Chapter IV: Appendix: Note to Page 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 cause _primary lesions in the lung_ in an entirely different way [different from direct infection by inhalation], namely, through _lymphogenous_ or _hæmatogenous channels_ after an _intestinal 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 to _intestinal_ or _pulmonary_ infection, 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 tuberculosis I 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 the same 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 TO PAGE 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) and _undoubtedly 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 the _Press Medicale_ to which you have referred.

Thanking you in advance, I remain

Sincerely yours,
KARL VON RUCK.

NOTE TO PAGE 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 injected _too cold_. This happened on a Hessian farm on a cold winter day, and resulted in the collapse of _all_ the 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.

FOOTNOTES:

[1] Address delivered at the seventy-fifth meeting of Naturalists and Physicians in Cassel, September 25, 1903.

[2] On the other hand, certain stages in the development of various malaria parasites resemble each other very closely; but we distinguish the parasites definitely because they are of different origin.

[3] Formula for the digesting fluid:

Pepsin 1-2 gm.
Glycerin 10 c.c.
HCl 22° Baumé 10 c.c.
Sodium fluorid 3 gm.
Distilled water 1000 c.c.

[4] The intestine reckoned from the pharynx down through the stomach to the rectum. See appendix, p. 81.--TRANSLATOR.

[5] See appendix, page 84.

[6] It will be well to retain the name “Scrofula” for those tubercular processes _outside_ of the lung which go on with cheesy degeneration. Only in that way can the connection between the histogenetically so important results of earlier investigations be maintained.

[7] Rules 1, 2, and 3 have been _purposely_ neglected in certain dairies in Savár, Teschen, and Mecklenburg, as can be seen by the reports of Messrs. Strelinger, Rösler, and Ebeling (_Beiträge zur experim. Therapie_, No. 8, 1904), without, thus far, injuring the inoculated animals.

[8] §2 includes the following disinfecting agents:

1. Water, steam, hot water, boiling for one hour.

2. Soap-suds.

3. Soda-lye solution (at least 2 kilos soda in 100 liters water).

4. Freshly slaked lime, powder, and milk of lime, 1:2 aq. and 1:20 aq.

5. Sol. chloride of lime, 1:3 aq. and 1:20 aq.

6. Sol. carbolic acid, 5%.

7. Sol. crude cresol, 5% (Liquor cresoli saponatus of the German pharmacopœia).

8. Coal-tar and wood-tar.

9. Fire.

The most reliable and cheapest agent for rendering harmless Tb. virus in stables is hot 2% soda solution, whenever a surface disinfectant is desired. Disinfection of the stable air is as yet to be classed only as a pious wish.

[9] See appendix, page 84.

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