In all history man's greatest enemy has been a small, hard-shelled germ called the tubercle bacillus. It causes tuber­culosis.

According to all statistical surveys and conjecture, the death toll exacted by this germ is staggering and beyond any comparison. Undoubtedly it runs into tens of millions. No catastrophies—wars, pestilences, famines—have produced anywhere near the casualty lists brought about by the tubercle bacillus.

"The great white plague" it was called. Silently, certainly, and devastatingly, it struck generation after generation with deadly consequences. Mysterious, unconquerable, defiant, it remained secure in its ravaging imperviousness until within our contemporary time.

Today tuberculosis—TB—still is a major menace. Part of the fight against TB possibly has been won. But only part.

New treatment methods have brought wonderful results. It is estimated that our progress against the disease has saved more than 9 million American lives between 1900 and 1959.

But tuberculosis still is a major menace for very specific reasons which all of us should know:

1.  TB is like no other disease. For one thing, we can be in­ fected with TB germs, but not have active TB. However, our infection can become active. (About 36 million of us have TB germs in our bodies. When and if they become active, we truly "have" tuberculosis.)

2.  TB is a communicable disease—in other words, it is "catching." (It is never inherited.) You can catch it almost anywhere, any time, from anyone who is an active TB case. Your children might catch it from a baby sitter, a grandparent, parents, or other relatives. Your spouse can catch it from a salesclerk, a friend, or any active "case" who might cough or breathe into his or her face. Today about 250,000 Americans have active tuberculosis, accord­ing to the Public Health Service and National Tuberculosis Association. Of these TB victims, 150,000 know that they have active tuberculosis. The other 100,000 may not know it as yet. Almost 60,000 new cases are reported each year.

3.  Once you have had the disease, you have no dependable immunity. To the contrary, a TB victim who has recovered always is in danger of a relapse.

Before our modern methods of treatment gave us potent tools to fight the "white plague" the treatments varied from the ridiculous to a sensible attempt to build up bodily strength to fight the disease with the body's own weapons.

Up until 1882, when Robert Koch discovered the tubercle bacillus, no one knew what caused the disease, nor did they know it was communicable. Frequently it was known as "consumption" and one variety was called "galloping" or "hasty" consumption.

At one time, less than three centuries ago, one type of TB was thought to be curable by a touch from a king.

In 1858, Gunn's New Domestic Physician, a source of home remedies for many pioneers, made the following sug­gestion for treating tuberculosis:

"Live temperately—avoid spirituous liquors—wear flannel next to the skin—and take, every morning, half a pint of new milk, mixed with a wineglassful of the expressed juice of green hoarhound."

George Henry Napheys, M.D., in 1879, gave the following explanation for the cause of "consumption" in his Handbook of Popular Medicine: "This (consumption) is almost invari­ably hereditary, but may occur by change of climate, and at the same time, change from an outdoor country life to one in a large city, where the home is situated in a small, ill ventilated, never too cleanly street, and where the occupation almost constantly necessitates indoor life. This accounts for the mortality by this disease, among the immigrants from Ireland to America."

Dr. Napheys was quite candid about the improbability of a successful treatment. He began a long dissertation on treat­ment with these words: "While instances have occurred, of the arrest of this disease, and an apparent approach to health, these are so rare that they cannot be depended upon, and the main hope is to postpone the fatal hour, which is often pos­sible, and to make the patient comfortable while life lasts."

In discussing prevention of consumption he wrote: "Horse­back exercise is especially useful. . . Sydenham, the great physician, said, 'in consumption the best doctor is a horse, the best apothecary an ass.' "

Today the fight against tuberculosis is organized, intelligent, and certain.

A young stenographer, Cynthia Ellis, was among those of her office who had a routine "miniature" X-ray of her chest when the mobile X-ray unit of the local tuberculosis associ­ation visited the industrial plant where she was employed.

Within a week she received a letter from the association requesting her to report for a large follow-up X-ray.

Readings of the larger X-ray indicated that Cynthia had active TB. She was immediately referred to her private phy­sician and other tests were taken to confirm the diagnosis.

Frightened and uncertain about the nature of the disease, she was on the point of tears when her doctor told her that she had tuberculosis.

"What do I do?" she asked. "Can you treat me at home? Will I have to quit work? Isn't . . . isn't it usually fatal?"

"Let's answer the last question first. It no longer is usually fatal—especially when we catch it early, as we have with you. Second—you'll have to quit work for a while, and in your case we can't treat you at home.

"TB is a communicable disease—you could infect your family and people who might visit you. As a matter of fact, I will have to file a report of your case with the health department, which is entirely as it should be. And you'll have to be hospitalized in one of our state tuberculosis hospitals."

"You mean for a long time? I seem to remember reading that it takes years sometimes—"

"Once it might have, but not now. With modern chemo­therapy we may have you out in three to six months."

"Would it help if I went to another climate? Like Arizona?"

"That's an old fallacy. Climate has little or nothing to do with TB—only if a poor climate for you keeps you unhealthy and lowers your resistance to the germs so that you become an active case."

"Won't it cost a great deal, Doctor?"

"You'll lose time on your job. In this state there will be a nominal charge for your care at the hospital—if you can pay it."

"When I can leave—I mean, if I'm cured, won't I still be dangerous? I'm engaged. Can I marry. . . ?" she asked fear­fully.

"When you have recovered and no longer are an active case, you won't be able to pass on the disease to anyone else.

But you must have regular examinations to make certain that you stay healthy. And—if your recovery is as successful as I'm certain it will be ... there's no reason why you shouldn't marry."

Cynthia entered the state tuberculosis hospital in her area and with the aid of chemotherapy she was released within four months and was soon able to return to her job. She was married the following year.

The first breakthrough in drugs to fight TB came with streptomycin in 1944. However, it did not prove to be the final answer. Researchers continued their important work and developed PAS (para-aminosalicylic acid) and isoniazid. All three drugs are frequently given in combination for effective treatment.

Of the three, isoniazid holds the most promise for the future. It is especially effective, has few unpleasant side effects, is comparatively inexpensive, and can be easily taken in pill form.

Of additional importance are indications that isoniazid may have value as a preventive of active tuberculosis, particularly with infected children.

As powerful and effective as the new drugs may be, there is reason for concern. The TB germs evidently tend to become resistant to each new drug, so that after a while the drug ceases to be very effective.

Surgery also has reached a new apex in the treatment of TB. Diseased portions of a lung, or the whole lung, may be removed with relative safety because the new drugs stop the spread of the germ.

So far, no completely satisfactory vaccine to prevent TB has been found. The one frequently mentioned is BCG, devel­oped by two French scientists, Leon Calmette and Camille Guerin, after whom it is named, bacille Calmette Guerin, and first used in 1923. It is prepared from a weakened strain of the bovine tuberculosis germ. Usually its use is restricted to persons who never have been infected with the TB germ and who have a negative reaction to a tuberculin skin test. Con­sequently BCG is virtually useless to millions who are already infected. Experts say it gives only limited immunity to many others.

A few years ago it was recognized that though major vic­tories against TB were almost within our grasp, the disease was dangerously close to breaking loose again because of the germ's ability to build resistance to our chemotherapy weap­ons. A major plan of strategy obviously was needed.

From November 29 to December 2, 1959, some of the nation's leading authorities on tuberculosis held a vitally im­portant meeting in Harriman, New York. Called the Arden House Conference on Tuberculosis, it was sponsored jointly by the National Tuberculosis Association and the U. S. Public Health Service, Tuberculosis Program.

The results of the conference emphasize the immeasurable importance of immediately establishing a program for wide­spread application of chemotherapy as a public health meas­ure for the elimination of tuberculosis in the United States.

In other words, the feeling runs high that we must work surely and quickly to eliminate tuberculosis—while we have drugs that still work, and making full use of the methods we have of detecting the disease.

Eleven pertinent recommendations came out of the Arden House Conference. The conference is now being followed by similar conferences in the various states. All-out war has been declared against the tough, hard-to-detect tubercle bacillus.

To treat TB, we have to find it. To prevent its spread, we have to find it and treat it. Detection is an important key word in the fight.

Most of us are familiar with the chest X-ray. It takes only a few moments and is the easiest way to check for TB. An­other test, not so familiar to many, is the tuberculin skin test. This test is being used with increasing frequency. The test tells whether or not we have ever been attacked by TB germs. If the results are positive, it simply means the germs are there, even if they have caused no damage. It indicates that X-rays and other tests probably should be used to make certain that we are in no immediate danger, or to determine if we are active cases.

Rene Dubos, Ph.D., Member and Professor, The Rocke­feller Institute, New York, who was one of the 18 conferees at the Arden House Conference, is credited with this poignant summation of the TB problem in the United States:

"It's now or never. Conditions are at present favorable for the bold and decisive action that could virtually wipe out tuberculosis in this country because the general health of the nation is very good. But we can expect that more and more bacterial resistance to antituberculosis drugs will develop. In twenty years it may be too late. Miracles do not happen very often."

The National Tuberculosis Association in its annual report for the year ending March 31, 1960, announced its determi­nation to play an important part in the drive against TB to its 2500 local and state tuberculosis associations across the country—and thousands upon thousands of volunteer workers —by accenting that 1959 was "the year of a new beginning in tuberculosis control. A year of climax after fifty-six years of steady effort. A year of ferment, planning, and decision. The year when the judgment was made that 'TB can be wiped out in this country if bold and decisive action is taken.' The time is now!"

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