General Articles

New Foe for TB

Whisked from maternity wards to a Montreal clinic, babies from tubercular families get a double chance to beat TB

GEORGE H. WALTZ July 1 1948
General Articles

New Foe for TB

Whisked from maternity wards to a Montreal clinic, babies from tubercular families get a double chance to beat TB

GEORGE H. WALTZ July 1 1948

New Foe for TB

General Articles

Whisked from maternity wards to a Montreal clinic, babies from tubercular families get a double chance to beat TB

GEORGE H. WALTZ

MONTREALERS these days are seeing more and more of motor cars bearing large doorpanel signs which read, “BCG Clinique de Montreal.” The driver is a girl in the trim uniform of a social worker. Usually, beside her sits another, tenderly cradling a well-blanketed youngster in her arms. The blanket also bears a large BCG monogram and the infant it protects is on its way to he immunized against one of the world’s most dreaded diseases.

The letters BCG are becoming to mean more and more; not only to Montrealers, but to all Canadians, all Americans and all Europeans. They are growing symbols of hope, for they stand for the “Bacillus of Calmette and Guerin” an inexpensive, easily administered vaccine that is medical science’s newest preventive weapon against the deadly “white plague” of tuberculosis.

BCG is not new. It is 40 years old and is just now receiving medical acceptance in the form of world-wide tests on humans. And it is gaining that acceptance largely because of the hard work and faith of a small grouj) of never-nay-die Canadian scientists.

BCG’s long story goes back to 1908. It was then that two French researchers Albert Calmette and Camille Guerin working at the Pasteur Institute made an important discovery. They succeeded when? a good many others had failed.

Ever since I)r. Robert Koch, the celebrated German physician, succeeded in isolating the bacillus which causes tuberculosis in 1882, scientists all over the world had been striving to develop a vaccine that would immunize humans and cattle

against the disease. By the turn of the century, however, little progress had been made. Various experimental vaccines had been produced, but when they were tried on cattle they proved too powerful, too virulent. Instead of protecting the test animals from tuberculosis it gave it to them.

Then in 1908, after a long series of tests, Calmette and Guerin found that they could weaken the living tuberculosis germs progressively to a safe level for use as a vaccine by growing them slowly in a culture broth concocted of potatoes and ox bile. By periodically transferring a germ colony to a new culture plate containing the same potato-and-bile diet, the experimenters literally starved the growing bacilli to the point where they grew less and less deadly. After two long years of planting and transplanting, they had succeeded in weakening their germ colonies sufficiently to produce a strain that was strong enough to immunize a test animal but not strong enough to infect it. As with all vaccines, the goal was to give a test animal a very slight case of the disease so that its own bodily protective system could marshal its forces and build up a wall of immunity.

Finally, after 13 years of additional work, Calmo tie and Guerin announced to the medical world that they bad been successful in producing a safe vaccine that would immunize cattle against tuberculosis. That was the birth of BCG.

BCG Comes to Canada

I''HAT was in 1921 and in that year BCG vaccine, offered to the medical profession without cost by the Pasteur Institute, was first tried on humans. It was administered to a group of newborn babies in the maternity ward of a Paris

hospital. The results were more than encouraging. Then, during the course of the next six years in France, more than 50,000 infants one out of every eight coming from a tubercular family were inoculated with BCG. Less than one per cent of the BCG vaccinated children, living in known tubercular homes, died of tuberculosis as compared to 25 per cent of t hose who were not vaccinated.

All during this time, these experiments in France were being enthusiastically watched by a small group of Canadian scientists headed up by Dr. Joseph Baudouin of Montreal. In 1926 Dr, Baudouin decided to try a few tests on his own. He began by vaccinating newborn babies orally with BCG. As an acid test of BCG’s immunizing powers, he deliberately selected children of tubercular families, vaccinating some and leaving others in the same households unprotected. His tests bore out the findings of the doctors in France. BCG was able to reduce a child’s chances of catching the “white death” by more than half.

These were the first, clinical tests of BCG on this side of the Atlantic.

A few years later, however, BCG suffered a serious setback. A group of well-meaning doctors in Lubeck, Germany, decided to try BCG on several hundred newborn infants. Unfortunately wha: they had thought to be pure BCG vaccine late: proved to be impure. In some way it bad beconif contaminated with a virulent form of tuberculosis germ. Instead of protecting the children, ii infected them with TB. Despite every medical effort, one third of the children died.

This disastrous experiment had the unfortunate, but natural, effect of cooling off the enthusiasm 0: most of the medical profession. Perhaps, they reasoned, BCG was Continued on page

New Foe for TB

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not all that its French discoverers claimed it to be. Had it not been for Canada’s experimenters, and similar small believing groups in the United States and Europe, much of the basic work of Calmette and Guerin might well have gone for nought. In any case, the Lubeck experiment put BCG back many years.

In Canada, however, Dr. Baudouin, reinforced in 1932 by the help of Dr. Armand Frappier who was producing a pure-strain BCG vaccine at the University of Montreal, continued his vaccination experiments on newborn babies. His tests were completed just about a year ago; in them he

found that three times as many T.B. deaths occurred in unvaccinated groups of newborn babies from tubercular families as in BCG-vaccinated infants from similar homes.

A few years after Dr. Baudouin started his BCG experiments in Canada, Dr. Joseph Aronson of the University of Pennsylvania in the United States also started a long-range BCG test. For his case-history laboratory, he selected several tuberculosis - ridden Indian communities in America’s Wast and in Alaska, long a hotbed of “white death.” Over the course of several years, Aronson and his associates vaccinated about half of the Indians on these reservations with BCG. The others, in order to maintain a comparative control group for his experiContinued on page 34

Continued from page 32

monts, he vaccinated with a simple solution of table salt.

Dr. Aronson allowed two years to pass before he began checking the results. It proved to be pretty much the same encouraging story. Of some 1,600 Indians inoculated with BCG, only 40 had contracted tuberculosis. On the other hand, of the 1,400 Indians also living in these same communities who had not received BCG protection 185 developed tuberculosis. BCG had increased the immunity to tuberculosis in this widespread group of 3,000 test patients in the ratio of about, four to one.

World-wide Tests

Similar BCG experiments carried on in Saskatchewan by Dr. R. G. Ferguson, who is medical service director and general superintendent of the Saskatchewan Anti-Tuberculosis Association, also followed pretty much the same pattern. Working with nurses and attendants serving in tuberculosis sanatoriums, Dr. Ferguson found that from four to five times as many cases of tuberculosis were contracted by those who had not been vaccinated with BCG as in those who had. And Dr. Ferguson’s test subjects were in almost continuous contact with tubercular patients.

Other reports from England, Norway, Sweden, Denmark, France, Germany, Hungary, Czechoslovakia, Austria, New Zealand, Chile and Russia tell of the same effective results.

During the next 18 months more than 15,000,000 children in 11 European countries will receive BCG vaccinations in an effort to stem the rising TB tide. This will he financed by a $2 million grant from the United Nations International Children’s Emergency Fund.

Montreal’s pioneering BCG clinic, located on the Rue Letourneux, has been in operation now since 1935. It was in that year that Senator Athanase David, then Quebec’s Minister of Health, after returning from a trip to Paris where he had met Calmette, conceived the idea of a free BCG clinic. The clinic, which costs about $100,000 a year to operate, is financed by public funds granted by the Quebec Provincial Government and by individual donations.

During its 13 years of existence, under the able direction of Dr. Albert Guilbeault, it has blossomed from a comparatively small institution with a few workers and fewer beds into a busy clinic with almost 100 beds.

Principally concerned with the new infant born into a tubercular family, the clinic is fully equipped to receive the young patient, test it for the first signs of tuberculosis, administer BCG, and then, after a period of from three to s'\ months of expert care and isolation, return it to its family. With periodic re vaccination, given whenever a tuberculin test shows a negative reaction, the youngster can live and thrive in tubercular surroundings with a good degree of immunity. During the early years, such a child is checked hv one of the clinic’s visiting nurses every three months.

In a recent issue of Health, the official organ of The Health League of Canada, Dr. Guilbeault reported that of some 900 children vaccinated and cared for by his Montreal clinic, not one has died of tuberculosis nor has a single patient shown any symptoms of tubercular infection. And this in spite of the fact that about half of these children have gone back to sleep, eat and live with tubercular parents.

The administration of BCG is neither expensive nor difficult. It can

be given by mouth or by the usual vaccination procedure used for smallpox.

Although the best TB-free results so far have been obtained by vaccinating infants who have been completely isolated from possible infection, BCG also provides a good degree of immunization for older children and adults. According to Dr. Guilbeault’s recommendations, infants born into tubercular families should be vaccinated with BCG before they are 10 days old. Older children, living in completely healthy surroundings and who are found to be tuberculosis free, can be vaccinated at any time up to the school age of six. Tuberculosis-free children already in school, and tuberculosis-free adults, can be given the BCG vaccination after two successive tests, taken a month apart, have shown no tubercular signs.

Across the border an interesting large-scale test of the powers of BCG now is in progress. The U. S. Public Health Service, at the suggestion of leading tuberculosis authorities, now is sponsoring the vaccination of 100,000 Americans, both young and old, this year.

Chosen as the community for these wholesale vaccination tests is Muscogee County, Georgia, which includes the city of Columbus. As a starter, 16,000 school children are being tested for possible tubercular infection. Later, those who show no symptoms of the disease will be vaccinated with BCG.

Others to be vaccinated in the U. S. test include adults and children living in localities where there are no adequate centres for the treatment of TB, nurses and attendants working in TB hospitals, and children living in known tubercular homes.

A Note of Caution

One thing, however, must be borne in mind. BCG is not a cure for tuberculosis. It is not a disease killer like streptomycin (see Maclean’s, Jan. 15, 1946), which has shown some value in the actual treatment of certain kinds of tuberculosis. BCG is a vaccine — a preventive designed to provide a certain degree of immunity to TB germs.

So far, on the average, BCG vaccinations appear to more than double a child’s or adult’s chances of not contracting tuberculosis, even though he may live in tubercular surroundings. On the face of it, that may not sound particularly startling until you study the grim cold figures of death statistics. Last year more than 65,000 people in North America alone died of tuberculosis. Cut that in half with BCG vaccinations and you have saved 32,500 lives in one year.

True, the full worth of BCG has not yet been fully tested. There still are medical men who are not convinced of its value. Cautious observers point out that sufficient time has not yet elapsed to show whether BCG can protect for a lifetime and some have wondered whether it does anything more than delay the appearance of TB. Whether or not the injections would have the same effect if used to treat the general public, rather than individuals known to be exposed to the disease, is something else yet to be confirmed.

However, it has been well-established that the vaccine is safe to use. And as the new results gathered in each large-scale vaccination test are made known, more and more of the medically sceptical are swinging over to the ranks of the enthusiastic. When fighting a killer like tuberculosis, anything that can reduce the toll, even by 50% , is vitally important. ★