Rangitikei Advocate. SATURDAY, MARCH 7, 1908 EDITORIAL NOTES.

Rangitikei Advocate and Manawatu Argus, Volume XXXIII, Issue 9089, 7 March 1908, Page 4

Rangitikei Advocate. SATURDAY, MARCH 7, 1908 EDITORIAL NOTES.

THE crusade against consumption has excited considerable public interest and a good deal of more or less accurate information on the subject of the causes and cure of tuberculosis has become general. The current opinions on the subject may be put in a few words. It is believed that tuberculosis is on the increase, that it is by means of the bacilli contained in the dried sputum of sufferers, that it is therefore of a somewhat infectious character that it can be cured in its early stages by resort to one of the sanatoria for consumptives and that unlimited fresh air is the best preventive of the disease. These are roughly the opinions held by the average man who acquires his information from newspaper articles and popular addresses, and they approximate to the truth so far as it is known to medical men. A very important report by Dr. Bulstrode “On Sanatoria for Consumption and Certain Other Aspects of the Tubercuslosis Question,” has recently been published by the English Local Government Board, and a study of this work reveals that there is still far greater uncertainty on the subject of the origin and methods of cure of consumption than is commonly believed. As in so many other subjects the more knowledge the investigator acquires the less dogmatic he appears to become.

TUBERCULOSIS is caused by a bacillus which can grow upon practically every tissue or organ of the human body but by far the most common seat of its detected manifestation is in the lungs. It used to be supposed that the affection of the lungs was due to the of

infected air, but lately evidence has been obtained] which "points' to the infection of the lungs by way of the intestinal tract and it is believed „by many tMt this is the main source of infection, a theory which, if true, shows the, vital importance of the prevention of tuberculosis in cattle, especially in milking^cows.

THE idea that the mortality from consumption, tubercular lung disease, is increasing, is quite contrary to the evidence given by statistics, lu England and Wales the deaths in 1838 from consumption were at the rate of 89.9 in every 10,000 persons living. In 1855 the rate had fallen to 27.7 and in 1906 it was only 11.5. The fall has, on the whole, been continuous, though naturally there have been rises and falls in the death rate. Moreover, the age of maximum mortality which between 1851-60 was 20 to 25 among males and 25 to 85 among females, is now from 45 to 55 for the former and 35 to 45 for the latter, a change which seems to show an increased power of resistance in the subjects. In New Zealand there also appears to have been a similar reduction, though it is less marked ais the figures have always been comparatively low. At present the death rate from ail forms of tubercular disease is only about eight per 10,000, which compares very favourably with the British figures which apply to tubercle of the lungs only.

IN relation to the value of the sanatorium treatment Dr. Bulstrode points out that in this early stage of the progress of the movement it is both impossible and undesirable to draw precise conclusions from the evidence so far available. Statistics as to the condition of those who have left the sanatoria are not of long enough standing and are not drawn up with sufficient care to warranty absolutely definite statements, but it seems certain that little permanent benefit can be hoped for in advanced cases of disease. For example at the Durham Sanatorium during the seven years 1900-7, 406 “early or consolidation cases” were discharged, and of these, on the 30th of April, 1907, out of 303 who had^“returned to work,” 197 were still “at work,” 47 were “at home,” 93 were “dead,” and 70 were “lost sight of.” During the same period 268 “advanced or cavity cases” returned to work, and of these, on the 30th of April, 1907, 41 were still “at work,” 34 were “at home,” 144 were “dead,” and 49 had been “lost sight of.” The conclusion is that patients should take advantage of the sanatoria as soon as the disease manifests itself, as otherwise even under the best conditions the hope of their permanent restoration to health is very remote. REFERRING to the danger of infection from consumptives the report is of a consoling nature to those unfortunate sufferers who are often shunned as though a danger to all. Dr. Bulstrode discusses at length the evidence in favour of and against a belief in the ordinary transmission of infection by the expectoration, and points out that the bacillus when expelled from the body is less tenacious of life than many persons have supposed. Ho also indicates that the actual amount of occurring infection appears to be less than it probably would be if the discharged bacilli possessed the virulence and the vitality with which they have been credited, and shows it not to be improbable that a material amount of human tuberculosis is attributable to the introduction into the alimentary tract of bacilli of bovine origin. The determination ultimately reached upon this question will be largely influenced by the amount of tuberculosis which the Commission now sitting is able to ascribe to bovine disease; or it would, perhaps, be more correct to say that any evidence which can be adduced in favour of infection must be considered side by side with the evidence of indirect infection from bovine animals.