Medical research; Tuberculosis, part 2

The following program is 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 tuberculosis. The second programme on this subject from the series human behavior social and medical research produced by the University of Michigan Broadcasting Service. The programs have been developed from interviews with men and women who have the too often unglamorous job of basic research. Research in medicine the physical sciences social sciences and the behavioral sciences. OK surely you will hear what may seem like strange or unfamiliar stuff. These are the sounds of the participants office laboratory or clinic where the interviews were first conducted. The people you will hear today are Dr. Saul Roy Rosenthal of the University of Illinois Dr. Julius Wilson of the American Trudeau society and doctors. James Waring and Roger Mitchell of the Colorado foundation for research into brick Ulos and Dr. H. S. Willis who is

superintendent and medical director of the North Carolina sanatorium system and Dr. Gardner Middlebrook of the National Jewish Hospital in Denver and my name is Glenn Phillips. Dr. Middlebrook discusses first on today's program one of the newest discoveries in vaccination methods. He said well some years ago. Five or 10 years ago I was attracted to the possibility of doing experiment work with experimental animals which would perhaps a little more clearly. Imitate the natural disease which tuberculosis causes in human beings. Several previous investigators had shown that. One could. Induce tuberculosis in experimental animals by letting them inhale very small numbers of fairly very ill and fairly

potent TB germs. And we set about to use this technique devising. New and simpler type of. Apparatus for inducing airborne tuberculosis and exposure to control conditions in experimental animals. During the course of these studies we thought. That we should investigate the not only of the fairly potent fully proven TB germs but germs which were partially weakened. Including those germs those strains of germs which. Have been used. To immunize against tuberculosis. We anticipated that it would be necessary for the animals to inherit a very large number of these germs for each animal to inherit and hail a very large number in order to. Develop any immunity

against the fairly potent germs. But to our surprise we found that. It was not necessary. To for the animals for guinea pigs in particular. To her have very large numbers of these attenuated vaccine living vaccine germs. It was sufficient for them to inhale a very small number. To develop. An immunity which was as great as if they had inhaled a million times that number. I say if they had received a million times that number. Into the skin. Which is the usual route by which these vaccine organisms are introduced into human beings too with the purpose of vaccinating against tuberculosis. The. Guinea pig girl needs inhale only one or two or three of the proper strain BCG vaccine organisms. Living BCG

vaccine organisms. To develop as much immunity as he would develop if he had received a million. Of the same Reaganism from the same test tube. Into the skin or under the skin. I furthermore. We have shown that this is not because there is any local immunity in the lungs which develops from the BCG from the attenuated a weakened infection of the lungs. It's a general immunity which they develop. And it's probably due to the fact that these germs multiply especially in the. In the chest. Related to this is related obviously to the fact that. Most. Of the tuberculosis that occurs does occur in the chest in human beings. As well as in. Most experimental animals. Subsequent to our. Original observations

this has been applied this technique has been tested. In human beings by Dr. So Rosenthal at the University of Illinois in Chicago. Where. We set up the apparatus for him to use and he has found that it works just as well or nearly as well in human beings as a dozen guinea pigs. That is that the vaccine will take. When the human beings in Hale a very small number of germs. Now it's just an assumption that the human beings are just as immune as they would be if they had received the same germs by the skin route. It's a fair assumption in view of the many studies that have been done in guinea pigs showing that they're just as immune after they have inhaled very small numbers as they are after they have received very large numbers in the skin.

There are possibilities that the success with the attenuated TB organisms for vaccination against TB suggested the same route. Namely the airborne route and inhaling. Vaccine organisms might be a. Good one for the mass immunization of human beings against other infectious processes. The Russians have been using the airborne route for vaccinating against certain rather right variety of types of infectious diseases especially the virus infections these is caused by sub microscopic viruses. However. The Russians have. Used this on an individual basis not on a mass basis and in a very crude way namely spraying from a nebulizer right in the individual's face each individual's face a very large

number of the microscopic virus vaccine organisms. The studies the success that we've had with the BCG vaccine by the airborne route when the numbers of vaccine organisms in here was very small suggests approaches to vaccination against other infectious diseases are entirely different order. From that which the Russians of have used. For example it might be possible if we had the proper vaccine strains to vaccinate our two or three thousand schoolchildren at one time in a school or a school auditorium. No needles. This is a very important thing anybody any pediatrician a public health worker will tell you not to have to use a needle on each individual.

No pain. And. I think it's fair to first see that airborne immunization will have a hay day. How long that will last I'm not sure because the developments of science the most important developments are those which are completely unanticipated and I'm sure that there will be developments in the field of vaccination of immunization against the plagues of man which haven't even been imagined by any of us. But I think we can anticipate that certain that a certain usefulness will derive from the application of airborne vaccination methods. Against. Several different infectious processes and human beings. The man that is perhaps most closely associated with Dr. Middlebrook in these studies is Dr. Rosenthal who carries further the possibilities of airborne

vaccination for the future for the present moment I would say that. Any disease that is contracted by where the respiratory tract. Would best be. Punched. By this by tracked. This is for Immunization and for treatment. Now. For example we have shown back in 1040 too. That we were able to get five year cures in regular doses. By spraying. Vaccine as it were in the air. So that. For such diseases is tuberculosis. Influenza. Virus is along. The Moonies. And something even polio. My beef with the coach in that way. You might be able to a vaccine against these diseases by this tract.

And be treat them. After they've developed by this approach. The. Importance of this approach though is that it can be done. Without. Much inconvenience to the individual and very little monetary outlay. Much of this work could be done. While say the students are having the regular classes they would have to be inducted at all. So that. He would be no hardship to the children or the adults. And. Would to. Eliminate injection procedures which are always been a bugaboo to everyone children and adults. And would also cut down on the price of administering the method's forms of immunization are treated.

These were Dr. Roger Mitchell's feelings about airborne vaccination airborne infection as a well-established and well controlled fact work at Johns Hopkins and at the Veterans Hospital in Baltimore under the direction of Riley and work at the National Joycean of the direction of Middlebrook. I have documented these facts. You can control with great precision the number of infecting units delivered to the lungs of a person exposed to airborne. Biological. Particles or germs or bacteria. Secondly. BCG vaccination against tuberculosis has already been proven effective and safe especially in the countries where it was originated namely France and in the Scandinavian countries which rapidly took it up after the discovery by Kalimat. In the third place.

To avoid the use of needles and punching the skin in young children would be an advantage. I see difficulty however. In using an airborne administration of vaccination in a public place or a place containing anyone who had not given permission or whose parents had not given permission for the administration of such vaccine. Even today we see objections to the administration broadly of smallpox vaccination in schools. Small groups of people still object to its use although it has been proven highly safe and highly effective. The second place in this country any rate the need for a vaccination against tuberculosis is relatively minor except in a few heavily infected areas such as in big cities and in poor social and socioeconomic surroundings. In in places like

India and China where tuberculosis is still a huge problem. Vaccination. Of large numbers of the population. Could very easily be very helpful in controlling tuberculosis. In many countries of the world however. The best way to control tuberculosis is not by means of vaccination but in wiping out and controlling the sources of infection. Dr. Mitchell pointed out the problems in controlling the TB Germ. Ideally in a country such as ours where the infection rate. Of the population has reached a workable level considerably lower than what used to be the proper procedure in most centers is not vaccination. The huge numbers of one infected persons. But good public health control of the sources of infection. I say this because vaccination is not 100 percent or even 90 percent effective. People who are vaccinated still contract

tuberculosis although it shows in and carefully controlled studies at. The TB that people have been vaccinated. A contract is apt to be less severe as well as less frequent. It is true that. Public health control is expensive but this is the best way to spend money. I think in our country at this time and I think the same would apply to many other countries have the advantages of the United States. I do not think that trying to wipe out sources of infection in China or India would make any sense and therefore the aire airborne vaccination and these and many other heavily infected countries makes good sense provided the government can be sure that it will not be intruding upon the rights of those who might not want to be vaccinated or want their children to be. I don't know what the solution that problem will be in these countries and this country I know it but pose a very serious problem.

When tuberculosis is mentioned. The mind begins to envision scenes of extensive and prolonged hospital care. Is it possible however that the TB patient can be cared for at home. Doctor has Willis addressed himself to this question. Yes home care has improved it has increased a great deal in the last decade. And I say last decade because that's the time when. We began to use drugs for the treatment the device allows the stack to use an effectively. The increase in numbers of people to take the drug is an outcome of great faith that we have been in drugs and drugs do do a tremendous amount because. Again 10 years ago the average patient stayed

a long time in the hospital 12 15 months and now he stays five or six or eight at most on the average a long time ago he had 25 percent of the mission of missions to the hospital died and now its props are less than five. So what drugs are here and there and they're here to stay. Doing wonderful a good job. But. When one realizes that the average case of tuberculosis is from the people with lower income. Levels people often with crowded living in crowded circumstances. It's a serious business to leave a patient in the hospital. I'm sorry living in a home where while he's undergoing his treatment he can. He can get well. Eventually with his drugs at

home but from him new cases develop with all the grief and all the personal tragedy and all the family's Aster and all the cost that attaches to this disease because he's he's calling reading new cases. Now. It seems to me that the best way to treat it. Is to have the person in the hospital as long as he is positive as long as he's getting off his germs and then let him go home for as long as tuberculosis has been known. It was thought that conditions of squalor contributed to the disease but the infected person was an untouchable. I asked Dr. Willis if there was any truth to this. All of those conditions are they have nothing basically good except that it undermines whatever. Resistance the body had been partially or subject to.

To a person who knows conditions are subject to malnutrition to overwork strain and stress of many sots and those those factors those features plus many others like it like them. If. Carried on for a long time months like a locket to solor our body defenses that the germ which is already there can develop and then a fat person develops clinical advice losses that he spreads his germs. In the in the household to the other members of the family. And sooner or later one or several members of the family may likewise come down thats one of the reasons that caused it to be thought of as a family disease or an hereditary disease at one time.

Because of the mere mechanics of treatment cure recuperation and the idea of a person being an untouchable tuberculosis must contribute to the psychological outlook of a patient and his family. I asked Dr Mitchell about this. This is a very important question and has been for a long time. Less important perhaps now than it used to be because we are now able to tell patients confidently that we can cure them. And this is true in the vast majority. Of course you cannot restore damaged lung and if a person comes in with a quarter to a half of his lungs completely destroyed eaten away by tuberculosis. The best you can hope for is to arrest the condition and give him some measure of breathing capacity able to carry on a partial life. But most patients come in before the stage. And you can tell them that they are curable and this greatly alters the situation which used to pertain before we had such a heavily or I should say

markedly effective treatment. We still however have the feeling on the part of patients that they are unclean that there is something as a reflection upon them and their families by having TB they have that leper feeling as if they are driven away from other people. The impact of having to be away from home and family and children and wife and husband. Also creates problems. My guess is that it would accentuate the personality problems of individuals. The well-balanced person used to take the information that he had tuberculosis exceedingly well. And the neurotic individual became more neurotic. And perhaps those who had pre psychotic disturbances that is to say persons who were on the brink of insanity might have been thrown into. Acute insanity States by such shattering Knowledge is having tuberculosis

in short. Tuberculosis still is a trigger mechanism bringing out underlying psychological difficulties. It still does it. I cannot deny even though we can tell people now that they can be cured and they do not have to spend so long away from home. We are fortunate now on a six to eight month average hospitalization being necessary for the average severe case in the milder cases we can talk in terms of two or three months in hospital. This greatly changes the situation that existed when we kept people home away from home for a year or two or up to six or ten years. In the old days because of these facts it would seem that tuberculosis is a disease that requires the treatment of the whole man. Dr. Wilson stated I think perhaps picking up your word of the whole matter and we shouldn't limit it entirely too emotional. But consider it from the old fashioned word with the word mental that

it's a problem. And these are very considerable. We have. Such an excellent program of treating pulmonary tuberculosis and indeed of all forms of tuberculosis that if we could have patients. Come to us reasonably early in the disease if they continue to be what we call a cult operative that is did exactly as we sat for a period of two years or so feeling average would be tremendously good we'd have very few ever. Down here to death or even towards enver chronic adolescent and most of them would really be restored to work. The thing that we run into which defeats is the human element share cussedness if you want our emotional reaction. In that in a free country. And. Under our conditions.

A patient is very inclined first place to. Put off. Seeking medical attention to begin with and when she's under medical attention and as long as he feels there is always no problem he does exactly as the doctor says but as soon as he begins to feel well and extremely well it's very difficult for him to see why he should stay in the hospital in the first place for another day. If an operation is indicated he should have as part of his lung removed quite a major operation and it costs a lot and doesn't show on the outside. I'd rather it's our house right it is so on and he doesn't see in the second or third year of treatment why I should go on taking those pills every day so we just forget to take the pills so that we run into this real defeat in the treatment tuberculosis day largely through. The natural difficulties of motivating people. And keeping them motivated.

Now that the purely emotional side is a different thing. It is very probable that the stresses of life. Mobilizing the various hormones like cortisone. Corticosteroids which come from the add rain lead to stress wearing on the patient interfering with his nutrition may have some protective precipitating effect on tuberculosis and maybe even a causative factor in the breakdown. Originally are in the relapse of patients. It may be that emotional stress during the treatment simile may hold back the successful treatment of patients for the old idea of treatment by going away to a health resort or going away to a distant hospital had certain advantages in that isolated the patient from his family from his business K.S. the woman from a children's mother

for my children and so on. Today i medical treatment is so effective however medical and surgical treatment so effective that this isolation by distance so called climactic treatment climatic treatment originally is no longer important. However the human element the. Difficulty everyone finds in taking those pillows and accepting a major surgical procedure an amputation if you will a part of the law is still there. I often joke when he said that in addition to the ice and eyes it it me the medicine to go with it we needed a yes pill at a certain point in the treatment that we could give the patient so the patient would say yes. This of course is a dangerous thought because it would lead to grave difficulties if such a pill were available. Dr. James J Waring said in Denver that what is needed for the future is a

test that will distinguish between an inactive tuberculosis in the lung and an active tuberculosis in the lung. Perhaps in a few years we will be able to discuss this aspect. Next week you will hear Dr. Ernest Runnion and Dr. Wilson as they discuss atypical tuberculosis. On the next program from the series human behavior social and medical research consultant for this program was Dr. Winthrop Davy of the University of Michigan Medical School and 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 I ybe Radio Network.