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Calf lymph.—Medical men complain bitterly of the difficulty of getting active lymph.
Much of the lymph supplied during the currency of the present epidemic of small-pox, while
being of sufficient strength to ensure a satisfactory result in primary vaccinations, has proved
too feeble in cases of attempted revaccination. Great public advantage would accrue if the
Local Government Board would supply doctors with lymph for revaccination, but hitherto the
lymph cultivated upon calves at the Government establishments has been issued only to public
vaccinators. Some of the private firms engaged in the production of calf-lymph send
out material to which no exception can be taken; but it appears to me desirable that,
should the Board be indisposed or unable to supply Government lymph to all applicants, they
should, at least, be empowered to exercise such supervision over the production of lymph for the
use of private practitioners as may be necessary to secure that persons upon whom it is used
shall be "effectively revaccinated." Multitudes of persons, I doubt not, have been made happy
recently, by the thought that they are immune to small-pox, as their revaccination did not
" take; " the negative result of the operation being due, often, to the inertness of the lymph
employed.
THE PREVENTION AND TREATMENT OF CONSUMPTION.
INTERNATIONAL CONGRESS.
The most interesting event of the year in connection with the subject of consumption, a
subject which is engaging the attention of the medical profession in all civilized countries, was
the Congress on Tuberculosis,* held in the month of July, and of which the leading feature
was a paper by Professor Koch, in which if was stated that bovine tuberculosis is not
transmissible to man ; so that, quâ tuberculosis, no danger need be apprehended from the drinking
of the milk, or the eating of the flesh of tuberculous cattle. This view was combatted by Professor
McFadyean in a paper on "Tubercle bacilli in cow's milk as a possible source of tuberculous
disease in man." Professor Koch's views were opposed by other prominent members,
and at the final general meeting of the Congress a resolution (5) was unanimously adopted
to the effect—
" That in the opinion of the Congress, and in the light of the work that has been presented at its
sittings, medical officers of health should continue to use all the powers at their disposal,
and relax no effort to prevent the spread of tuberculosis by milk and meat."
In this connection it may be mentioned that in the eighth report, 1901, I expressed the
opinion that, apart from the question of danger of the spread of tuberculosis, no effort should be
spared to prevent the drinking of the milk of diseased cows, and (subject to the limitations prescribed
by the Royal Commission on Tuberculosis) the eating of the flesh of any tuberculous
animal, upon the ground that such articles being ''diseased, or unsound, or unwholesome," are
" unfit for the food of man." (Public Health {London) Act, 1891, section 47.)
The Congress, having regard to the weight due to the utterances of Dr. Koch, himself the
discoverer of the tubercle bacillus, thought it right to pass a further resolution (6)—
" That, in view of the doubts thrown on the identity of human and bovine tuberculosis, it is
expedient that the Government be approached and requested to institute an immediateenquiry
into this question, which is of vital importance to the public health and of great
consequence to the agricultural industry."
Though the Congress was indisposed to accept, without further proof, Dr. Koch's startling
(but not uncomforting) assurances as to the insusceptibility of man to bovine tuberculosis—heasserted
in unqualified terms, as the result of experiment, the non-transmissibility of human
tuberculosis to animals—there was absolute agreement between him and the members generally,
as to the main cause of the spread of consumption; viz., direct infection by inhalation, in the
moist or the dried state, of tubercle bacilli contained in the sputum of consumptives, especially
in the overcrowded rooms, bedrooms particularly, of the poor, to whose "sad lot," when stricken
with this disease, he made pathetic reference. The great reduction in mortality from tubercular
disease generally was attributed, by Dr. Koch, and others, to improved sanitary conditions ; and
the most hopeful anticipations were expressed of further benefit from the carrying out of precautions
now becoming generally known; and by the establishment of sanatoria, Dr. Koch
believes that tuberculosis may, and will, ultimately be extirpated, as other plagues have been,
now that it is known to be dependent upon a parasite. He emphasised the need for obligatory
notification of tuberculosis in cases that, " owing to the domestic conditions, are sources of danger
to the people about them"; and so that necessary precautions against spread, including disinfection
of rooms, might be ''effected when consumptives die or change their residence, in order that
those who next occupy the infected dwelling may be protected against infection." It will be
a comfort to many to learn that Dr. Koch attaches a minimum of importance to heredity in
regard to the causation of tuberculosis. "Hereditary tuberculosis," he admits, is "not absolutely
non-existent," but " it is extremely rare, and in considering our practical measures," we
may " leave this form of origination entirely out of account."
* The proceedings at the Congress were ably summarised in a volume for which we are indebted to Dr. Vinrace, a
Member of the Public Health Committee of the Council, and one of the Council's delegates at the Congress.