Doctor von Ruck has shown that it is not necessary to inject living tubercle bacilli for the purpose of successful immunization, but for a proper combination of the various extractives will accomplish this purpose with equal efficiency and certainly with far greater safety. He has even succeeded in removing the suppurative action of the tubercle bacilli by a proper balancing the contents in fats, or perhaps better, by removing the excess of fats and waxes from the tubercle bacilli, which he had found to be responsible for abscess formation after hypodermic injection.

In children who are susceptible to prophylatic inoculation with this remedy, which (N. B.) entails no risk, for it does not contain living tubercule bacilli, the most surprising clinical improvement was shown, especially a decided improvement in nutrition, a disappearance in all clinical signs where they had existed, of lung signs, of enlarged lymph, of anemia, etc., and what is more significant, the

of all these children showed progressive increase in tuberculosis antibodies, agglutinins, amboceptor, opsonins. Further, they showed and continue to show Lytic Power, the power to dissolve tubercle bacilli In Vitro.

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A PROPHECY OF THE FUTURE

“It is possible to believe that all the past is but the beginning of a beginning, and that all that is and has been is but the twilight of the dawn. It is possible to believe that all that the human mind has even accomplished is but the dream before the awakening. We cannot see, there is no need for us to see what this world will be like when the day has fully come. We are but creatures of the twilight. But it is out of our race and lineage that minds will spring that will reach back to us in our littleness to know us better than we know ourselves, and that, will reach forward fearlessly to conprehend this future that now defeats our senses.

“All the world is heavy with the promise of greater things, and the day will come, one day in the unending succession of days, when beings who are now latent in our thoughts and hidden in our loins, shall stand upon this earth as one stands upon a footstool, and laughs, and reach out their hands amid the stars."

PEDIATRICS

ORIGINAL ARTICLES

SPECIFIC RESISTANCE IN TUBERCULOSIS Its Increase by Prophylactic Vaccination, with Special Re

ference to Children.

DR. K. v. RUCK AND DR. H. J. ACHARD

Asheville, N. 0.

At the International Tuberculosis Congress in Washington, 1908, Irving Fisher (1.) presented statistical data on tuberculosis according to which it was estimated that, in 1906, a total of 138,000 persons died of tuberculosis in the United States and that 5,000,000 of all persons then living in our country will die of the disease.

The economic loss to the nation from death due to tuberculosis is over $8000. per death, and the total in the United States exceeds the sum of $1,100,000,000 per annum, two fifths of which ($140,000,000) must be attributed to other forms of tuberculosis than the pulmonary.

To cope with this evil which, translated in figures of dollars and cents is staggering, the Crusade against Tuberculosis in this country expended, in 1912 alone, the sum of $20,000,000 dollars and is spending similar sums by the year. Sanatoria, dispensaries, invalid homes, children's homes, floating hospitals, open air schools, preventoria, etc., have been and are being erected in great numbers to take care of the actually tuberculous, and also of those who show the earliest clinical signs of tuberculosis, or who appear to be in danger of acquiring it, for purposes of prevention. The entire far reaching mechanism of the social service, of district nurses, mother's classes, popular lectures, school inspection and factory inspection, etc., has been set in motion to find out the cases of tuberculosis at an early stage when thưy can derive most benefit from suitable treatment. Municipal and state authorities as well as business concerns, fraternal societies, private philanthropists and

life insurance companies have enlisted in this gigantic struggle, with the firm determination to clip the fangs of this terrible monster, the white death.

And yet, by all these great efforts and sacrifices the evil is only touched in its offshots as it were. Persons ill with tuberculosis are cured or their lives are prolonged, and incidentally they are rendered harmless to a certain degree as possible sources of infection for others. Some early cases and predisposed persons are protected against the acquirement of clinical tuberculosis, by suitable treatment through which their nutrition and their natural resistance is increased. A more and more efficient follow-up system of the results of school inspection will aid in eliminating many of the future consumptives by relieving and removing the conditions which

predispose them to the disease. In many portions of the country the mortality from tuberculosis has been lowered, and patients apply for examination and treatment far more frequently and at earlier stages than was the case formerly. In so far the crusade against tuberculosis has matured tangible results. But on the other hand it must be admitted that the frequency of tuberculosis has not only not diminished, but appears to have increased, owing to the more exact and refined methods of diagnosis by which tuberculosis can be recognized at a stage at which clinical signs, that may be present, as yet lack every characteristic feature.

In recent years the struggle against tuberculosis has entered into a phase which promises to produce more far-reaching and lasting results and to go more deeply at the root of the problem. We refer to the increasing efforts which are being made towards childhood prophylaxis, which followed upon the seemingly remarkable discovery that tuberculosis is actually a disease of childhood.

Assertions to this effect have been made as long ago as 1892 by Felix Wolff (2), in 1897 by Petruschky (3) and in 1899 by Heubner (4) before the Berlin Tuberculosis Congress. The fact has even been indicated in 1888, at the first French Tuberculosis Congress, when Babes (5) reported that in more than one-half of the children, dead from any cause whatever, tuberculosis of cervical, bronchial and mesenteric lymph glands was found at autopsy; and that, in 1887 for instance, 65 out of 93 autopsied children's bodies showed such lesions, although tuberculosis had been the cause of death in only 13 of the 93 cases. The assertion of v. Behring (6), that the actual source of adult phthisis must be referred to milk infection during infancy, stimulated the investigations concerning the true origin of phthisis and concerning the frequency of childhood infection; and the researches of Naegeli (7) for healed and obsolete, as well as latent and inactive tuberculous lesions in the organs of persons dead of other diseases than tuberculosis were supplemented by those of many other anatomists, with the results that the frequency of tuberculous lesions found in many series of autopsies was placed at figures varying from fifteen to ninety per cent of all bodies examined.

The finding of latent, inactive and even of healed lesions in the bodies of children, however, was at variance with the prevailing opinion that children were comparatively non-resistant to tuberculosis and that infants succumbed to it almost without exception. This difficulty was removed by the results of MacFadyen & McConkey (8), Gaffky (9), Weichselbaum & J. Bartel (10) and of others who found virulent tubercle bacilli in lymph glands of children, and even of infants, in which microscopically no evidence of tuberculosis lesions could be discovered. It was thus shown that tuberculosis infection must be strictly differentiated from tuberculosis disease and that the organism may, after infection, resist the development of active tuberculosis. This resistance, evidences of which had long been noted in bodies at all ages, although the cause had not been appreciated, explained how it is possible that “most people are a little tuberculous” or at least infected by tubercle bacilli, while a comparatively small number develop the active disease and still less succumb to it.

The great frequency of infection with tubercle bacilli was further proved by the results of diagnostic tuberculin applications which were undertaken for the purpose of discovering lesions at a time before clinical symptoms had become manifest. This mode of investigation was made use of particularly after v. Pirquet had elaborated his cutaneous tuberculin test, but before him the employment of the subcutaneous method had likewise produced interesting results.

H. Kossel (11) had reported upon 63 children of 1-10 years of age, of whom 28 or 44 per cent reacted to subcutaneous tuberculin injections, although only 4 of the 28 showed clinical signs of tuberculous disease.

According to a letter from Budapest to the Berliner

klinische Wochen.chrift (12), Berend & Preisich found in a considerable number of children that the tuberculin reaction occurred promptly in all cases of occult tuberculosis, including scrofulous of internal organs. Eighty per cent of all children with palpable lymph glands had reacted to the test.

The advantages to be derived from tuberculin tests, for statistical investigations, received particular emphasis through the publication, by the Austrian Staff Surgeon, K. Franz (13), of his results in the recruits of a Bosnian regiment. In a first series of 400 recruits, who were selected because tuberculosis is very frequent in Bosnia and in the Herzegovina, 245 or 61 per cent reacted to 1-2-3 subcutaneous injections of tuberculin, up to 3 mg; 10 or 2.5 per cent remained doubtful and 145 or 36.5 per cent did not react.

As these recruits had been in service but little over one month, they probably had not acquired the infection in this short time but had brought it from hoine. Representing, as they ao, the pick of the male population and showing no sigus of tuberculosis on repeated careful examination, the results demonstrate the possibility of a latent infection on the one hand, and on the other the great frequency of exposure to in. fection in the portions of the country from which these recruits were drawn.

Of a second series of 321 Bosnian recruits, who were subjected to examination the following year, under exactly like conditions (14), 222 and 68.8 per cent were found to react. By way of comparison, 279 recruits of another regiment, supplied mostly from Hungarian counties, were examined and of these 108 or 38.7 per cent responded with a positive reaction

During their three years of active service and the three or four years of service in the reserve all these men were under more or less constant medical supervision, and it was found that during this period of six, resp. seven years: of the 1st. series of 400 Bosnians, 32 or 8 per cent. acquired clinical tuberculosis; of the second series of 323 Bosnians, 23 or 7.12 per cent acquired clinical tuberculosis; of the third series of 279 Hungarians 9 or 3.22 per cent. acquired clinical tuberculosis. Some of these men had not reacted to the diagnostic tuberculin injections in 1901 and 1902. Among a total of 1002 recruits, 575 or 57.38 per cent. had reacted, and 64 or 6-38 per cent. had become clinically tuberculous.

These two communications by Franz possess an interest