Evening star., 1901-11-16
TWO FACTORS IN DISEASE.
Infection and Predisposition Both
Play q Prominent Part.
From the Hospital.

From the Hospital
The pendulum Of fashion has, during the
last few years. swung far in the direction
of depriving many of the influences to
which people used to attribute the onset of
tuberculosis Of their significance. Much
popular teaching, often of a somewhat ad
captandum nature, has tended to under
mine the Importance of diathesis, facies
and predisposition in regard to tuberculo-
sis. The germ has been placed on high
pedestal, infection has been made into a
fetch and the faiths of our fathers have
been to a large extent deserted. Neverthe-
less, artists and people of observation Sill
hold to the 'consumptive type girls and
young men are still said to be "conSump-
tive looking" and those who, putting theory
on side, are content to watch events
find too often that these old notions turn
out to be correct The infectionists have.
in fact, overdone it. To thinking men the
widespread diffusion which is claimed for
the infection of tuberculosis and the multi
plicity of the chances which we all have
of coming across 1t at every turn have al
ways stood in the way of a thorough
going acceptance of the theories which are
now so popular. In opposition to the mod
ern explanation of the prevalence of con-
homes of poverty infection has far more
opportunities than in homes of light and
air and cleanliness, they have held that
there is something else. and that one great
among the poor is that the conditions of
their lives ingram in them predisposition
to the disease. Everything turns upon the
comparative value of infection and predis-
position, and now, after the violent oscilla-
ton set up by the popularizing of the infec-
tion theory, we find the pendulum swinging
back once more under the influence of COM
mon sense in the direction of predisposi-
tion. As we have just said, the widespread
nature of the Infection of tuberculosis
makes 1t fairly clear that something be-
sides exposure to it Is involved in the de-
velopment of the disease. But when we
spread, but that large proportion of the
population are actually infected by them.
and yet are able to throw off the disease.
1t becomes more evident than ever that it
is the condition of the individual rather
than the presence of the germ which de-
cides whether man shall or shall not
become consumptive
At the present day post-mortem exami-
nations at certain institutions are con-
Quoted in a much more complete and per-
feet manner than in times past, with the
the bodies are found to snow traces of
having been at some time another in
fected with tuberculosis than was formerly
thought to be the case. When We hear
that in 500 post-mortem examinations made
at the Zurich Pathological Institute un-
doubted signs of tubercle were discovered
In 81 per cent of the bodies examined and
when we compare with that the compara-
lively small proportion of the population
which is carried or by the disease, when,
in fact, we find that far more people threw
of the disease than ultimately died of It.
we cannot resist the conclusion that the
ultimate result OF an infection with tuber-
culosis must depend far more upon the re-
sisting power OF the patient than on the
presence or even on the reception of the
fnfective material. Thus we find ourselves
swinging back again to the theory OF pre-
disposition, whether inherited as q diafhe-
siss IL we may venture once more to use
the term. or developed as a result of the
conditions and accidents of life.
These good people at Zurich did not es-
cape tuberculosis because they had the good
luck not to come across the microbe, for