APPENDIX.
NOTE TOPAGE 28.
... Nowadays, however, there are few authorities who do not admit that tubercle bacilli which have gained lodgment in the nasopharynx or in the oral cavity may causeprimary lesions in the lungin an entirely different way [different from direct infection by inhalation], namely, throughlymphogenousorhæmatogenous channelsafter anintestinal infection(the intestine reckoned from the pharynx down through the stomach to the rectum).
Whether this inhalation of tubercle bacilli from the air into the nasopharynx is followed by a pulmonary tuberculosis, and whether, if it be demonstrated that this actually occurs, the disease is to be ascribed tointestinalorpulmonaryinfection, is the thema probandum.... How little I deny the possibility of an inhalation of tubercle bacilli and the consequent danger of infection to many persons can be seen from two quotations, one from my Vienna lecture, March 12, 1903, and the other from the lecture held at Cassel, Sept. 27, 1903.
“In my plans for the suppression of tuberculosisI give the central place to the feeding of infants with milk both harmless and capable of healing. But as already stated in my previous communications, it is absolutely important to keep coughing consumptives away from the nursing infant. The tubercular virus scattered throughout the dwelling of the consumptive surely finds its way in one way or another into the mouth of the nursling, and then, just like the tubercle bacilli in the milk, it reaches the lymph-vessels and the circulation. It will, of course, also get into the infant’s milk, and when, therefore, in my lecture in Cassel, I stated that ‘the milk fed to infants is the chief cause of consumption,’ I presumed that my auditors and readers were familiar with the following paragraph of my Vienna lecture: ‘If I may apply the experiences gained in studying the conditions under which tubercular and other cattle are housed, etc., I must say that model hygienic housing can do little to prevent the spread of tuberculosis, if at the same time the scattering of tubercle bacilli by the cattle with open tuberculosis is not prevented or at least lessened. It is absolutely impossible to determine all the numerous ways in which tubercle bacilli coughed up, or otherwise scattered about by the tuberculous animals, will finally reach the organism of the other cattle in the stable; and I regard it as almost impossible, by means of mechanical or other measures, to prevent the spread of virus from a case of open tuberculosis to the other inmates of thesame room. For adults who, in healthy circumstances, possess a strong protection against the action of the tubercle bacilli, in the form of the epidermis, the epithelial covering of the mucous membranes, and the anti-bacterial ferments, I regard the danger of infection as not particularly great, provided, of course, the dose introduced is not as large as in our laboratory experiments. On the other hand, the new-born, whose mucous membrane is so very permeable and lacks the protective ferments, are so very much exposed to the danger that I cannot conceive such individuals escaping infection if they be in the same room with a coughing consumptive. It has been amply proved that the air can carry not only dry but also moist tubercle bacilli. If, then, this virus be present in the air (in a measure ‘volatile’), its introduction into the mouth and so into the intestinal tract cannot be avoided.
“These facts apply equally well to infants and to new-born calves.”
NOTE TOPAGE 51.
Mar. 3, 1904.
Excellence E. von Behring, Marburg, Germany.
My dear Professor Behring:
I have seen in recent discussion, reported in the medical journals, a reference to Dr. Knopf in regard to the infection of record-books, which he attributed to an occurrence in the Health Bureau of Lansing, Michigan, and seems to have reported in one of the French journals.
Dr. Henry B. Baker, who is the Secretary of the State Board of Health of Michigan, and who is a personal friend of mine, has been applied to for more particular information, and it appears that the matter refers to a newspaper (published in Detroit Oct. 14, 1899) andundoubtedly refers to a claim made by some one in Russia, where such an infection is said to have taken place.
I send you herewith a copy of the notice that has been sent out by the Lansing Health Bureau, and may say that Dr. Baker writes me that nothing of the sort has occurred in the office at Michigan.
I would be greatly pleased if you could send me a copy of Dr. Knopf’s publication in thePress Medicaleto which you have referred.
Thanking you in advance, I remain
Sincerely yours,Karl von Ruck.
NOTE TOPAGE 75.
... One unpleasant possibility [in the making of inoculation] is to be mentioned, one which I did not originally think of and which was called to my attention by Ober-med. Rath Lorenz. It consists in the general collapse of the inoculated calf, of very threatening aspect, when the inoculating fluid has been injectedtoo cold. This happened on a Hessian farm on a cold winter day, and resulted in the collapse ofallthe inoculated calves. (It would, by the way, have happened if only the cold fluid without the virus had been injected.) As it was, all the inoculated animals had recovered by the following day. This teaches us to warm the inoculating fluid to about body temperature before injecting it. This is readily done by placing the bottle containing the fluid into a little lukewarm water.