The daily morning journal and courier., 1901-11-15
TWO FACTORS IN DISEASE.
Infection And Predlsposition Both Play
 a Part

Infection And Predlsposition Both Play
 8 Part
 The pendulum of fashion has during
 the last few years, swung far in the
 direction of dapriving many of the
 influences to which people used tc
 attribute the onset of tuberculosis o1
 their significance. Much popular teach
 ing, often as somewhat ad captandulr
 nature had tended to undermine the
 importance of diathesis, facies and pre-
 disposition in regard to tuberculosis
 The germ has been placed on a high
 pedestal, infection has been made into
 a fetich, and the faiths of our fathers
 have been to large extent deserted.
 Nevertheless artists and people of
 observation still hold to the "con-
 sumptive type" girls and young men
 are still said to be consumptive look
 ing" and those who. putting theory on
 one side. are content to watch events, find too often that these old notions turn out to be correct. The infection ists have, in fact. overdone 1t. To thinking men the widespread diffusion which is claimed for the infection of tuberculosis, and the multiplicity of the chances which we all have of coming across it at every turn. have always stood in the way of a thoroughgoing acceptance of the theories which are now so popular. In opposition to the modern explanation of the prevalence of consumption among the poor, name ly that in homes of poverty infection has far more opportunities than in lao s,f I;rr1,t al t11i they have held that there is something else, and that one great reason why consumption prevails so largely among the poor is that the conditions of their lives engrain in them a prediposition to the disease. Everything turns upon the comparative value of infection and predisposition and now, after the vio lent oscillation set upon by the popu- larizing of the infection theory we find the pendulum swinging back once more, under the influence of common sense in the direction of predisposition As we have just said the widespread nature of the infection of tuberculosis makes it fairly clear that something be- sides exposure to it is involved in the development of the disease. But when we find that not only are the germs 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 decides whether a man shall or shall not become consumptive.
 At the present day post mortem ex- aminations at certain institution are in a much more complete and perfect manner than in times past, with the result that a much larger of the bodies are found to show traces of having been at some lime of another infected with tubercu- osis than was formerly thought to be he case. When we hear that in 800 post mortem examinations made at the Zurich Pathological Institution un- loubted signs of tubercle were discov- ,red in 97 per cent of the bodies exam ned, and when we compare with that he comparatively small proportion of he population which is carried off by he disease when in fact we find ulti- nately died of it, we cannot resist the conclusion that the ultimate result of ln infection with tuberculosis must de- ,end far more upon the resisting power if the patient than on the presence or ven on the reception of the infective Thus we find ourselves winging back again to the theory of ,redisposition whether in herited as a if we may venture once more O use the term, or developed as a re ut of the condition and accidents of lie.
 These good people at Zurich did not scape tuberculosis because they had he good luck not to come across the licrobe, for 97 per cent of them had ctually ben affected by the disease. afety in such cases has been the re- ult not of escaping infection but of vermastering It. The vitality of the individual rather than the virulence of he germ Is then the predomlnating in- uence. As Sir William Covers has ltely said, facts may be differently ex- lained, but they cannot be destroyed y new knowledge, and although there as come to be strong popular i'm ression that an inherited influence in 1e causation of tuberculosis has been isproved by the discovery of It's de- on organisms received from -ithout the facts which led to the be- eff in that inherited influence still re- lain. These facts are, he says, equally yplained by the assumption that what
 inherited is a relatively low power destroying the tuberculosis organ ms which have gained entrance into le system
 Of course the same thing holds good
 regard to the arguments which nge upon the prevalence of phthisis nong those who dwell among unsan- ary conditions. It is not entirely the or virulence of the germ, 1t the lack of resistence in the indivi- lal which is at fault. This view was e keynote of much that was said by r. Alchin last week in his presiden- Il address to the Medical Society; i'd so we see the pendulum swing back ain toward it's old position. Toward, It never quite to it; for new knowl- ge must always leave it's mark and ake permanent indent upon our inception of things.-From the Hos .al