Progress Report

Guarded communiques reported four important breakthroughs on the tuberculosis front. Yet strategists and tacticians alike muffled their enthusiasm in public; the fight was not yet won; TB was still the No. 1 killer of U.S. citizens between 15 and 35.

Next to Koch. The biggest news last week came from Buffalo, where three tuberculosis societies held a joint convention.* Bacteriologist Rene Jules Dubos of the Rockefeller Institute had at last discovered a method of cultivating TB bacteria, simply and quickly, in test tubes. The basis of Dubos' method is a synthetic detergent made by Atlas Powder Co. (which calls it "Tween 80") for use in cosmetics. Doctors hailed the discovery as the greatest contribution to TB research since Robert Koch first isolated the germ itself in 1882.

Researchers, who have fumbled and bumbled for lack of an effective technique, can now "do an experiment a day instead of two a year," according to Dr. Dubos. They can also diagnose new TB cases, where X rays are useless, in a few days instead of two months. Previous methods of cultivating the bacteria were not only slow but they usually modified the organism so as to make the experiments inconclusive.

The man responsible for this notable advance is a 45-year-old, twinkling professor with a scientific slouch, a strong French accent and gestures. He came to the U.S. in 1924, at Rutgers completed the training he began in Paris. The TB culture may or may not be his greatest achievement: his discovery (in 1937) of gramicidin, first of the germ-killing mold extracts, led to the development of penicillin. His latest find, he hopes, will lure young doctors into TB research, hitherto shunned because "the chances of finding something have been practically nil."

Promising Drug. Dr. Horton Corwin Hinshaw of the Mayo Foundation also had some news for the Buffalo meeting. Tests on 65 patients had proved that streptomycin definitely arrests TB. It looks like "the first clinically feasible" drug for use in TB, said Dr. Hinshaw.

Streptomycin is slightly toxic (but no more so than the sulfa drugs, which do not halt TB) and makes patients rather dizzy. Though it suppresses the disease, it does not actually kill the germs. Patients who are taken off the drug do not continue to improve, sometimes relapse.

Dr. Hinshaw's great fear: that thousands of TB victims will beg for treatment at once, that thousands more will postpone urgently needed therapy in the expectation that streptomycin will cure them day after tomorrow. It will not--for the drug, a distant relative of penicillin, is exceedingly scarce (cost: $24 to $50 a patient a day), and the results, however promising, do not yet warrant its widespread use. Dr. Hinshaw's great hope: that a better, cheaper drug will soon appear.

For desperate cases, there was a third development. In the past, surgeons have tinkered gingerly with lungs, but shied away from bulldozing into them; it was generally feared that shock would kill the already debilitated patients and, if not, that the disease would spread to an uninfected lung area. Now, with a radically new surgical approach, Dr. Richard H. Overholt of Boston has cured 56.2% of a group of 27 TB victims who were so far gone that no other therapy could save them. Dr. Overholt boldly cut open their chests, sliced out huge sections of rotten tissue, even entire lungs, saving the lives of most of the doomed consumptives.

Infection v. Infection. The U.S. Public Health Service also chose last week to announce another major development: the first U.S. successes in immunizing against TB--a protection long sought chiefly for such continuously exposed groups as sanatorium staffs.

The immunizing vaccine, known as BCG,* has been used by Denmark's Dr. Johannes Holm since 1930--with such favorable results that it warranted a campaign to vaccinate everyone in Copenhagen between the ages of 15 and 35. (Mysteriously, TB almost never kills children between two and 14.) U.S. scientists verified the Danish claims on a group of 3,000 non-tuberculous Indians. Half were injected with BCG, half with a harmless salt solution. Only 40 TB cases developed among the vaccinated group, but the non-vaccinated group had 185 cases, 38 of them fatal. The relative immunity seems to be permanent.

But despite encouraging BCG reports from Canada, Cuba, South America and other lands, some U.S. authorities are violently opposed to the vaccine. Since it is actually a weakened TB organism, they suspect that it may create infections which appear late in life.

BCG enthusiasts argue that a mild TB infection is the best protection against a later infection. In July the cautious Public Health Service plans to hold a powwow of experts, and thrash out the pros & cons of BCG before venturing any big-scale vaccination program.

* The three: National Tuberculosis Association, American Trudeau Society, National Conference of Tuberculosis Secretaries. *For "Bacillus of Calmette and Guerin," the two French scientists who did the spadework on TB immunization in Paris in 1920.

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