Rural Hygiene

by Henry N. Ogden

The eating utensils used by a consumptive patient must not in any way be allowed to infect other people. The consumptive must have his own dishes reserved exclusively for him, and they must be, after each meal, carefully disinfected. With these precautions and with avoidance of such practices as kissing or otherwise directly infecting others, there is no reason why a consumptive patient should be in any way an object of dread or why he should not live with his family in as much comfort as he can obtain, in perfect safety to himself and to them.

Cure of consumption.

The chief factor in the cure of consumption is the time at which the attempt at cure is started. Consumption is not an incurable disease, as was once thought, and there is no reason for so considering it. There is no such thing as galloping or quick consumption as distinguished from slow or lingering consumption, since the consumptive germ is the same in all people. The same germ may act differently in different people, and if one's power of resistance, as happens with those accustomed to drinking liquor, is low, the action of the germ is rapid, although the disease is identical with the form in which death comes only after years and years. If taken in time, that is, before the germ has so infected the body as to be beyond all possible restraint, as large a proportion of consumptive patients may recover as of patients from typhoid fever or diphtheria or any other infectious disease, but the cure must be started early. For instance, at one of the sanitariums in the Adirondacks, out of 267 patients admitted, who had the disease in an incipient stage, complete recovery was had in 219 cases, the disease was arrested in the case of 42 others, and in only 6 was the treatment not effective. Where the disease had become advanced, however, it was found that out of 192 cases, only 32 apparently recovered and 140 were improved to some extent. These are the significant facts in an institution for incipient cases only, where advanced cases, such as are met with by the practicing physician, are not received.

Unfortunately, the ordinary physician does not always recognize the disease in its first stages, and a person may suffer for months with consumption, and even pass the time when the cure of the disease would be possible, without its being recognized. Such sick persons are treated for catarrh, for an obstinate cold and bronchitis, for grippe or malaria, whereas a proper diagnosis of the disease would be a recognition of the early stages of consumption and thus would prompt the patient to start at once on the necessary methods for cure. Nor is it possible to recognize the disease by any one definite indication. The cough which was once thought to be the deciding symptom is very often absent until the last stages of the disease. Expectoration of blood is similarly one of the last symptoms, exhibited only when too late for remedial measures. The presence of the tuberculosis bacillus or "T. B." in the sputum is also not generally found until the tissue of the lungs has become well advanced towards destruction, too late for remedy.

Experts in diagnosis attach great importance to family history, and have learned to expect the disease in persons when exposure to contagion is inevitable. They will recognize the disease from evidence not discernible to regular practitioners. For instance, if one member of a family is known to be affected, any chronic indisposition in another member, involving, perhaps, a daily rise in the temperature of the body, not sufficient to arouse alarm, but apparent in the listless behavior of the person, may be enough to suggest the beginning of the disease. An expert may detect the clogging up of the lung tissue by an examination of the lungs themselves, and probably this direct examination, with a record of the daily rise and fall of temperature, particularly if the suspected patient has a listless feeling and a gradual loss of weight, would be sufficient to suggest the ordinary remedies.

The three remedies, which are nature's own methods, are good food, fresh air, and rest. It is difficult to say which of these three items is the most important. Certainly no hope of building up the resistance of the patient against the inroads of the disease can be expected unless the patient is thoroughly nourished. One of the sad facts in connection with those unfortunates whose fight against tuberculosis is nearly over and who in desperation have fled to Arizona, hoping that the dry air might afford relief, is that the lack of nourishing food, inevitable in those deserts, hastens on the disease, so that the expected benefits from the dry air are entirely offset. Likewise, in tenement-house districts in cities, the fight against consumption is practically useless because of the impossibility of securing for those starved or underfed helpless ones the nourishing food necessary. In the country, this part of the treatment ought to be the simplest, and yet one fears that the habit of eating through nine months of the year only salted and dried foods has not furnished patients in the country with the kind of nourishment necessary. Experience indicates that eggs and milk should be the bulwark on which the patient must depend for food, and in the sanitariums of New York State it is not uncommon for patients to be stuffed with two dozen raw eggs every day in addition to other food.

The next important factor is rest, since the effect of tuberculosis is to break down lung tissue, and for the prevention of this it is necessary to give the forces of the body every aid in preventing this destruction. All exercise taken by a tuberculous patient means the withdrawing of that much blood from the lungs, where is the strategic point of the disease, to the part of the body being exercised, and one of the most striking features of sanitarium treatment is the absolute rest enjoined on the patients. Flat on their backs, day and night for months, without so much exercise as walking across the room, is the ordinary treatment, and the effect of disobedience is plainly seen in the rise in temperature or increase in fever which follows a violation of these rules. Even when the patients are allowed to sit up, they do not sit straight, but rest on couches or reclining chairs, so that their heads are down and their feet up, making the passage of the blood to the lungs easier. Even where the patient, determined to recover, is not able to place himself in the hands of a hospital physician, he can adopt this important method of arresting the disease by strictly avoiding exercise and exertion of every sort. The Massachusetts General Hospital in Boston has tuberculosis clinics, where patients who are not far enough advanced in the disease to require absolute rest are inspected daily, their condition noted, and advice given for the following twenty-four hours. One of the most common violations of the prescriptions given is overexertion, and yet the rest condition is essential for building up the diseased lung.

The third method of treatment involves fresh air, in order to improve the oxygenating character of the blood. If one remembers that the oxygen in the blood is the chief scavenger of the body and that the vitality of the red corpuscles and their abundance is an essential factor in curing the disease, it will be seen why fresh air is so important. The tendency to-day is to insist on fresh air and to lay less stress on the climate than was formerly done.

It was not uncommon a few years ago for a physician, recognizing consumption, to send his patient away, partly because he honestly believed the climate of Arizona or Colorado or the Sandwich Islands was better than that where the patient lived, and partly, without doubt, because he was glad to get rid of a disease which he knew it was not in his power to cure. To-day, unless the patient can go to a properly equipped and maintained sanitarium, physicians recognize that conditions may be as beneficial at home as elsewhere and, provided the three factors mentioned—good food, rest, and fresh air—can be obtained, the chances for recovery are better because of better care at home than elsewhere.

But fresh air is essential, and this means that the patient must spend twenty-four hours a day in the open. He must eat and sleep out of doors. He must not go into the house when it rains, nor when it snows, and even with the thermometer at zero he must still stay out, wrapping himself up, to be sure, so that his body is not cold, but breathing into his lungs the life-giving, vitalizing, oxygen-bearing air. The side porch of a house may be very easily transformed into a room with a cot bed and an easy chair, where the consumptive may stay continually, and while it is convenient to have a window or a door opening from the porch into a room where the patient may be dressed and bathed, this is not essential, although customary in sanitariums. If no side porch exists, it is possible to build such a porch, and the picture shows how such a construction may be added to even a small house in the city (Fig. 75). If this is out of the question, the windows of a room may be left open all the time, or the patient may lie on a bed, the head of which either extends through the window or is arranged to admit fresh air by a specially devised window tent.