Robert Koch

Source: The British Medical Journal , Aug. 16, 1924, Vol. 2, No. 3320 (Aug. 16, 1924), pp.
285-286
Published by: BMJ

Stable URL: https://www.jstor.org/stable/20437533

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 AUG. i6, 1924] 'FRUITS OF THE ANTITUBERCULOSIS CAMPAIGN. r. DTn BOanA 285
method of carrying on a large clinic. As Dr. R. W. environmental factors have exerted an important in
Johnstone truly said, " Ante-natal observation no fluence, especially in the initial fall in the tuberculosis
longer mneans merely the testing of the urine and the mortality during the, seventies and eighties. But on
examination of the pelvis." The more experience one the basis of many statistics Sir Robert Philip showed
acquires in ante-natal work the more numerous its that the progressive decline in the general mortality,
opportunities appear. Ballantyne foresaw these possi which is on a uniform rate, cannot explain the
bilities at the very start. In 1901 we find that one accelerated fall in the tuberculosis mortality, and that
of the benefits which' he expected to follow the a much more powerful influence has been brought to
establishment of pre-maternity wards was the oppor bear on tuberculosis than on the other forms of disease
tunity that such beds would afford of studying collectively. Thus in Scotland, during fifty years
pregnancy diseases and normal pregnancy metabolism. (1871-1921) the death rate from all diseases was
It is during the next decade that this ideal will be reduced by less than half, whereas the mortality from
realized. Indeed, it is being realized already, for in tuberculosis fell by more than two-thirds. In Den
some of the larger teaching centres such studies have mark the fall in the tuberculosis death rate has been
been in progress on an intensive scale for some con even more abrupt than in other European countries.
siderable time. A further point of great significance as regards the
Thus all along the line the forces of progress are efficacy of the campaign is that the drop in the tuber
massing. There has been a tendency in the past among culosis mortality has occurred most conspicuously in
other branches of the profession, and not altogether the earlier periods of life, up to the age of 25; in Den
without reason, to look upon obstetrics as a crude and mark Knud Faber shows that up to the age of 14 years
unprogressive science. Indeed, it is only too true that the tuberculosis mortalitv has fallen since 1890 bv
with the exception of the advances rendered possible more than 70 per cent., and in the discussion
by the advent of anaesthesia and of Listerism (chiefly Professor Winslow mentioned that in the United
in Caesarean section) there has been little progress in States pasteurization of milk has brought down the
obstetrics during the last fifty years. This is a reproach statistical incidence of non-pulmonary tuberculosis.
that should soon be removed, and in its removal all The suggestion that the decline of the tuberculosis
who are engaged in the teaching, study, and practice mortality is due to an advancing immunization of the
of obstetrics-specialist and general practitioner alike civilized population against the disease does not receive
-can play an honourable part. To the younger support from Sir Robert Philip's survey of the con
obstetrician with a scientific bent the gate of oppor ditions in nations of the older civilization, whiclh
tunity stands wide open. Inside are ranged the should show the effect of such a factor in a more or
'' secret truths that yearn for birth." The time is less uniform degree, for there are striking differences
ripe. May their delivery be safely accomplished, and between the rates in England and Scotland on the one
soon ! hand and in Ireland on the other, as, indeed, there are
between various cities, both in Great Britain and also
in the United States of America. The view that varia
FRUITS OF THE ANTITUBERCULOSIS tions in the mortality rate of tuberculosis in different
CAMPAIGN. countries depend on differences in racial characteristics
AT the fourth Congress of the International Union cannot be entirely set aside, for the Jews are specially
against Tuberculosis, held at Lausanne on August 5th, resistant and some Celtic strains are peculiarly suscep
6th, and 7th, a number of important papers were read, tible, but it does not explain the decline in the rate
such as Professor A. Calmette's discourse on the per since 1871 in Britain, with its fairly constant racial
manent separation between tubercle bacilli and para qualities of the population, or the high tuberculosis
tuberculosis organisms, and on the modifications which mortality in Austro-Hungary and the low rate of mor
can be artificially produced in the virulence of tubercle tality of these races when domiciled in America. In
bacilli, although thev do not thus become paratuber short, all the evidence points to the beneficent in
culosis bacilli. But the most fundamental question fluence of a widespread and well planned campaign
raised was that so ably discussed by Sir Robert Philip, in diminishing the death rate from tuberculosis. One
who for forty years has devoted his energies to the authority, indeed, went so far as to express to Sir
antituberculosis campaign-namely, Has this cam Robert Philip the opinion that " tuberculosis is on the
paign justified its existence and diminished the toll run. "
levied by this infection on the human race? In
arriving at an affirmative conclusion Sir Robert brought
forward statistics from two sources-from England anid ROBERT KOCH.
Scotland and from North America. In many of his THE life of Robert Koch has often been told-his ear lv
arguments he was supported by Professor Knud Faber start as a bacteriologist, lacking both leisure and labora
of Copenhagen, who showed that in Denmark, where tory, and his quick but not quite constant spring to fanme
the antituberculosis campaign has been widespread, and all facilities. It is an interesting story, however, and
specia,lly well organized, and provided with a more of so much importance to the history of bacteriology that
liberal State expenditure than in any other country, it will bear telling again. This Professor Martin Kirchiner
the death rate from tuberculosis is the lowest of all has done in a small book.' It is very simply written, but
European nations, being in 1922 at the rate of 9.5 as is the more impressive for its simplicity. In 1876, at the
against 11.2 per 10,000 for this country. age of 33, Koch was engaged in private practice in Bom.st
Sir Robert Philip passed in review and refuted the in Wollstein, a little town of 4,000 inhabitants, and also
explanations other than the influence of the anti held the post of Kreisphysikus, a position roughly equi
ttuberculosis campaign sometimes given for the fall in valent to that of part-time medical officer of health. It
the mortality from tuberculosis since 1870. It has would be hard to conceive a position more unfavourable to
often been pointed out that this decline began before research, but Koch worked in such time as he could spare
the campaign and open-air treatment came into exist from his other duties, with very limited equipment, without
ence, and it has therefore been suggested that the
decline in the tuberculosis mortality is merely part of 1 Robert Koch. Von Professor Dr. Martin Kirchner. Band V, Meister
der Heilkunde. Vienna and Berlin : Julius Springer. 1924. (5? x 8?,
the reduction in the general mortality, and no doubt pp. 84; one portrait.)
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 286 AuG. I6, !9241 DANGERS OF ZINC TEATE DUSTING rOWDERF MZDICL JOVMxS
any assistance, in isolation from other investigators, and when the Section on Diseases of Children recommended
with no library facilities. It was under these conditions unanimously to the House of Delegates of the American
that he succeeded in working out the life-history of the Medical Association that warning labels should be placed
anthrax bacillus. He developied methods for cultivating on all containers of the powder, and that the form of the
bacteria on solid media, and proved that the anthrax container be modified so as to prevent the risk of accidents.
bacteria formed spores, that these spores could develop into In response to a request for information in February
bacteria, and that the cultivated bacteria, when inoc.ulated last by the Joubrnal of the American Medical Association
*inlto animals, produced the disease anthrax. This work records of 34 other cases were obtained, and these have
established firmly the causation of anthrax, and was at been published in our contemporary's issue of July 12th.
onlce recognized by Cohnheim as beinig of the greatest Of these cases 5 had terminated fatally, the youngest
fundamental importance. Koch's scientific reputation was patient, an inf ant aged 3 months, to whom a tin of the
established by it, but he continued to combine general powder had been given as a plaything, dying in one hour.
practice and bacteriological research until 1880, when he It was noted that in all cases the onset of the symptoms
was called to the Kaiserlich Gesundheitsamt in Berlin. was immediate, and that they varied in severity accord
Here he had adequate time and equipment for research, ing to the amiiount of the powder inhaled. The collapse
and was amidst a circle of other brilliant investigators, observed in many patients strongly suggested a toxic
ilncluding Loeffler, Gaertner, and Gaffky. In these favour effect, possibly zinc poisoning. In their conclusions the
able surroundings he became one of the leaders in the rapid American investigators state that zinc stearate powders
advance of the new science of bacteriology. In 1882 he possess no special advantage over other and harmless pre
discovered the tubercle bacillus, possibly the chief single parations, such as those containiing talc. While, doubtless,
discovery of his career. Kocli himself always regarded his the recommendation to attach warning labels to the zinc
investigations on tuberculosis as the most important portion stearate containers has been adopted and will serve to
of his life's work. In 1883 Koch was sent to Egypt and prevent such tragic accidents in the future, it would seem
India to investigate cholera, and succeeded in demon to be, nevertheless, very much open to question whether
strating that the comma bacillus was the causal agent. In the use of this type of powder is to be commended. So
1890 he created a great senisationi by declaring that he had far as can be ascertained, dusting powders consisting of
discovered substances which would arrest the growth of the zinc stearate are rarely employed in this country, but in
tubercle bacillus, not only in the test tubes, but also in the view of the accidents following their use in America it
livinig body. This discovery of tuberculin aroused immense would seem desirable to bring their qualities under the
general interest, but the final result was a severe dis notice of the medical profession.
appointment to the early hopes, and Koch felt this dis
appointment very keenly. From boyhood he had had a keeni
desire to travel, and during the last fifteen years of his THE INTERNATIONAL UNION AGAINST
life he was able to gratify this passion to the full, for nearly TUBERCULOSIS.
lialf his tilue was spenit in the tropical centres of disease.
THE International Union against Tuberculosis, which was
He visited practically every tropical country in Africa and
founded in 1920, has published the first number of its
Asia, investigating diseases both of animals and men. In Bulletin.' The internal affairs of the union, with which
an imiterval of travel, however, he attended the Inter twenty-four countries are affiliated, are directed by an
nationial Tuberculosis Congress in London in 1901, and executive committee and a council. The council meets
caused a great deal of surprise by announicing that human once a year, and, in addition to doing administrative work,
and bovinie tuberculosis were separate forms, and that hear s a scientific paper from' some person of authority.
bovine tuberculosis was practically harmless to man. This These papers will be published in the Bulletin, which is
conclusion gave rise to long controversy, and though the to be issued quarterly in French and English on facing
distinction between the two strains is now generally pages. The first number contains a short account of the
accepted, the belief that the bovine is not injurious to man activities, of the union from 1920 to the present time.
is known to be incorrect. In 1904 Koch retired from the Summaries of subjects discussed at the international con
post of director of the Institute for Infectious Disease, ferences, held in Paris in 1920, in London iin 1921, and in
a post he had held for thirteen years; he continued to work, Brussels in 1922, are provided, and the constitution and
lhow ever, and in 1906 went to East Africa to investigate
by-laws of the union are set out in full. It was formed
sleeping sickness. He died in 1910 at the comparatively primarily among the nations signatory to the covenant of
ear ly age of 67. The mere recital of Koch's chief dis the League of Nations, and includes the United States of
coveries indicates better than aniything else the dominant
America. Its objects are to co-ordinate the efforts of all
part he played in the development of bacteriology. the organizations engaged in the campaign against tuber
culosis, and to collect and distribute information on
questions concerning the scientific and sociological study
DANGERS OF ZINC STEARATE DUSTING POWDERS. of tuberculosis. The Bulletin contains a report of the
THE attention of the medical profession in the UnTited meeting of the council held in July, 1923, and also of the
States has been specially drawn to the serious consequences meeting of the executive committee held in December, 1923.
of usinig an apparently harmless substance-zinc stearate To the last council meeting Professor Bezan9on contributed
in dusting powder s for infants and young children. The an exhaustive and detailed criticism of the methods used
untoward results range from severe bronchopneumonia to for the detection of tubercle bacilli in sputum, pus, cerebro
simple toxaemia of variable duration. Accidents have spinal fluid, faeces, urine, anid blood. Full references to
occurred, attributable, it seems, to the inhalationi of the the authors of various methods are given. The Bulletin
powder-as, for example, m-lwen deposited oni the hands of also contains niews from the various countries affiliated to
the child. Heiman published a paper in 1922, recording the union. The nationial associations of Czechlo-Slovakia,
12 cases of poisoning follouwing this accidental inihalation. Italy, and Alsace-Lorraine held conferences during 1923.
Of his series, one patient died witlhin twentv-fouir hours, The English National Association held its tenth annual
thlree developed bronchopneumonia from wlich thev re conference in July of this year. The Belgiani National
covered, and in the remainiing cases there were symptoms 1 Bulletin de l'Union Internationale contre la Tuberculose. (VoL I,
of partial asphvxia without definite pulmonary disease. No. 1.) Iusued by the Executive Committee, 2, Avenue Velasquez,
Paris Ville. (Medium 8vo, pp. 127.) Subscription 12 francs (French) for
Fur ther publicity was given to the question in 1923, the year 1924.

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