Medicine: T.B.

Across Europe tuberculosis, the White Plague, is riding in all its medieval fury. In Berlin, it kills 302 of every 100,000 persons a year; in Warsaw, 500. In Latin America, the disease is reportedly gaining ground. But in the U.S. the battle against T.B. is a winning fight. Last week the National Tuberculosis Association and allied groups, at their annual meeting in San Francisco, heard strategic details, including accounts of some defeats along the way.

Advance. The best news was a sharp drop in T.B. deaths. In the first five months of 1947, the T.B. death rate among industrial insurance policyholders fell to 34.9 per 100,000—11% below the same period last year and the lowest mortality on record. T.B., once the No. 1 killer, is now No. 7. But the disease is still one of the nation’s costliest ($100,000,000 a year for treatment alone), the most widespread (500,000 active cases), and the No. 1 killer in the age group 15 to 40.

The U.S. Public Health Service’s unspectacular mass X rays of the population (for early T.B. detection) have done most to take the T.B. death rate for a fall. This year a large-scale BCG (for bacillus of Calmette and Guerin, named for its discoverers) vaccination project (TIME, Nov. 11) may take it still further. The plan, to vaccinate 100,000 U.S. schoolchildren against tuberculosis, has already been begun in Columbus, Ga., will soon move on to T.B. areas in large cities (including San Francisco’s Chinatown). U.S. specialists, who have long viewed BCG with suspicion in spite of its prewar successes in the Scandinavian countries, are now more enthusiastic; the San Francisco delegates gave the PHS experiment a hopeful endorsement.

Retreat. The bad news was that the great hopes placed in the “wonder drug,” streptomycin, as a T.B. cure have not entirely materialized. The experts at San Francisco heard a report on the first large-scale test of streptomycin. More than 800 cases were treated by the Veterans Administration, the Army and the Navy.

In certain types of T.B.—pulmonary (lung), miliary (small spots that may scatter through the body) and meningeal (brain and spinal cord)—streptomycin seemed to help. A few patients were completely cured, many of them gained weight and felt better during the four months’ treatment. But in most patients the disease remained active; many infections developed resistance to the drug; the death rate was still high (up to 90% in some forms of the disease). And on many types of T.B. the drug had no appreciable effect at all. Most discouraging finding of all was that streptomycin, in the doses tried so far, is definitely poisonous. It attacks the equilibrium centers in the brain or the inner ear and may cause permanent deafness. Doctors consider, it too dangerous to use in mild cases.

Nonetheless, the experts thought that streptomycin might be the beginning of the end of the long search for a tuberculosis cure. It is the first drug to have made any impression at all on forms of T.B. that used to be virtually 100% fatal.

Tuberculosis fighters are convinced that the absolute weapon against the disease is only a few million dollars off. Dr. Cassius J. Van Slyke, chief of the PHS research grants division, thinks that $6,000,000 a year for research (instead of the present $500,000) would solve the problem within a few years. Says he: one big push would do it.