THE ROYAL COMMISSION ON TUBERCULOSIS.
THE final Report of the Royal Commission on Tuber. culosis leaves one in no doubt that bovine tubercu- losis is communicable to human beings and that it is particularly dangerous in the case of children. This is a serious though, of course, not unexpected conclusion to the long labours of the Commission, but it is as well that there should no longer be any excuse for relaxing restrictions on the sale of contaminated milk and food. At the Inter- national Congress on Tuberculosis in London in 1901 Professor Koch made his famous announcement that he had been unable to induce tuberculosis in bovine animals by inoculating them with human bacil- lus, and that he inferred that the contrary process of the infection of human beings by bovine bacillus was impossible. Most people will remember the deep impression caused by the statements of such an eminent investigator. Up to that time it had been assumed that human beings could be infected from animals. The general feeling would have been one of intense relief if other doctors had not questioned Professor Koch's experiments as incomplete and his infer- ences as unwarranted. The net result was a state of uncertainty in which the public retained a good many mis- givings, while dairymen and butchers pleaded justification for the relaxation of hampering rules governing their trades. Nothing could have been more unsatisfactory than such a situation, and Mr. Walter Long most wisely recognized the danger of remaining indefinitely in doubt and at once procured the appointment of a very able Com- mission.
The Commission were invited to inquire :-
1. Whether the disease in animals and man is one and the same ; 2. Whether animals and man can be reciprocally infected with it.
3. Under what conditions, if at all, the transmission of the disease from animals to man takes place, and what are the circum- stances favourable or unfavourable to such transmission.
It was at once obvious that the examination of witnesses, which is the ordinary method by which Commissions arrive at solutions, would be useless, for it was certain in advance that the data necessary to give value to evidence did not exist. The Commission were compelled to conduct experiments for themselves—there was no other way. Brief experiments were likely to be as misleading as Professor Koch's statements were suspected of being, and the Commission, with an admirable devotion which was freely given to the public service, and for which they cannot be sufficiently thanked, settled down to the labour of ten years. The experiments were conducted on two farms generously lent by Lord Blyth, who has also put the nation under a great obligation.
The first interim report was issued in 1904, and stated that human bacilli had produced in cattle a disease indistinguishable from bovine tuberculosis. Thus within three years the Commission did what Professor Koch had failed to do. The second interim report -stated that fatal cases of tuberculosis in human beings had been proved to be caused by the typical bovine bacillus, but that all these cases had occurred in children, and were examples of abdominal tuberculosis. Abdominal tuberculosis is of course different from pulmonary tuberculosis, which is generally spoken of as consumption. The fourth interim report dealt with tuberculous cows and the manner in which their infection is conveyed. And now we reach the final report, which shows among other things that con- sumption in adults can sometimes be traced to the typical bovine bacillus. Even if such cases are infrequent, the fact that they exist at all completely upsets the inferences of Professor Koch. Three years ago Professor Koch accepted the evidence of the Commission as to abdominal tuber- culosis in children, but reasserted his belief that consump- tion in adults was caused by the human bacillus alone.
Now that it is established that tuberculosis can be con- veyed from bovine animals to human beings, especially in the form of abdominal tuberculosis in children, it is im- portant to know under what conditions the infection is transmitted. (We may say here that the Commission experimented in the tuberculosis of birds, as well as in that of various mammals, but regard bird tuberculosis as a negligible danger to the human race.) The Commission, who think that half the children who die from abdominal tuberculosis contract it from the bovine bacillus, consider that this bacillus is generally conveyed in cows' milk. They recommend that the administrative measures for preventing the transmission of the bacillus both in milk and food should be made more stringent. The bovine bacillus frequently finds its way into milk from the udders of tuberculous cows, and when the disease is seated in the udder it is at least visible. But the bacillus may also be present in the milk when there are no symptoms whatever of disease in the udder. The Commissioners earnestly recommend that milk from tuberculous cows, whether affected in the udder or internally and invisibly, should be absolutely prevented from reaching children. We our- selves believe that parents would often do well to try goats' milk, which in the case of most children is more nourish- ing than cows' milk and does not carry the same risks.
As to the future we do not pretend to say at the moment exactly what preventive measures ought to be taken. It is a difficult problem, and ill-judged measures might Eo immense and unnecessary injury to farmers. Mr. Burns intends to introduce a Milk Bill, and when we have seen it we shall know better whether it meets the situation. Next week the National Association for the Prevention of Consumption will hold its Congress in London, and it is certain that the Report of the Royal Commission will be considered. Then, again, the establishment of sanatoria for consumptives has a prominent place in the Insurance Bill, and we may hope gradually to be informed by experts whether these are likely to be as useful in reducing disease as Mr. Lloyd George believes. That the Report of the Commission must not be ignored is certain. It is one great point gained that we are no longer in doubt whether milk does or does not spread tuberculosis.
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