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By way of explaining the importance of the results of the commission's work on the transmission of human tuberculosis to cattle, it should be noted that this flatly contradicts the results obtained by Koch. He made a few attempts to infect cattle from man and, failing, assumed that this would never occur. This assumption is advanced by him as an argument that the disease in cattle and man is not intercommunicable, and hence different.
INTERIM REPORT OF ROYAL COMMISSION ON TUBERCULOSIS. The Royal Commission which was appointed on 31st of August, 1901, to inquire into the relations of human and animal tuberculosis, has issued the following interim report, which is signed by all of the commissioners:
To the King's Most Excellent Majesty,
May it please your Majesty, we, your Majesty's commissioners; appointed to inquire and report with respect to tuberculosis :
1. Whether the disease in animals and man is one and the same; 2. Whether animals and man can be reciprocally infected with it;
3. Under what conditions, if at all, the transmission of the disease from animals to man takes place, and what are the circumstances favorable or unfavorable to such transmission: humbly submit this report on the progress which we have made in the inquiry.
The greater part of the above reference is directed to the view which had been expressed that the bacillus which gives rise to tuberculosis in the human being, and that therefore the presence of the bovine bacillus in the milk or flesh of the cow, consumed as food by man, is not to be regarded as a cause of tuberculosis in the latter. To this point we first turned our attention.
After duly considering the matter, we came to the conclusion that it would be desirable not to begin the inquiry by taking evidence—that is to say, by collecting the opinions of others (though this might be desirable at a later stage) - but to attack the problem laid before us by conducting experimental investigations of our own.
The first line of inquiry upon which we entered may be stated as follows:
What are the effects produced by introducing into the body of the bovine animal (calf, heifer, cow), either through the alimentary canal as food, or directly into the tissues by subcutaneous or other injection, tuberculous material of human origin-i. e., material containing living tubercle bacilli obtained from various cases of tuberculous disease in human beings-and how far do these effects resemble or differ from the effects produced by introducing into the bovine animal, under conditions as similar as possible, tuberculous material of bovine origini. e., material containing living tubercle bacilli obtained from cases of tuberculous disease in the cow, calf, or ox?
We have up to the present time made use in the above inquiry of more than twenty different “strains'' of tuberculous material of human origin-that is to say, of material taken from more than twenty cases of tuberculous disease in human beings, including sputum from phthisical
patients and the diseased parts of the lungs in pulmonary tuberculosis, mesenteric glands in primary abdominal tuberculosis, tuberculous bronchial and cervical glands, and tuberculous joints. We have compared the effects produced by several different strains of tuberculous material of bovine origin.
In the case of seven of the above strains of human origin, the introduction of the human tuberculous material into cattle gave rise at once to acute tuberculosis, with the development of widespread disease in various organs of the body, such as the lungs, spleen, liver, lymphatic glands, etc. In some instances the disease was of remarkable severity.
In the case of the remaining strains, the bovine animal into which the tuberculous material was first introduced was affected to a less extent. The tuberculous disease was either limited to the spot where the material was introduced (this occurred, however, in two instances only, and these at the very beginning of our inquiry), or spread to a variable extent from the seat of inoculation along the lymphatic glands, with, at most, the appearance of a very small amount of tubercle in such organs as the lungs and spleen. The tuberculous material taken from the bovine animal thus affected, and introduced successively into other bovine animals, or into guinea-pigs from which bovine animals were subsequently inoculated, has, up to the present, in the case of five remaining strains, ultimately given rise in the bovine animal to general tuberculosis of an intense character; and we are still carrying out observations in this direction.
We have very carefully compared the disease thus set up in the bovine animal by material of human origin with that set up in the bovine animal by material of bovine origin, and so far we have found the one, both in its broad general features and in its finer histological details, to be identical with the other. We have so far failed to discover any character by which we could distinguish the one from the other; and our records contain accounts of the post-mortem examinations of bovine animals infected with tuberculous material of human origin which might be used as typical descriptions of ordinary bovine tuberculosis.
The results which we have thus obtained are so striking that we have felt it our duty to make them known without further delay in the present interim report.
We defer to a further report all narration of the details of our examinations (and we may say that up to the present time we have made use of more than two hundred bovine animals), as well as all discussions, including those dealing with the influence of dose and of individual as well as racial susceptibility, with questions of the specific virulence of the different strains of bacilli, with the relative activity of cultures of bacilli and of emulsions of tuberculous organs and tissues, and with other points. In that report we shall deal fully with all these matters, as well as with the question why our results differ from those of some other observers.
Meanwhile we have thought it our duty to make this short interim report, for the reason that the result at which we have arrived-namely, that tubercle of human origin can give rise in the bovine animal to tuberculosis identical with ordinary bovine tuberculosis ---seems to us to show quite clearly that it would be most unwise to frame or modify iegislative measures in accordance with the view that human and bovine
tubercle bacilli are specifically different from each other, and that the disease caused by the one is a wholly different thing from the disease caused by the other.
THE FLY AND THE TUBERCLE BACILLUS.
‘The recent stress which has been laid on alimentary infection in tuberculosis should lead to a more careful consideration of the means by which tubercle bacilli may reach the alimentary canal. The recent studies of Lord show that the ubiquitous fly may play an important part in alimentary transmission. The bacilli not only pass the alimentary canal of the fly unchanged, but undergo a marked proliferation there. Fly specks may contain as many as 5,000 bacilli, and, according to Lord's computations, thirty infected flies may deposit within three days from 6,000,000 to 10,000,000 tubercle bacilli. The danger does not seem to be from the liberation of bacilli in the air, but from the deposition of the fly specks on food. That this can and does occur under certain circumstances was abundantly demonstrated by our experience with typhoid fever during the Spanish-American war.
We should bear in mind the possibility of infection by the fly and be much more strict than we are at present in the disposition of sputum and in the protection of foodstuffs, and this refers particularly to the summer months.”—Journal of American Medical Association.
Reports of smallpox still come from all parts of the State, although active work on the part of local health officers has kept it from becoming extensively epidemic. During December, January, and February there were in San Francisco 99 cases. Dr. Ragan, Health Officer of that city, in his February report, says:
“The history of the entire 99 cases (taken at the smallpox hospital) shows that 96 of them were never vaccinated; three were vaccinated once, the remaining scar being evidence of a successful 'take.' None of these individuals infected had been vaccinated since childhood. Of these 99 cases, 47 were of the confluent type, 52 of the discrete type, and one of the hemorrhagic type. The mortality in the 99 cases was four-one of these being the hemorrhagic case above noted."
This is the universal observation. Very few that have ever been vaccinated have the disease. Health officers should see that cases are not allowed to go free until they are entirely clean of scabs, for as long as the remains of one are left the patient is dangerous. It is far better to be on the safe side, by keeping a patient a few days longer, than to have others contract the disease.
Postal report cards have been sent to all health officers known to the State Board, on which to make monthly report of diseases. A few send them regularly. Why don't the rest ? It is a State law, and every officer swears to obey the law.
MABTIN REGENSBURGER, M.D., President,
F. K. AINSWORTH, M.D.
San Francisco San Francisco A. C. HART, M.D.
..Sacramento WALLACE A. BRIGGS, M.D., Vice-President,
O. STANSBURY, M.D.
STATE BUREAU OF VITAL STATISTICS.
STATE HYGIENIC LABORATORY. ABCHIBALD R. WARD, D.V.M , Director.
University of California, Berkeley
VITAL STATISTICS FOR APRIL. Summary.-For April there were reported 1,113 living births, 2,386 deaths, exclusive of stillbirths, and 1,010 marriages, which, for an estimated State population of 1,882,483, give the following annual rates: Births, 7.1; deaths, 15.2; and marriages, 6.4, per 1,000 inhabitants. The relatively low rates are explained by the seismic disturbance in San Francisco and vicinity on April 18th. The great fire in the metropolis destroyed the statistical records for the first part of the month, and the deaths for the latter part, even including deaths recorded as due to earthquake and fire, fall short of the usual monthly total. Moreover, the disturbed conditions necessarily resulting prevented (or at least have postponed) the recording of marriages and births, especially the latter, in San Francisco and other counties.
Altogether 607 deaths were reported as due to earthquake and fire, 395 being in San Francisco and 212 in other counties. The bulk of the deaths outside the metropolis were at Agnews State Hospital and in Santa Rosa city, the rest occurring mainly among refugees from San Francisco dying of exposure or fright.
Of the normal deaths for the State outside the metropolis, tuberculosis, as usual, was the leading cause, followed by heart disease and pneumonia. The principal epidemic diseases were typhoid fever, measles, influenza, and diphtheria and croup.
Causes of Death.- The confusion resulting from the great fire in San Francisco has delayed the transmittal of original certificates for that eity, so that only a brief summary of deaths there from April 18th to 31st is available. Accordingly, the following table shows the number of deaths in April due to certain important causes only for the rest of the State:
Francisco. of State. ALL CAUSES.
547 1,839 Typhoid fever.
5 Diphtheria and croup
16 Other epidemic diseases
9 Tuberculosis of lungs.
276 Tuberculosis of other organs.
81 Other general diseases.
27 Other diseases of nervous system.
127 Diseases of circulatory system.
215 Pneumonia and broncho-pneumonia
145 Other diseases of respiratory system..
40 Diarrhea and enteritis, under 2 years.
14 Early infancy
37 Unspecified natural causes
145 101 Suicide
23 Earthquake and fire.
395 212 Other violence...
Altogether 607 deaths were due to earthquake and fire-395 in San Francisco and 212 in other counties, as follows: Santa Clara, 139; Sonoma, 55; Alameda, 12; Sacramento and Solano, 2 each; and Napa and Nevada, 1 each. The bulk of the deaths in Santa Clara County were at the State Hospital at Agnews, and all in Sonoma County were in Santa Rosa city. Most of the deaths in Alameda County and all in the remaining counties occurred among refugees from San Francisco, young children dying from exposure and elderly people from fright or heart disease.
Of the normal deaths in the State outside of San Francisco, tuberculosis, as usual, was the leading cause, 276 deaths being due to tuberculosis of the lungs and 36 to tuberculosis of other organs. The next highest number, 215, was for diseases of the circulatory system (heart disease, etc.), followed by 145 for pneumonia and broncho-pneumonia.
The leading epidemic diseases in April were: Typhoid fever, 21; measles, 18; influenza, 16, and diphtheria and croup, 15.
THE CATASTROPHE IN SAN FRANCISCO. On the morning of April 18th a severe earthquake visited San Francisco and surrounding towns. Chimneys and cornices were thrown down and buildings of poor construction destroyed. Houses on wooden foundations that had decayed went down, and brick structures built with mortar which was largely sand, collapsed.
In San Francisco fire immediately followed and, owing to the destruction of the water mains, swept over and destroyed a large part of the city, rendering homeless 300,000 people. The loss of life was severe, but not so great as in many other calamities. Reports which are nearly complete show a death list of 607 in the entire State.