Medical research; Tuberculosis, part 1

The following program is produced by the University of Michigan broadcasting service under a grant he made from the National Educational Television and Radio Center in cooperation with the National Association of educational broadcasters tuberculosis the first of three programs on this subject from the series human behavior social and medical research produced by the University of Michigan Broadcasting Service. The people you will hear today are Dr. Julius L. Wilton and Dr Floyd M. Feldman of the American Trudeau society and Dr. Saul Roy Rosenthal who is director of the Institute for tuberculosis research in Chicago. And my name is Glenn Philips. Tuberculosis is still a serious disease. Since modern treatment has helped to cut the TB death rate some people think it is under control. About two hundred fifty thousand Americans have TB an active form and even more startling one fourth of two one third of the population is infected by the TB Germ. First suppose we find out if there are

different forms or kinds of TB. Dr. Rosenthal explain this way. Practically speaking there's only really one kind of tuberculosis and this is the human. Type of tuberculosis that affects the lungs and perhaps ninety nine percent of the cases. However there are other types. There is a type that affect. Cows called Moving to regular doses. Now this used to be a problem in this country. But with Bricklin testing. Eradication of those who are tuberculous. That is those who reacted to the tests which means that they have tuberculosis and one in either latent form or an active form. The pasteurization of milk. Inspection of meat all of that has practically a limited this type directors of the United States. Now it's still quite a problem in other countries England France for example and some of the other countries in Europe. And there's also

even directly asked us which of. Its birds This is known. To occur. And something that might even be passed on to humans but it's extremely rare. Recently however there is something there isn't which it is new. And this is a type of tuberculosis which we call it typical. Which also affects the lungs of human beings. But doesn't act quite the same way as the human form that we know but we have known all these years. One. Aspect in many of these atypical forms is that. When you inject it into a guinea pig it doesn't kill them. Which human form of tubercle was a lie. When injected would. And many feel that this may be due to the fact that. Following treatment of tuberculosis. Lead To prick of a cell

as which causes disease. Is so changed. Become resistant to the drug. Especially the drug called I so why is it. When this happens. The organisms lose their ability to cause progressive tuberculosis in the guinea pig. But it does not mean they lose that ability in humans. Now. Some feel that it is this form. Of the Tobruk of Solace which is infecting human beings causing disease. And that but differing from the original. Strain of tuberculosis known as the human strain. Dr. Julius Wilson of the American Trudeau Society added this tuberculosis is a costly disease of the whole body it just has a predilection for the lung it attacks the brain the meninges brain and produces to break this meningitis

in its most extreme and least scattered form so-called nearly every tuberculosis with little lesions the size of a millet seed all through the tissues of the body. And this of course was previously a very fatal form now the most readily cured for tuberculosis the lymph nodes of the neck and other parts of the body. Tuberculosis of the bones the joints the kidneys. And the skin These are the chief manifestations of generalized tuberculosis but in every instance it involves the whole body it merely heals up and all other parts and attacks one part for the lungs as a rule. Both of these men have referred to the tubercle bacillus which causes TB. I asked Dr Wilson what they meant by bacillus. It's a bit Seles it's a mycobacterium that is a bestseller list which is classified as generally related

and a distant cousin sort of way to the funguses. They might cover my cosies. Has some of the same characteristics as a fungus slow growing. Set and staining characteristics and so on. In New York I visited with Dr Floyd Feldman and asked him Is this something like good diabetes where I've been told that if you have been going to get diabetes you have the germ all all your life and it just becomes manifest itself and at some later date sometime. Do you always carry the regular bassoon. You know it is quite different from diabetes of course diabetes is not a germ disease in the sense that tuberculosis is. It used to be thought that by totally everybody got infected with the tubercle bacillus but that just is not so and in this country the rate of new infections has been dropping very rapidly. Some recent studies on the Navy

recruits and they're about 19 years old has shown and have shown that their rates of infection now are only about 5 percent and have dropped considerably just in the last few years. And when we test school populations we find that nowadays you find whole schools with nobody positive to the brakeman test and that test is the one we used to tell if people are infected. So where are quite sure now that. Most of the new cases that we're getting are coming from people who have been infected quite a long time ago. This may have been a year or two years or even as long as 20 or 30 years and that one of our biggest problems and tuberculosis is in the older segment of the population. You see they went through periods of years and years ago when tuberculosis was everywhere and they got heavy infections at that time. And this

this germ is like well is like a seed in some people it stays there for years and then for unknown reasons it suddenly becomes active and they get active tuberculosis. This has been one of the real problems in trying to control the disease or you can say it doesn't have a nice short information period between infection and disease like some of our other things. Just how does the United States compare with other countries in the rate or not the rate but the number of cases of tuberculosis the United States is in a pretty favorable condition situation maybe I should say compared to other countries they northern European countries United States. Australia few of the others have relatively low rates and lower numbers of tuberculosis patients and of course fewer deaths. This is a relative matter however and if you were to compare. The number of

people sick for instance with tuberculosis was some of the other diseases we worry about. It is still a pretty considerable number of well for instance the newly reported active cases in this country for nine hundred fifty eight were sixty three thousand. Now this is not as many as some other diseases but sixty three thousand cases a rather serious disease we think is still worth working on. There were also I might say some 12000 deaths from the disease during that year. Now that these rates are pretty low compared to what we had back in 1900 but they're still relatively high compared to some of the other things we have now just this is a single disease to remember this is not like heart disease which really is quite a number of disease but together. One of the controls over TB is known as BCG the

basilisk helmet and gallant so named Forrest discovers it is a vaccine and the first vaccination unmanned occurred in 1921 at the hotel Charlotte De in Paris. Dr. Rosenthal is one of the leading exponents of this type of control and his research has yielded dramatic results. He tells us about that research. We are engaged in. Vaccination against tuberculosis. I think that. No one will deny. That the best way to treat disease is to prevent it. This has been true over the ages and it says to now as ever. If we ever are going to eradicate tuberculosis is going to have to be done. In combination with vaccination. Not Alone of course. Now the vaccine which we have worked with here and which we feel is

the. Best vaccine available at this time is called BCG. This is the means or stands for the bacillus of Kemet. And again. These are two Frenchmen who isolated this organism. From a Bovino strain of tuberculosis that is a tuberculosis that came from a cow. And this organism was weakened if you will by. Culturing it an artificial artificial media. And it became so attenuated. Or lost its potency to such an extent that when injected into animals would produce no progressive disease. When this was known it then was applied to humans this was in 1921. We have in Chicago. At the institution for Tuberculosis Research University of Illinois.

And Research Foundation. I. Worked with this organism. And. Have been able to. Show its a few. Activists in animals and in man. What we have recently done was to. Develop a method for preserving it in the dried state. Which now makes it possible. To do all the sterilization on this organism before it's released. Now in France for example where this vaccine first were developed they use it in a fresh foam which means you have to be going out immediately knew within a week. But it is not possible for example to keep it for six months and do all the work. In animals and even in humans before it's given out for general distribution. This is the so-called process for you Don. This means then that we have a vaccine that's

well standardise and safe. Without any question. And it's quite an advantage to have this. Now. We have vaccinated thousands upon thousands of children and. Young adults. Medical students nursing students. And this has also taken place in every state and Union and we have supplied vaccine to every state and union. Dr. Devi a University of Michigan for example went to one of the very first to vaccinate medical students. With BCG. And we were went there and. Assisted him in starting this program. And he uses the vaccine which is made here. Now just as an example of how effective this vaccine can be. In 20 years since we started vaccinating medical students at the con at the University of Illinois. We have not had a case of tuberculosis in the medical student during their school years. This is sort of a record I would say since we used to have a case or two every year. And in fact we had

13 cases in those not vaccinated during summer period. Used as controls. Recently. We have. Developed a method. Of vaccinating which is perhaps in a way unique. The idea of doing this first came to us in 1942 when we used it for the treatment. Of tuberculosis. In that instead of injecting the material. We sprayed it into the room. Or sprayed it into the chamber where these the first animals than humans were and let them breathe it in. And this way we effected an immunity a unity locally. Where the disease are taking place. That is the lung.

Recently Dr. Middlebrook of the National Jewish Hospital in Denver. Has applied this method for vaccinating guinea pigs. And he found that by this method. Such guinea pigs or such animals challenge with a potent or variant strain of the two proposals. Were immunized against this variant strain as compared to a normal. Control animal. We now have applied the same technique. To humans. And at first we have. Used a pressure chamber. Where we could determine the air in floor an air outlet and the humidity and all the various physical properties of this of the air going in and going out. But since this was a very traumatic experience for children. And adults.

We know. How able to effect the same. Vaccination. By allowing the children or adults. To simply remain in. Their classrooms. Or their living rooms. And introduce the spray. Where the ventilating system. The children are aware of that what is being done to them at all. They go on with studies in their classes. They're just inhaling these particles of. Vaccine. Which. We feel will then unite them against very disease. Naturally if this is just preliminary. And the human logic aspect has still to be. Proven in humans it has been proven in animals. Next week we will take up the subject of airborne vaccination which Dr. Rosenthal has just referred to. But first we go back to the BCG for a moment.

Some people feel there are difficulties with BCG. Dr. Feldman discussed this aspect but the vaccine we have for tuberculosis has certain difficulties with it in the first place. It can only be given to the people who are not already infected with tuberculosis. And you'll remember that I told you we thought our biggest problem now is of people who already had the infection because they were the ones who were breaking down and having disease. Well the vaccine isn't given to them because in the first place it wouldn't give them any more immunity than they have already and in the second place they tend to get big reactions from this vaccine. And that's one difficulty so that you're limited in the people to whom you can give it. Another thing is that it is a live vaccine we would prefer to have a vaccine killed so there isn't any question about any disease developing from it. I wouldn't want to put too much emphasis on that because actually it is a safe vaccine. Very few.

Accidents have happened with it and it certainly is safe as many of the others that we are using now because of this other thing I told you about first that you can't give it to the group. We are really most concerned about. We do not feel that this back seam is is worth giving on a large scale in this country and some other countries where they have high rates of new infections. Then we think it can be used on a large scale. But in this country we think it should be limited to those who are in places where the risk of getting infected is fairly high like people who work in the Regulus laboratories or maybe some medical students and nurses in certain situations or doctors. Now we have lots of research going on in this field and we have hopes that we might have a vaccine and would not sensitize a person that you could give to all people who already have been infected and without any danger to them although we doubt whether it would help them very much. But if you could give a broad scale side without having to do directly and

test first thats that you have to do that first you see to see if theyre infected and you can only give it to the negatives. Maybe we should discuss to break and testing just a little bit here some people may not have had much contact with it although it's been done in this country in large numbers for many many years. This is you want me to go on with yes go on I was just going to set the stage so to speak. Well we want to look at the braking test as being a very useful thing to us. It's a very it's a simple little thing to do which gives us very specific and valuable information by putting a very dilute solution of some of the products at the tubercle bacillus makes in the culture. If we put this dilute solution just in the outer layers of the skin we find that in people who have never been infected and nothing happens. But and the person has been infected with the

tubercle bacillus they get a swelling and redness at that point on the Skins last few days so that we can buy this method pick out the individuals who have had an infection with the tubercle bacillus and then of course going on from that. It is possible with X-ray examinations and other laboratory tests to tell whether this is really doing the person any damage. This by the way is another thing we have to keep in mind that infection with the tubercle bacillus is not the same thing as tuberculosis disease as many people carry the infection without ever having any knowledge that they have the infection without ever getting sick. This also makes it more difficult for us to find the people who are just getting sick with it and it's important we find them when they're just getting sick because that's the time the treatment will do some good. This to

Brooklyn test as I say it have been extremely valuable to us for that reason. And if I might go back to the BCG vaccine business a little bit when we give this vaccine these people do become positive. And from then on the Brooklyn test isn't so much value to us anymore because then we can we know they're they could be positive either from the vaccine or from an infection that they have picked up. So that's another reason for us not being so enthusiastic about the BCT vaccine. And we're hoping as I said that we might have a new vaccine that wouldn't do that. And there is we have some experimental work going on that leads us to think this might be possible. So in other words. You do envision perhaps in the near future that there may be another vaccine that Will Ripley has received. I think there might be but in this country I don't see that that vaccine would speed up our control program nearly as much as some other things that we now think we should be doing. Such as. Well this

is a rather new concept. We know of course that these drugs are fine for the patient they will cure a very high percentage of the patients who get. Them in adequate doses in the wrong a period of time. But we have rather slowly it seems to me come around to the concept that this treatment of patients that we do know about and those that we can find is really the most important public health. Program that we could put on. I think we will be doing it. We will be. Extending every effort to see that every patient gets complete drug treatment. Now this in the first place helps patients. But the most important thing from our. Public health standpoint is that the patients become non infectious rather

soon after they get adequate drug therapy as they are not longer no longer spitting out. Typical of a so why when they cough or sneeze or talk and they're not likely to infect other people. Our present program has some definite defects in this respect that is there are a number of people who have been treated with drugs they feel better they. Can see why they should continue to take them after they feel better they leave the hospital or they leave treatment wherever they are. And little bit later they break down again. And by that time the drugs no longer work as well as they did originally. And these people go on and with chronic disease. We think that if we could give adequate therapy drug therapy to every new case for a long time and by a long time I mean at least a year in most cases and in some cases several years that we could make a real.

Dan in our present problem and we would have to wait generations for it to gradually drift downhill. Now I know scientists always use their words very cautiously but you use the word with drug therapy. They can be cured. Did you mean to say cured. I should have said for practical purposes because we're never sure about a patient with tuberculosis that is absolutely sure. Unfortunately even with the best of our drugs we know where that we don't eliminate all of the tubercle bacilli in the body and we prevent them from growing and we prevent them from causing any further disease in the hand. But there are usually some still fighting in this incidentally is one of our big research problems too to find out why some of these organisms some of the 2 recall so why stay in the tissues. And in spite of adequate therapy and big doses of drugs they aren't killed they just stay there.

And you can if you can isolate some of these same organisms in a test tube they seem to be very sensitive to the drugs and the drugs kill them. But in the body for some reason they're not all killed. But for practical purposes they hold it in check until the body defenses really make progress against the disease and the. And you do get curious which are curious. Actually I might say one thing more about it as since we've had these adequate drugs this difficulty with relapses with the patient getting sick again has been cut down considerably. And we think now that if they really stay on the drugs continuously as long as they are advised to that the relapse rate is very low and a very small percentage will have difficulty in future years. Will this drug ice Eliason permitted tuberculosis patient to go on normally.

Dr Wilton said to that question well that of course is true after the first few months or a year when his disease is to all intents and purposes arrested when he first goes on to treatment. There's no really no difference in the treatment from previous years he's only had the fever has to be in bed the remarkable thing is that you know almost all instances is fever. Disappears with his temperature returning to normal he begins to feel well his appetite comes back in a relatively short time a matter of weeks rather than months. So that he is up and around much sooner perhaps in a month or so. He is home much sooner if he goes to hospital. And then he is able to return to work very much sooner if he had been among the among the fortunate majority who have gone to the physician early gotten a diagnosis gotten treatment properly and healed up the disease and the

treatment so what you could say is eyes and eyes it has enormously accelerated the process of recovery and made it possible of course for a much higher percentage of patients to recover. Treatment for TB depends on the body location and severity of the disease. Generally these methods are you used drugs in vaccine we have heard discussed rest and good care and good food are required for all good health and the last treatment surgery. Dr. Rosenthal spoke of this surgery. Should play a very important role in the treatment of tuberculosis. At the present moment. It didn't it years ago because we didn't have drugs which would cover the surgery as it were. There are too many complications. But now with the chemotherapy which we have. It is possible to do much more surgery than we were to before. The principle is simply this. If you have.

An isolated lesion. Take it out. Then you don't. Have to worry whether the drug will get through that lesion. Many times as well after that you cannot touch it. Surgery isn't applicable. To everyone but in certain cases it has a definite place. And from a theoretical and clinical standpoint it is very useful. Next week Dr. Rosenthal and Dr. Wilson will be joined by doctors Gardner Middlebrook Roger S. Mitchell and H.S. Willis as they discuss tuberculosis and airborne vaccination. On the next program from the series human behavior social and medical research the consultant for this program was Dr. Winthrop Davy of the University of Michigan Medical School. Glenn Philip speaking asking that you join us next week and thanking you for being with us at this time.

This program has been produced by the University of Michigan broadcasting service under a grant in aid from the National Educational Television and Radio Center in cooperation with the National Association of educational broadcasters. This is the end of a E.B. Radio Network.