmonary alveoli, or by way of the bronchial glands through the See also:blood and See also:lymph channels into the See also:lung. (2) Through the mucous membrane of the See also:nose, mouth or tonsils into the neighbouring lymphatic glands, and thence through the blood or lymph Path of into the lungs. (3) By ingestion of tubercle bacilli Infection, into the See also:lower part of the gastro-intestinal See also:tract in the food; thence the bacilli may pass through the lining membrane, infect the neighbouring glands and pass by the blood or lymph stream to the lungs. (4) By penetration of other mucus membranes (such as the conjunctival or urogenital) or through the skin. (5) Possible, though very rare, placental infection. Tubercle bacilli may not produce any anatomical See also:lesion at the point of entrance, or they may remain latent for a very See also:long time; and it has been experimentally proved that they may pass through mucous membranes and leave no trace of their progress. As reported to the Royal See also:Commission, the introduction of bacilli into the alimentary See also:canal is not necessarily followed by the development of tuberculosis. The writings of Von Behring have led to renewed attention being paid to intestinal infection, particularly through the See also:milk See also:supply. Von Behring suggests that the bacillus itself may become modified in the human body. See also:Measures for the prevention of tuberculosis may be divided into two classes: (1) general; (2) See also:special. Great attention Prevention. has been paid to the latter since the infectious nature of the disease was established. The former include all means by which the conditions of life are improved among the See also:mass of the people. The most important of these are probably housing and food supply. The reduction of the disease recorded in England is attributed to the great changes which have gradually taken See also:place in such conditions since, say, 1850. See also:Wages have been raised, food cheapened, housing See also:im- proved, See also:protection afforded in dangerous trades, air spaces provided, locomotion increased, the ground and the atmo- See also:sphere have been cleaned and dried by sanitary means. In addition to these general measures is the See also:provision of consump- tion hospitals, which See also:act by segregating a certain amount of disease. Yet all these things, beneficial as they may be, do not wholly See also:account for the reduction, for, if the records can be trusted, it was in progress before they had made any way or had even been begun. This observation, coupled with the appar- ently general tendency to diminution among civilized races, suggests the operation of some larger agency. The theory of acquired resistance, which has been already mentioned, would explain the diminution; and it is also in keeping with other facts, such as the great susceptibility of See also:savage races, which have not been long exposed to tuberculosis, and the results of labora- tory experiments in artificial See also:immunity. The point is of great importance, and deserves careful attention; for if the theory be correct, the special measures for preventing tuberculosis, which are occupying so much attention, may eventually have unexpected results. Their general aim is the avoidance of infection, and they include (1) the provision of special institu- tions—hospitals, sanatoria and dispensaries; (2) the prevention of spitting; (3) the notification of consumption; (4) the administrative See also:control of tuberculosis in animals; (5) the dissemination of popular knowledge concerning the nature of the disease. The greatest stress is laid upon the prevention of spitting, because the germs are contained in the sputum of consumptive persons, and are scattered broadcast by expectoration. The sputum quickly dries, and the bacilli are blown about with the dust. There is no question that infection is so conveyed. The Manchester scientific experiments, mentioned above, are only one See also:series out of many which prove the infectivity of dust in the proximity of consumptive persons, and they are confirmed by actual experience. Several cases are recorded of healthy persons having contracted the disease after occupying rooms in which consumptive persons had previously lived. It is a legitimate inference that spitting in public is an important means of disseminating tuberculosis, though it may be noticed that international prevalence by no means corresponds with this disgusting practice, which is a perfect curse in Great See also:Britain, and far more See also:common both there and in the United States than on the See also:continent of See also:Europe. See also:Prohibition of spitting under a statutory See also:penalty is attended with certain difficulties, as it is obviously impossible to make any distinction between tuberculous and other persons; but it has been applied in New York and elsewhere in See also:America, and some See also:local authorities in Great Britain have adopted by-See also:laws to check the practice. Another means of controlling dangerous sputa is more practicable, and probably more effective, namely, the use of See also:pocket spittoons by consumptive persons. Convenient patterns are available, and their use should always be insisted on, both in public and in private. The most effective way of destroying the sputa is by burning. For this purpose spittoons of See also:papier macho and of See also:turf have been successfully used in the Vienna hospitals (Schrbtter). When See also:glass spittoons are used the contents can be sterilized by See also:disinfectants and passed down the drain. Notification is of great service as an aid to See also:practical measures of prevention. It has been applied to that purpose with good results in several cities and states in America, and in some towns in Great Britain. New York has made the most systematic use of it. Voluntary notification was adopted there in 1894, and in 1897 it was made compulsory. The measures linked with it are the sanitary supervision of infected houses, the See also:education of the people and the provision of hospitals. In England, Manchester has led the way. Voluntary notification was adopted there in 1899: it was at first limited to public institutions, but in 1900 private practitioners were invited to notify their cases, and they heartily responded. In See also:Sheffield notification was made compulsory by a local act in 1904 for a limited period, and was found so valuable that the period was extended in 1910. The See also:objects aimed at are to visit homes and instruct the See also:household, to arrange and provide disinfection, to obtain See also:information bearing on the modes of infection, to secure bacteriological examination of sputum, and to collect information to serve as a basis of See also:hospital provision. Disinfection is carried out by stripping off See also:paper, previously soaked with a See also:solution of chlorinated See also:lime (1a oz. to the See also:gallon), and washing the See also:bare walls, See also:ceiling, See also:floor and everything washable with the same solution. This is found effective even in very dirty houses. In clean ones, where the patients have not been in the See also:habit of spitting about the rooms, it is sufficient to rub the walls with See also:bread-crumb and See also:wash the See also:rest with See also:soap and See also:water. Clothing, bedding, &c., are disinfected by See also:steam. The advantages of these sanitary measures are obvious. Notification is no less important as a step towards the most advantageous use of hospitals and sanatoria by enabling a proper selection of patients to be made. It is compulsory throughout See also:Norway, and is being adopted elsewhere, chiefly in the voluntary See also:form. In 1908 the Prevention of Tuberculosis (Ireland) Act was passed, which conferred on local authorities the right to make notification compulsory in their districts, and provided that certain sections of the Public See also:Health (Ireland) Act 1878 and the Infectious Diseases Prevention Act 1890 should apply to tuberculosis. By this act also the county See also:councils were enabled to establish hospitals and dispensaries for the treatment of tuberculosis and were empowered to See also:borrow See also:money or See also:levy a poor rate for the erection of sanatoria for the treatment of persons from their respective counties suffering from the disease. The prevalence of tuberculosis in See also:cattle is of importance from the point of view of prevention of the See also:probability that abdominal tuberculosis, which is a very fatal form of the disease in See also:young children, and has not diminished in prevalence like other forms, is caused by the ingestion of tuberculous milk. Whether it be so or not, it is obviously desirable that both See also:meat and milk should not be tuberculous, if it can be prevented without undue interference with commercial interests. Preventive measures may be divided into two classes. They may See also:deal merely with the See also:sale of meat and milk, or they may aim at the suppression of bovine tuberculosis altogether. The former is a comparatively easy See also:matter, and may be summed up in the words " efficient inspection." The latter is probably impracticable. If practicable, it would be excessively costly, for in many herds one half the animals or even more are believed to be tuberculous, though not necessarily the See also:sources of tuberculous food. Unless the danger is proved to be very much greater than there is any See also:reason to suppose, " stamping out " may be put aside. Efficient inspection involves the administrative control of slaughter-houses, cowsheds and dairies. The See also:powers and regulations under this See also:head vary much in different countries; but it would be useless to discuss them at length until the scientific question is settled, for if the reality of the danger remains doubtful, oppressive restrictions, such as the compulsory slaughter of tuberculous cows, will not have the support of public opinion. Whatever measures may be taken for the public protection, individuals can readily protect themselves from the most serious danger by boiling milk; and unless the source is beyond suspicion, parents are recommended, in the See also:present See also:state of knowledge, so to treat the milk given to young children. A great deal has been done in most countries for the dissemination of popular knowledge by forming See also:societies, holding conferences and meetings, issuing cheap literature, and so forth. It is an important See also:item in the general See also:campaign against tuberculosis, because popular intelligence and support are the most powerful levers for setting all other forces in niotion. In Ireland, where an See also:attempt had been made to deal with the question by arousing the See also:interest of all classes, tuberculosis exhibitions have been held in nearly every county, together with lectures and demonstrations organized by the See also:Women's See also:National Health Association; and an organized attempt was made in the autumn of 1910 in England, by a great educational campaign, to compel the public to realize the nature of the disease and the proper precautions against it. The improved outlook in regard to the See also:arrest or so-called " cure " of tuberculosis is mainly derived from the improved Diagnosis methods of diagnosis, thus enabling treatment to and be undertaken at an earlier and therefore more Treatment, favourable See also:stage of the disease. The See also:physical signs in See also:early stages of the lung See also:affection are often vague and inconclusive. A means of diagnosis has therefore been sought in the use of tuberculin. The methods are three: (1) The subcutaneous injection method of See also:Koch; (2) the cutaneous method of Von Pirquet; (3) the conjunctival method of See also:Wolff-Eisner and Calmette. The first method depended on the re-See also:action occurring after an injection of " old tuberculin." It is unsuitable in febrile conditions, and has now been relegated to the treatment of cattle, where it has proved invaluable. In Von Pirquet's method a drop of old tuberculin diluted with See also:sodium chloride is placed on a spot which has been locally scarified. The presence of tuberculosis is demonstrated by a local reaction in which a hyperaemic papule forms, surrounded by a See also:bright red See also:zone. Reaction occurs in tuberculosis of the bones of See also:joints and skin. Von Pirquet in loco cases obtained a reaction in 88% of the tuberculous, and io%, of those clinically non-tuberculous. In the latter there may have been latent cases of tuberculosis. In the conjunctival or opthalmo-reaction of Calmette and Wolff-Eisner the instillation of a drop of a dilute solution of tuberculin into the conjunctiva is followed in the tuberculous subject by conjunctivitis. The reaction generally appears in from 3 to 12 See also:hours, but may be delayed to 48. In a series of cases observed by Audeoud a See also:positive reaction was obtained in 95% of 261 obviously tuberculous cases and in 8.3 % of 303 cases which presented no clinical symptoms. Very advanced cases fail to react to any of these tests, as do general miliary tuberculosis and tuberculous See also:meningitis. As well as the three methods mentioned above the occurrence of a " negative phase " in the phagocytic See also:power of the leucocytes following an injection of Koch's tuberculin T.R. may be said to be diagnostic of tuberculosis. Another valuable aid in diagnosis is that of the X-rays. By their help a pulmonary lesion may be demonstrated long before the physical signs can be obtained by ordinary examination. To discuss at all fully the treatment of the various forms of tuberculosis or even of consumption alone would be quitebeyond the See also:scope of this See also:article. It must suffice to mention the more See also:recent points. The open-air treatment of consumption has naturally „attracted much attention. Neither the curability of this disease nor the advantages of fresh air are new things. Nature's method of spontaneous healing, explained above, has long been recognized and understood. There are, indeed, few diseases involving definite lesions which exhibit a more marked tendency to spontaneous arrest. Every case, except the most acute, bears signs of Nature's effort in this direction; and See also:complete success is not at all uncommon, even under the ordinary conditions of life. Perhaps it was not always so: the ominous See also:character popularly attributed to consumption may once have been justified, and the power of resistance, as we see it now, may be the result of acquired immunity or of the See also:gradual elimination of the susceptible. However this may be, the natural tendency to cure is undoubtedly much assisted by the See also:modern system of treatment, which makes pure air its first See also:consideration. The principle was known to See also:Sydenham, who observed the benefit derived by consumptives from See also:horse exercise in the open air; and about 183o See also:George Boddington proposed the See also:regular treatment of patients on the lines now generally recognized. The method has been most systematically See also:developed in See also:Germany by the provision of special sanatoria, where patients can virtually live in the open air. The example has been followed in other countries to a certain extent, and a good many of these establishments have been provided in Great Britain and elsewhere; but they are, for the most part, of a private character for the reception of paying patients. Germany has extended these advantages to the working classes on a large See also:scale. This has been accomplished by the united efforts of friendly and philanthropic societies, local authorities, and the state; but the most striking feature is the part played by the state See also:insurance institutes, which are the outcome of the acts of 1889 and 1899, providing for the compulsory insurance of workpeople against sickness and old See also:age. The sanatoria have been erected as a matter of business, in See also:order to keep insured members off the See also:pension See also:list, and they are supported by the sick clubs affiliated to the institutes. They number See also:forty-five, and can give three months' treatment to 20,000 patients in the year. The clinical and economic results are said to be very encouraging. In about 70% of the cases the disease has been so far arrested as to enable the patients to return to See also:work. In England, where more than 14 millions of the population belong to friendly societies, it is estimated that the sick pay of consumptive members See also:costs three times as much as the average sick pay to members dying of other causes. An effort has been made by the National Association for the See also:Establishment and See also:Maintenance of Sanatoria for Workers Suffering from Tuberculosis to establish such sanatoria, together with training for suitable work during convalescence, the gradual resumption of wage-earning being resumed while in See also:touch with the medical authorities. The important features of the See also:sanatorium treatment are life in the open air, independently of See also:weather, in a healthy situation, rest and abundance of food. The last has been carried to rather extravagant lengths in some institutions, where the patients are stuffed with food whether they want it or not. The sanatorium See also:movement on the See also:German See also:model is rapidly extending in all countries. For those who are able to do so See also:advantage may be taken of the combined sanatorium and See also:sun treatment. In certain high altitudes in See also:Switzerland, which are favoured by a large amount of See also:sunshine and a small percentage of moisture, much benefit has been derived from the exposure of the unclothed body to the sun's rays. The power of the sun in high altitudes is so great that the treatment can be continued even when the See also:snow is on the ground. Not only is the sun-treatment applicable to pulmonary tuberculosis, but also to the tuberculosis of joints, even in advanced cases. The treatment has to a great extent replaced surgical See also:procedure in tuberculosis of joints, but it requires to be persevered in over a considerable period of time. It should be remembered that the benefits of fresh air are not confined to sanatoria. If the superstitious dread of the See also:outer air, particularly at See also:night, could be abolished in ordinary life, more would be done for public health than by the most costly devices for eluding microbes. Not only consumption, but the other See also:respiratory diseases, which are equally destructive, are chiefly fomented by the universal practice of breathing vitiated air in stuffy and overheated rooms. The cases most suitable for the treatment are those in an early stage. Other special institutions for dealing with consumption are hospitals, in which England is far in advance of other countries, and dispensaries; the latter find much favour in France and See also:Belgium. In Great Britain the See also:pioneer work as regards the establishment of tuberculosis dispensaries was the establishment of the See also:Victoria Dispensary for Consumption in Edinburgh in 1887, where the procedure is similar to that in Dr Calmette's dispensaries in France. In connexion with the dispensary home visits are made, patients suitable to sanatoria selected, advanced cases drafted to hospitals, bacteriological See also:examinations made, cases notified under the voluntary system, and the families of patients instructed. There is an urgent need for the multiplication of such dispensaries throughout the United See also:Kingdom. The recent act providing for the medical inspection of See also:schools has done much to sort out cases of tuberculosis occurring in children, and to provide them with suitable treatment and prevent them from becoming foci for the dissemination of the disease. In Germany special open-air schools, termed See also:forest-schools, are provided for children suffering from the disease, and an effort is being made in England to provide similar schools. Of specific remedies it must suffice to say that a great many substances have been tried, chiefly by injection and inhalation, and good results have been claimed for some of them. The most noteworthy is the treatment by tuberculin, first introduced by Koch in 189o, which, having sunk into use as a diagnostic reagent for cattle, received a new See also:lease of life owing to the valuable work done by See also:Sir Almroth See also:Wright on opsonins. The tuberculins most in use are Koch's " old " tuberculin T.O., consisting of a See also:glycerin broth culture of the tubercle bacilli, and Koch's T.R. tuberculin, consisting of a saline solution of the triturated dead tubercle bacilli which has been centrifuged. This latter is much in use, the dosage being carefully checked by the estimation of the tuberculo-opsonic See also:index. The injections are usually unsuitable to very advanced cases.. Marmorek's serum, the serum of horses into which the filtered young cultures of tubercle bacilli have been injected, and in which a tuberculo-toxin has been set See also:free, has proved very successful. Behring's Tulase is a tuberculin 'preparation formed by a See also:process of treating tubercle bacilli with See also:chloral, and Bereneck's tuberculin consists of a filtered See also:bouillon culture treated with orthophosphoric See also:acid. The variety of cases to which these treatments are suitable can only be estimated from a careful consideration of each on its own merits. In the treatment of tuberculous lesions, the surgeon also plays his part. Tuberculosis is specially prone to attack the spongy See also:bone-See also:tissue, joints, skin (See also:lupus) and lymphatic glands—especially those of the See also:neck. Recognizing the infective nature of the disease, and knowing that from one See also:focus the germs may be taken by the blood-stream to other parts of the body, and so cause a general tuberculosis, the surgeon is anxious, by removing the See also:primary lesion, to cut See also:short the disease and promote immediate and permanent convalescence. Thus, in the early stage of tuberculous disease of the glands of the neck, for instance, these measures may render excellent service, but when the disease has got a See also:firm hold, nothing short of removal of the glands by surgical operation is likely to be of any avail. The results of this modem treatment of tuberculous disease of the skin and of the lymphatic glands has been highly gratifying, for not only has the infected tissue been completely removed, but the resulting scars have been far less noticeable than they would have been had less See also:radical measures been employed. One rarely See also:sees now a network of scars down the neck of a See also:child, showing how a See also:chain of tuberculous glands had been allowed towork out their own,cure. A few years ago, however, such conditions were by no means unusual. Additional information and CommentsThere are no comments yet for this article.
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