Medical research; Tuberculosis, part 3

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 last of three programs on this subject from the series human behavior social and medical research produced by the University of Michigan Broadcasting Service. These 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 usually you will hear what may seem like strange or unfamiliar silence. These are the sound of the participants office his laboratory or clinic where the interviews were conducted. The people you will hear today are Dr Ernest Runyon of the veterans hospital in Salt Lake City and Dr. Julius Wilson director of medical education of the American Trudeau

society. And my name is Glenn Phillips. In research studies show a new strain of bacillus similar to tubercle bacillus but producing different disease. A great deal is not yet known about them for clarification of these atypical germs. I asked Dr. Wilson for an explanation of them. He said this is a family of organisms the mycobacterium and we've known from the very earliest days of back to reality that there were many first second cousins of the typical Persepolis all around us in nature so called soil by cell life you dig in any on yard or backyard for that matter and cultivate the organism to find things that look exactly like typical Bush ally they're perfectly harmless that were considered perfectly harmless. In recent years in order to treat patients with

these various powerful new drugs and in order to find out more thoroughly whether they had been successfully treated we have turned more and more to cultures cultural methods with the bacteria grown on a synthetic medium in a test tube rather than to just smearing him on a glass slide and putting it under a microscope. There were just been a further refinement in our. Technique in most institutions health departments and so on. And this. Is when we had nothing but a lot of tuberculosis. We very we only occasionally found these other organisms the harmless ones and then we thought they were just sort of happenstance picked up from the body or that we ate because it was August and Dr. Mary found it by their homicide and they found out Timothy they called Timothy bacillus and so. As to Beck you know Sis was filed less often that is the

very a what typical bacillus was found less often more frequently the cultures carefully done and done in thousands instead of in tens thousands of times more frequently picked up these other bugs. So that we began to realize that they were found in various parts of the country. More or less by geographical location. Then the second thing which gave us a lot of interest in this was to Brooklyn testing in the South in particular in Georgia Alabama Mississippi across the from the Atlantic across the upper. Part of the shore of the Gulf of Mexico. In doing master buckling tests they found that many individuals were infected. If you used a very strong dose of tuberculosis. But did not seem to be

infected if you used a weak dose in other words there was a large percentage of the population that reacted to only to a strong dose at the Berkeley. And putting two and two in together and making up a special tubercular from some of the soil of a still life you want to call it that mycobacteria which were relatively a variant for human beings they found that apparently the cause of this diverting reaction skin reaction with the buckling test of the stronger strength was not human infection in fact human infection was relatively suppressed in Georgia and Alabama Mississippi as it is in the other northern states but a large percentage of population reacted to the special tubercular. Again in addition to that they found about 4 percent of the admissions to the state

hospital in Georgia did not have true tuberculosis at all but were what we might call. Victims of Pareto Burkill osis are we call it jokingly bad iOS just because a hospital is bad a hospital in other words they're not. Carriers of tuberculosis but they are people. Who have become heavily infected from some source presumably in the soil or in their environment and who have developed disease in their lungs from this cause rather than from catching it from another case of tuberculosis. This is extremely interesting development. Dr Ferko out in Kansas City as found in the. Large number of cases of this sort. In addition to this we have. Confusion to a certain extent. With patients

having fungus infections which imitate tuberculosis in California this is Cox a day out of my coast issues really in the Midwest it's histoplasmosis usually in the south it's blast of microswitch usually. So the map of the United States shows a. Tendency for various types of. What we call non tuberculosis public eye disease to go by geographic areas. So are these diseases one of morbidity one of mortality or are they particularly needed. They they are diseases which like tuberculosis seem to have a tremendous do in fact a tremendous number of people. And to kill very few out of the total number they in fact. Arise tuberculosis. On the other hand. Formely had let us say. 10 percent of those infected developing disease and 40 50 percent of

those developing disease die in these diseases I. Don't know the exact proportions but it might in fact 90 percent of the population and only 1 percent of those infected might develop disease and only 1 percent of those with disease might die of it it's a very non-lethal form of infection. One laboratory which has worked extensively with these atypical Bush ally is in Salt Lake City at the Veterans Hospital. Dr. Ernest Runnion heads the investigating team and I talked with him. We hear that interview with my question recorded for clarity. I ask him first if these germs had a peculiar regional or racial characteristic. Yes both of these. They these are very interesting aspects of the these micro bacterial diseases. Lee There are very

perplexing localizations of some of these known or recognized diseases for instance in the southeastern part of our country. There is a prevalence of disease to the group three way call we call less the battery type are going to ASM because it was first studied and recognized as distinct from. By workers at the baddy State Hospital in Rome Georgia. Large numbers of this type of patient are in Florida Texas and other southern states.

There have been some peculiar concentrations of some of the other micro bacterial infections but this is perhaps the most interesting one in our country. As far as racial distinctions these other types of micro bacterial infections differ from tuberculosis. Evidently in the incidence amongst colored people as compared with white people. This has been found in the three states that I just mentioned Georgia Florida and Texas where many fewer negroes.

In proportion to white people. Are found as patients in tuberculosis hospitals with these newer micro bacterial diseases than is the case with true tuberculosis. Would you explain once again your reaction to my perhaps weak analogy that I tried to pull out of the thin air earlier about the color spectrum. We have the gray in the middle in this case have the tuberculosis tubercular bacilli in the middle and then it would branch off into the other types of bacillus which you are studying. A typical term you dislike but for now I have to use it. The atypical type bacteria. So why would it not be merely degrees or shades or different strains of the tubercular

facility. I think this is mostly a matter of how you wish to define your terms. I think the main requirement is that we be clear and I think and not use a word which may mean different things to different people. Tuberculosis in the past at one time included things like Brockie actress's and carcinoma sarcoid and many other disorders of the lung. Which now have been separated often are recognized as completely separate and distinct from tuberculosis. Some feel that the newly recognised pathogens in the genus mycobacterium constitute

admissions to the entity tuberculosis this disease so that instead of having a disease caused by just one species it may be caused by any one of six or seven species. This is alright if everyone agrees to this but it seems that seems to me more reasonable and a little more accurate and a little less susceptible to misunderstanding. If we hold to the definition how to break your losses as disease do to Mycobacterium tuberculosis our mycobacterium both of us rather late by Mycobacterium avium and let the diseases which are caused by these other distinct forms of Mycobacterium

be given other names. I admit we do not have other names as yet. I feel this is something that this is a gap which will be felled. They may be called mycobacteria overseas. This sounds like a hard word it's just a general name of course meaning any disease caused by a member of this group of organisms. The analogy with the spectrum it is perhaps a reasonably adequate If one recognizes that the different colors of light may have very distinct affects. I suggest that you recall what happens to a piece of photographic paper that is exposed to.

On the one hand red light and then put in the developer it stays white. On the other hand if it is exposed to blue light and then put in developer it becomes black. So the effects of different kinds of light may be as different as black and white. Similarly I suggest that the effects of these different species of Mycobacterium which are in truth related because they are all mycobacteria. Nevertheless Les there are effects may be very different. Actually we have not recognised very great differences between these different types of micro bacterial infections. This however has mostly I feel a lack of information.

And I think the more that we study these the more differences we will recognize already. We do know of some quite definite differences between these diseases. How do these diseases however react to the methods of prevention used in tuberculosis. This is a question which I wish I knew the answer to. It's a question which needs to be answered. We know that the. Diseases caused by these other organisms are associated with sensitivity to to break heal them. Which is produced from true tubercle but still alive. In other words there are cross to regular reactions. However the cost to break it in reactions are not as great as the

reactions to to break plans made from the homologous the same organism that produced the disease so that the. There is a specificity and immunological response in who are these different diseases. It would it might be expected that immunity or partial partial immunity to tuberculosis to tuberculosis would very likely produce some immunity but not as good. I mean anti are not as good protection and a degree of protection to these other micro bacterial infections. Is there any possibility that there is a hereditary connection in these diseases. The record is that we have very few.

Cases where more than one member of the family has had one of these infections. So there is there is really no data suggesting a special hereditary susceptibility for instance to the body type organism or any other. Well and if my lay understanding is correct and this would indicate immediately that there is that they actually are unlike tuberculosis. Because isn't there a belief that tuberculosis is developed from heredity. It is very well established that tuberculosis. He has more serious in some families than in others. Another way that another way is that there is a hereditary susceptibility. Or maybe I read a Terry susceptibility or hereditary resistance to tuberculosis. I had seemed very credible that this is what will be found also when enough data has been

gathered and for these other micro bacterial diseases that we just do not have this type of data. Specifically how do these differ from the true tubercle but still is typical but still I differ from things either. Which cause these tuberculosis like diseases in almost every respect. If one examines them under the microscope they have in their state they are seen to have a different size a different a different state reaction from true to recall but these differences are very small so that they are usually overlooked. But when they are studied carefully these differences are varied and real. In almost every other respect. Besides their shape size and staining

these other mycobacteria differ from to recall the so why. That's they are not very late for guinea pigs. As are typical of us so I. They have different rates of growth. They're able to grow at room temperature to reproduce so why I'm not able to grow room temperature. They have different nutrient requirements in practically every respect. These other kinds of mycobacteria differ from typical amps. I do not like to call them a typical typical so I they are not typical B'Tselem. There are other kinds of this so I do the diseases produced by these basal I differed. Yes this is not so easily answered. If the diseases are indistinguishable

except by the causal agent then we would surely have less reason for insisting on different terms for the diseases that they produce. Actually while the symptoms of the disease are very similar the X-ray picture is very similar. The pathological picture is very similar. The diseases are not identical. The more we study these infections the more sharply differences begin to appear. The most prominent differences are in the reaction to. Drug treatment

whereas tuberculosis now is regularly held in check properly by. The ral well-recognized drug stopped him ice and paramita salicylic acid. And I saw nigh as Ed and other drugs. These infections by these other organisms are not easily checked by a drug treatment. This is perhaps the most conspicuous difference. Either differences. Include the. Matter that we spoke of previously the difference in racial susceptibility evidently of white and colored races and some other differences in the course

of the disease. A very important difference is that many patients with these other micro bacterial diseases do not show. The direct insensitivity which a person with tuberculosis shows. Sometimes the to break test is completely negative. Many times. The Mark frequently it is only very weakly positive. There is a difference and infections with the different groups of mycobacteria as to how much cross reaction there is with human type to break it up. This difference of the tiebreaker than the relative insensitivity to human turbulent is eloquent testimony that this is not the same disease. Can one distinguish this atypical micro bacteria from the tubercle

bacillus. We do not yet have a generally available to break your lens which are specific for these distinct micro bacterial diseases. It is expected that within a year or two however such specific to break humans may be available. Already the United States Public Health Service. Has been engaged in the production of specialty brake humans and. Others in other countries as well as other laboratories in this country likewise have made special to break your loans from these other mycobacteria when the Turnberry Kulin made from one of these distinct mycobacteria is tested

in a patient having that type of infection. The response is greater than with the human type tuberculosis and so with these to bury Killen's it may be possible in the future to distinguish the diseases. This is more likely to be true for the battery type infection than for some of the other types. We have in the in this area a very interesting situation that very large proportions of the population of given parts of some parts of the world react more to these new to regulations than they

do to human to break through and the implication of this is that there are more of these other mycobacteria prevalent in those areas of the world than typical of US ally. And that man and these areas become infected Mark commonly with these other mycobacteria then with tuberculous alive. The result of this. The sensitivity to only high doses of human to human. It is often spoken of has low grade sensitivity to tuberculosis have resulted in. Some very grave problems in knowing

whether a patient is really to breakthrough and positive to human type to bury Dylan or to what time. And the question then of whether these people should be vaccinated with BCG or not comes out. This has been an interview with Dr Ernest Runyon of the veterans hospital in Salt Lake City about a strain abyssal different from the typical busy ally but resulting in a disease very similar to tuberculosis. Earlier in the program we heard Dr. Julius Wilson of the American Trudeau society. Next week you will hear Dr F. D.W. Lukens Dr. Garfield Duncan and Dr. Randall G's pray as they discuss the first of two programs about diabetes from the series. Human behavior social and medical research consultant for this program with 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 NEA E.B. Radio Network.