REPORT OF CASES OF TUBERCULOSIS AS TREATED WITH BACILLUS X, MAHER.

BY T. E. OERTEL, M.D., AUGUSTA.

In the New York Medical Journal for January, 1904. Dr. Stephen J. Maher of New Haven, Conn., published a paper entitled "Some Investigations of a Bacterial Treatment of Tuberculosis."

For the information of those who have not read this paper it is well to state that Dr. Maher reported a series of forty cases of tuberculosis treated with living cultures of a bacillus which he isolated from the milk of a tuberculous cow.

Prof. H. W. Conn, to whom this bacillus was submitted for identification, reported that it is "a not uncommon dairy bacterium, which is at all events very closely related to bacillus mycoides."

He further states "it does not exactly agree with any described species except B. mycoides III, Conn, and it differs slightly from this." Dr. Maher has called it bacillus X.

The results reported by Dr. Maher were such that they claim attention, for while many of his cases did not improve under the treatment others seemed to be benefited to a marked degree, and in several instances apparent cures were effected.

Through the kindness of Dr. Maher I was furnished with a culture of his bacillus. It is not my purpose to discuss the rationability of a bacterial treatment of dis

ease. The time limit of papers presented to this Association prevents even a lengthy report of cases. I intend only to present for your consideration, and in as brief a form as compatible with clearness, the results of my clinical experiments with Bacillus X (Maher), in a series of seventy-three (73) cases of tuberculosis. These cases are divided into two groups, for reasons that are obvious. Dr. Maher has used the organism with good effect in otitis and bone infections of a tubercular nature, by instilling pure cultures or by packing with gauze wet with cultures of B. X.

In all of my cases I have injected subcutaneously the B. X. grown in bouillon, generally using a forty-eight hour culture, as recommended by Dr. Maher.

The bacillus X is a motile, spore-bearing, faculative anaerobe, growing well in all ordinary culture media, in which it produces an alkaline reaction. Dr. Maher reports that he has been able to reclaim it from the sputa and blood of patients several days, and in the urine even weeks, after subcutaneous injection. Unfortunately it has not been possible for me to pursue investigations along this line. I have followed the suggestions of Dr. Maher that the injections should be not oftener than once in three weeks, and that they should be in the proportion of one cubic centimeter of bouillon culture to each 100 pounds of body weight.

In the negro population of our State Sanitarium for Insane tuberculosis runs riot, a large majority of deaths. in this class being due to it. Not only is this the case, but in nearly every instance the disease is of the florid type and often death ensues within a few weeks after the condition is detected. Also, in the large majority of cases tuberculosis is not suspected until it is well advanced, the mental condition of the patient being such that no cooperation on his part can be obtained. I have in mind

one case, a negro woman, who died with extensive pulmonary tuberculosis, who through the whole course of the disease never was observed to either cough nor expectorate.

Because the negro so quickly succumbs to tuberculosis, and the insane negro is without question even less resistant to the progress of the disease, and because the factors that militate against recovery from tuberculosis are unavoidably present in the negro population of our State Sanitarium for Insane to such a great degree I consider that in this class of patients an ideal field existed for experimentation with the B. X.

All

With the permission of Dr. Powell, the superintendent of the institution, I used bacillus X in the following series of cases. Only those individual cases that are of especial interest are reported in detail, the remainder appearing in tabular form. The cases treated were not selected. cases were injected where a diagnosis of tuberculosis was reasonably certain. Many were in the last stages of the disease, not a few in articulo mortis. Gain in body weight is taken as an evidence of improvement. It may be well to add that the diet of these patients is not ideal. The State allows for the maintenance of the institution the munificent sum per capita of 30 cents per diem.

Treatment other than with bacillus X. was limited and entirely symptomatic. The patients are kept in the open air as much as possible.

I wish first to present a series of nineteen cases of pulmonary tuberculosis in patients at large. You will see from the details of the cases that they were not selected. I have given the injections to all of these patients only after explaining the experimental nature of the treatment. I may add that in no case have I seen any serious symptoms or condition that I could attribute to the injection.

In one or two instances small abscesses formed at the

point of puncture, but these readily healed when drainage was established.

Case No. 1.-C. W. H. White, male, aged twentythree. Professional athlete. Has had tuberculosis about two years and has been treated in Western sanitarium without benefit. Has come home to die. Symptoms of third stage, with marked emaciation.

Bacillus X. was injected without beneficial effect, patient dying within a few weeks.

Case No. 2.-J. H., colored, male, aged twenty-two. Father, mother and two sisters died of tuberculosis. Two sisters living and well. Has been sick with cough for a year or more. Now has fever and night sweats. Tuberculosis in sputa and signs of third stage; liver slightly enlarged. Pulse 132. Respiration 44. Temperature 102. Expansion 11⁄2 c. m. Cough at night is distressing and keeps him awake. Injections 1.75 c. c., forty-eight hours. Bouillon culture in right subclavic space.

At the end of ten days his condition has improved. Does not cough nearly so much at night, and sputa is easier to raise. His strength has also materially improved. Respiration 32. Pulse 114. Temperature

100.2.

Lungs not so sore as they were.

This improvement was but temporary, and patient died. about six weeks after first injection.

Case No. 3.-G. B. W. White, male, aged forty; carpenter. Had lung trouble for years, severe cough four years past. Normal weight, 168; present weight, 115. Large quantity of purulent sputum laden with T. B. Very weak and keeps his bed most of the time. Physical signs of advanced third stage. Injections of bacillus X had no influence whatever, and patient died within a few weeks after treatment was instituted.

Case No. 4.-T. M. O. White, male, aged twenty-six.

Has had pulmonary and laryngeal tuberculosis for three years. Has been West and had sanitarium treatment, and has come home to die. Can speak only in a whisper, is very weak and emaciated. Has five or six loose stools a day. Presents the picture of a man in the last stage of tuberculosis. Injected bacillus X. July 22d. No improvement resulted, and patient died October 24.

Case No. 5.-J. C. W. White, male, aged thirty-five. Boiler inspector. Has had tuberculosis for over a year. Respiration 30. Pulse 100. Temperature 101.5. Weight 140. A man of large frame, showing marked emaciation. Physical signs of third stage, with several cavities in left upper lobe, broncho-vesicular breathing and ribs over lower left lobe and lower right lobe in front and back. Vocal fremitus markedly increased over left lung with flat percussion note. He was given an injection of bacillus X. on November 16th. Reported December 26th. Weight 148, and expectoration decreased. The gain in weight was probably due to milk diet advised. His general condition and symptoms are the same. Another injection was given without benefit. Died April 5th.

Case No. 6.-J. K. H. Male, white, aged nineteen. Clerk. Father died of tuberculosis. Mother living; eleven children, three living. None died of tuberculosis so far as the patient knows. For several months has had cough, expectoration and fever, with frequent night sweats. Loss of flesh and appetite. Frequently has spit blood, at times a mouth full of red, frothy blood. T. B. in sputum in large numbers. Pulse 100. Respiration 32. Temperature 102.

Both upper lobes show signs of second stage of tuberculosis. He was anemic and frail. After the first injection of bacillus X. his night sweats ceased. He was sent to the country, but did not improve and had a severe