The bacillus tuberculosis and the etiology of tuberculosis : is consumption contagious? : second communication, read, by invitation, before the Philadelphia County Medical Society, November 14, 1883 / by H.F. Formad.

  • Formad, H. F. (Henry F.), 1847-1892.
Date:
1884
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Licence: Public Domain Mark

Credit: The bacillus tuberculosis and the etiology of tuberculosis : is consumption contagious? : second communication, read, by invitation, before the Philadelphia County Medical Society, November 14, 1883 / by H.F. Formad. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    in his views as would appear from his writings ; nor is he as self-satisfied and as rash to jump at conclusions as are some of his followers. Koch has the co-operation of an excellent staff of assistants, all able mycologists ; but it was a matter of surprise to me that there was not a single com- petent pathologist connected with his lab- oratory ; and such services are evidently much needed to give to the observations made there the proper interpretation from a biological and anatomical stand-point. I was also pleased to learn in Berlin that the discovery of the bacillus was exagger- ated not so much by Koch himself as by the Imperial Board of Health, which em- ploys him, and by his over-zealous follow- ers in the profession. There is strong evidence, however, that Koch’s investi- gations are biased by the determination to find for each specific disease a specific fungus. Following out the various phases in the study of tuberculosis, I am sorry to see that the entire subject is now being con- sidered from a purely etiological basis with reference to bacteria, while the study of the anatomical and biological relations is wholly neglected. I admire the beautiful bacteridian dis- coveries of Klebs, and particularly those of Koch in connection with the etiology of tuberculosis. The accomplishment of these results is a triumph for scientific botany and mycology ; but these studies are much too one-sided to have an application to scientific medicine. The bacillus is there. It is concomitant with most tuber- cular lesions. It is diagnostic of tuberculous change. It is, on account of its irritant properties, one of the causes of tuberculo- sis. But this forms no reason for asserting that tuberculosis should be considered a contagious disease, without further inves- tigation and proofs. A contagious disease can have only one cause. I cannot agree with those who define the predisposition to phthisis as being a condition of the or- ganism which offers merely a favorable soil for the tubercle-bacillus. Nor can I believe that inheritance is explained by subsequent infection from cohabitation, e.g., that children become scrofulous by living with consumptive parents. The latest fruits of the bacillus studies have even inspired Baumgarten (Centra/- blatt f d. Med. MBs., Aug. 4, 1883) and several others to come to the conclusion, in reference to the hereditary nature of tuberculosis, that the bacillus is transmitted in its larval state from mother to foetus in intra-uterine life ! One would think, how- ever, that one of the most wonderful effects of the tubercle-bacillus is manifested by the change it produced in the direction of the reasoning powers of some of our patho- logical and clinical investigators, both at home and abroad. Some of the younger pathologists are even affected by a regular fanaticism for bacterian studies in tubercu- losis. These studies now take the place of their former excellent pathologico-anatom- ical studies. Consideration is no longer given to the tissue-changes, or the nidus which invites the bacteria and nourishes them. In fact, Koch’s followers in their enthusiasm exaggerate matters, and, to Koch’s own amusement, go further in their bacillus speculations than he himself thinks justifiable. It is really painful to read how some of the younger German pathologists and a few of the prominent English sur- geons, under the influence of the bacillus craze, will make in their publications asser- tions entirely unwarrantable. They de- scribe, for instance, with the greatest inge- nuity and exquisite minuteness, how “one or more bacilli” will produce certain histo- logical changes in the lungs or in the peri- toneum, designating the exact route to the same; how the different cells, the lym- phatics, and the blood-vessels are affected ; how the bacilli convert one variety of cells into another; how they manufacture giant cells and cheesy material ; how acute and chronic phthisis is produced by the ba- cilli, and the quantity necessary for each; how tubercles develop only and exactly in those places where the bacillus becomes lodged ; how, if bacilli alone are inhaled, miliary tubercles form ; and how, if the bacillus is accompanied by some other ir- ritants, a broncho-pneumonia will ensue. All of the above statements are made by scientific medical men and pathologists, and offered as broad facts in full earnest ! I only have to say that here evidently ob- servation is substituted by imagination and mere speculation ; and all this is done for the sake of the convenience in explaining a disease by pretty hypotheses. The only men who attempted to repeat Koch’s experiments, besides the work done in the pathological laboratory of the University of Pennsylvania, were Spina (Studien liber Tuberculose, Wien, 1883)