TB: Then & Now

When 100 physicians, nurses and public-health workers met in Atlantic City, NJ. half a century ago to found the National Tuberculosis Association, the "white plague" was the No. 1 cause of death in the U.S. Each year it killed 188 out of every 100,000 people. Though Robert Koch had isolated the bacillus, little was known about how it infected mankind, or why the disease pursued such various courses. There was no vaccination against it and no drug treatment; X rays for diagnosis were still primitive, and medical thinking was full of superstitions about "hereditary taint." The cure consisted of raw eggs, milk and dry mountain air.

Last week, as 3,000 delegates (among them, half a dozen of the founders) gathered in Atlantic City for the soth anniversary meeting of the N.T.A., the TB picture seemed radically different. The disease has slid from first to ninth place among causes of U.S. deaths, and the rate has dropped to 16 per 100,000. There is a vaccine, BCG (Bacillus of Calmette and Guerin), which is fairly effective under some conditions. There are at least three wonder drugs--isoniazid, streptomycin & PAS--which can arrest a majority of TB infections, if not cure them. And with the aid of these drugs, daring surgery can save many patients.

No Back Pats. Much of this progress is due to the activities of the N.T.A., the first national organization in which doctors and laymen combined to fight a single disease, and to its 3,000 local chapters and two affiliates, the American Trudeau Society (for physicians) and the National Conference of Tuberculosis Workers. Supported by sales of Christmas seals ($23 million worth last year), they have spread the gospel that TB is, in the main, a preventable disease, that no effort should be spared to detect it early, and that treatment must be prompt. But last week's conferees were in no mood to write off the job as done.

Paradoxically, past successes have left the TB fighter a more difficult task for the future. Replacing widespread fear of the disease today are signs of a dangerous public complacency. Each year TB still takes 25,000 lives and strikes 110,000 fresh U.S. victims. For an estimated 400,000 who have the disease in active form, the annual cost is at least $600 million.

Many Unknowns. Researchers reported many promising new things for the continuing fight against TB: a drug which is related to isoniazid, and looks just as good; a powdered extract of bacilli to make a vaccine which compares with BCG; better understanding of the need for vitamins A and C in treating patients. But the dominant tone of the meetings was a harshly realistic note sounded by the Rockefeller Institute's famed Bacteriologist Rene Jules Dubos.

To his mind, it is of utmost importance to learn more about the fundamentals; how tuberculosis gets its start, and the factors which determine whether the victim will have a mild infection or "galloping consumption." Too little is still known, he complains, of the life processes of the bacillus or the mechanics of its virulence. And, amid its obvious ravages, no man can say why so many people enjoy a high degree of natural immunity to its invasion.

Says he: "The study of tuberculosis . . . now lags several decades behind that of many other human infections."

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