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NATHANIEL ALCOCK MEMORIAL FUND.
1430 throw
upon the method of differentiating the Dr. Moellers finds himself at a loss to explain the high proportion of bovine tubercle which the investigation of my cases revealed, and because he cannot do so he thinks it advisable that the results should be excluded from general consideration. Surely this suggestion is as unwarrantable as it is short-sighted. Would it not be better to face the facts and to recognise the explanations which undoubtedly do exist? It is probable that the striking difference between my results and 4hose published by Dr. Moellers may be explained by certain distinctions of child life in this country This is a as compared with those in Germany. possibility which does not appear to have been thought of by continental critics. I take it that there are three factors which are responsible for the remarkably large proportion of bovine in-
organism.
Correspondence. "Audi alteram
THE
partem."
ETIOLOGY OF BONE AND TUBERCULOSIS.
JOINT
To the Editor of THE LANCET.
SIR,-You published in your issue of Oct. llth ar abstract from the Deutsche Medizinische Wochen schrift of a paper by Professor Dr. B. Moellers or the Etiology of Bone and Joint Tuberculosis. Th( article dealt more especially with the type of organism found in these diseases. Dr. Moellers haE seen fit to subject to criticism certain work which I have lately published, and I feel it incumbent upon me to reply to these criticisms. The article which Dr. Moellers criticises appeared in the Journal of Experimental Medicine, Vol. XVI. No. 4, 1912, p. 432. It dealt with the type oj organism in 70 cases of bone and joint tuberculosis operated on in the Royal Hospital for Sick Children. and the result of the investigations. showed that 58 per cent. were bovine and 42 per cent. human in origin. The acme of Dr. Moellers’s criticism is reached when he says that the results published in the Journal of Experimental Medicine should not be accepted " until the reasons for these results, differing so widely from all other authors, are made perfectly clear." Dr. Moellers’s original article is a short one, and gives little detail of the methods by which his investigations were conducted. Only 12 cases were personally investigated, the results of the other 163 cases being collected from the literature of the subject. The method he employed in differentiating the organism was the injection subcutaneously into rabbits of 10 mgm. of the culture. He apparently questions the value of the intravenous injection of a much smaller amount, for he says: " Whether Fraser has established another standard than other authors by making use of his intravenous rabbit inoculation cannot be determined, because he does not communicate his post-mortem protocols." The test which I have employed in the differentiation of bovine bacilli has been the intravenous injection into a rabbit of standard weight (2000 grm.) of 0’01 mgm. of tubercle culture; a bovine infection has been in every instance followed by a general tuberculosis. I satisfied myself of the value of the test before I put it into routine use, and it was largely employed in the investigation of the British Royal Commission on Tuberculosis. I quote from the Commission Final Report, Part I., pp. 4 and 5 :-
fection :1. The age or the patients from whom the material was obtained-all being less than 12 years. Dr. Moellers says that it is impossible to accept this as the entire explanation, and with that we agree: but it is important in so far as it has a definite bearing upon the other factors to be immediately considered. 2. Mil7z infection.-I expect Dr. Moellers does not realise the absurdly inadequate conditions under which milk control up to the present has been conducted in Scotland and Edinburgh is no exception to the rule. 3. Milk sterilisation.-It is quite exceptional for the poorer classes, from which my material has been derived, to boil or pasteurise the milk on which their children are nourished. In this way they contrast unfavourably with the corresponding classes in Germany, and it is by the standard of these latter that Dr. Moellers probably judges.
Now, Sir, I consider that I have satisfactorily shown that the basis upon which my results were founded has been perfectly sound. In my published paper I cited several obvious explanations of the apparent difference between my results and those of others; and if any further proof is required of Dr. Moellers’s unwarrantable suspicion, it is this -viz., that the work which I began several years ago has been extended in parallel but different directions by other workers who have obtained results similar and even more striking than my Dr. A. P. Mitchell has courteously permitted own. me to draw attention to his, as yet, unpublished results.
I
Working on the type of organism occurring in tuberculous glands in children, derived also from the Royal Hospital for Sick Children, Edinburgh, he has found that 90 per cent. of the gland infections are bovine in type. I am, Sir, your faithfully, JOHN FRASER, M.D. Edin. Edinburgh, Nov. 5th, 1913.
NATHANIEL
ALCOCK MEMORIAL FUND. In rabbits generalised tuberculosis ending in death within 5 weeks resulted from the intravenous inoculation of To the Editor of THE LANCET. 0.101 or 0’1 of a milligramme of culture of bovine tubercle SIR,-Some months ago you were kind enough to bacilli....... The disease caused in rabbits by intravenous insert an appeal for subscriptions in aid of the tuberculosis is extensive characterised miliary by injection of the lungs, liver, spleen, kidneys, and other parts of the family of the late Professor Alcock. Owing to his body....... The results obtained by injecting the bovine early death he had been unable to make any probacillus into rabbits in the above doses are thus very vision for his family, and it was felt that the most striking and definite, and taken with the cultural charac- appropriate form of memorial to his memory would teristics of the bacillus afford a trustworthy means of be a fund to enable his three daughters and one recognising the bovine tubercle bacillus. son to receive an adequate education. A list of It is but reasonable to expect that the intravenous subscriptions received to date is given below. inoculation of a small amount of the culture Since we desire to close the fund before Christmas, should constitute a much more delicate test than in order that it may be invested and the proceeds the crude method of subcutaneous injections of a applied to the object mentioned above, we should much larger amount. There exists, therefore, no be glad to receive any further subscriptions to the ground for the suspicion which Dr. Moellers would fund as soon as possible. Contributions may be
upon the method of differentiating the Dr. Moellers finds himself at a loss to explain the high proportion of bovine tubercle which the investigation of my cases revealed, and because he cannot do so he thinks it advisable that the results should be excluded from general consideration. Surely this suggestion is as unwarrantable as it is short-sighted. Would it not be better to face the facts and to recognise the explanations which undoubtedly do exist? It is probable that the striking difference between my results and 4hose published by Dr. Moellers may be explained by certain distinctions of child life in this country This is a as compared with those in Germany. possibility which does not appear to have been thought of by continental critics. I take it that there are three factors which are responsible for the remarkably large proportion of bovine in-
organism.
Correspondence. "Audi alteram
THE
partem."
ETIOLOGY OF BONE AND TUBERCULOSIS.
JOINT
To the Editor of THE LANCET.
SIR,-You published in your issue of Oct. llth ar abstract from the Deutsche Medizinische Wochen schrift of a paper by Professor Dr. B. Moellers or the Etiology of Bone and Joint Tuberculosis. Th( article dealt more especially with the type of organism found in these diseases. Dr. Moellers haE seen fit to subject to criticism certain work which I have lately published, and I feel it incumbent upon me to reply to these criticisms. The article which Dr. Moellers criticises appeared in the Journal of Experimental Medicine, Vol. XVI. No. 4, 1912, p. 432. It dealt with the type oj organism in 70 cases of bone and joint tuberculosis operated on in the Royal Hospital for Sick Children. and the result of the investigations. showed that 58 per cent. were bovine and 42 per cent. human in origin. The acme of Dr. Moellers’s criticism is reached when he says that the results published in the Journal of Experimental Medicine should not be accepted " until the reasons for these results, differing so widely from all other authors, are made perfectly clear." Dr. Moellers’s original article is a short one, and gives little detail of the methods by which his investigations were conducted. Only 12 cases were personally investigated, the results of the other 163 cases being collected from the literature of the subject. The method he employed in differentiating the organism was the injection subcutaneously into rabbits of 10 mgm. of the culture. He apparently questions the value of the intravenous injection of a much smaller amount, for he says: " Whether Fraser has established another standard than other authors by making use of his intravenous rabbit inoculation cannot be determined, because he does not communicate his post-mortem protocols." The test which I have employed in the differentiation of bovine bacilli has been the intravenous injection into a rabbit of standard weight (2000 grm.) of 0’01 mgm. of tubercle culture; a bovine infection has been in every instance followed by a general tuberculosis. I satisfied myself of the value of the test before I put it into routine use, and it was largely employed in the investigation of the British Royal Commission on Tuberculosis. I quote from the Commission Final Report, Part I., pp. 4 and 5 :-
fection :1. The age or the patients from whom the material was obtained-all being less than 12 years. Dr. Moellers says that it is impossible to accept this as the entire explanation, and with that we agree: but it is important in so far as it has a definite bearing upon the other factors to be immediately considered. 2. Mil7z infection.-I expect Dr. Moellers does not realise the absurdly inadequate conditions under which milk control up to the present has been conducted in Scotland and Edinburgh is no exception to the rule. 3. Milk sterilisation.-It is quite exceptional for the poorer classes, from which my material has been derived, to boil or pasteurise the milk on which their children are nourished. In this way they contrast unfavourably with the corresponding classes in Germany, and it is by the standard of these latter that Dr. Moellers probably judges.
Now, Sir, I consider that I have satisfactorily shown that the basis upon which my results were founded has been perfectly sound. In my published paper I cited several obvious explanations of the apparent difference between my results and those of others; and if any further proof is required of Dr. Moellers’s unwarrantable suspicion, it is this -viz., that the work which I began several years ago has been extended in parallel but different directions by other workers who have obtained results similar and even more striking than my Dr. A. P. Mitchell has courteously permitted own. me to draw attention to his, as yet, unpublished results.
I
Working on the type of organism occurring in tuberculous glands in children, derived also from the Royal Hospital for Sick Children, Edinburgh, he has found that 90 per cent. of the gland infections are bovine in type. I am, Sir, your faithfully, JOHN FRASER, M.D. Edin. Edinburgh, Nov. 5th, 1913.
NATHANIEL
ALCOCK MEMORIAL FUND. In rabbits generalised tuberculosis ending in death within 5 weeks resulted from the intravenous inoculation of To the Editor of THE LANCET. 0.101 or 0’1 of a milligramme of culture of bovine tubercle SIR,-Some months ago you were kind enough to bacilli....... The disease caused in rabbits by intravenous insert an appeal for subscriptions in aid of the tuberculosis is extensive characterised miliary by injection of the lungs, liver, spleen, kidneys, and other parts of the family of the late Professor Alcock. Owing to his body....... The results obtained by injecting the bovine early death he had been unable to make any probacillus into rabbits in the above doses are thus very vision for his family, and it was felt that the most striking and definite, and taken with the cultural charac- appropriate form of memorial to his memory would teristics of the bacillus afford a trustworthy means of be a fund to enable his three daughters and one recognising the bovine tubercle bacillus. son to receive an adequate education. A list of It is but reasonable to expect that the intravenous subscriptions received to date is given below. inoculation of a small amount of the culture Since we desire to close the fund before Christmas, should constitute a much more delicate test than in order that it may be invested and the proceeds the crude method of subcutaneous injections of a applied to the object mentioned above, we should much larger amount. There exists, therefore, no be glad to receive any further subscriptions to the ground for the suspicion which Dr. Moellers would fund as soon as possible. Contributions may be