Prevention of Phthisis.
The number of deaths throughout the globe which are caused by pulmonary phthisis vastly exceeds the number caused by any other disease. The etiology of pulmonary phthisis embraces largely causes which can be removed. Hence the disease is to a great extent preventable. Are any comments on these simple statements needed in order that the prevention of phthisis may be regarded as among the most important of the subjects belonging to preventive medicine?
It has been assumed that phthisis involves a predisposition which is in most, and perhaps in all, cases innate. Putting aside all questions relating to an acquired tuberculous diathesis, it may be assumed that the development of the phthisical affection depends in many or perhaps in most cases, more or less, and probably often in a great measure, upon causes which promote the diathetic condition. Now, many of these causes are removable, and if removed phthisis is prevented, and the prevention of a disease which may properly be called a scourge of the human family will be diminished.
Of removable causes may be mentioned humidity of the soil in places of residence; living in small unventilated dwellings; confinement within doors; breathing in close workshops or factories, and in overcrowded rooms at night, an atmosphere deficient in oxygen and contaminated with pulmonary and cutaneous emanations; working underground in mines from which light as well as pure air is excluded; a deficiency of food sufficiently wholesome and varied; impairment of the cutaneous functions from uncleanliness; and want of a proper adaptation of clothing to the climate or season. These are obvious violations of the hygienic requirements for health. It is unnecessary to cite facts to show to what extent these violations prevail in different countries. They are causes which admit of removal, however difficult may be the task. Connected with their removal are other considerations than the prevention of phthisis. But confining the attention exclusively to the latter object, how incalculable would be the saving of life and health were these causes to be removed! Much has been done within the last half century toward diminishing the mortality from phthisis by advancement in pathological and therapeutical knowledge; how much more remains to be done by preventive measures!
The prophylaxis against phthisis must date from birth. An infant should not nurse a mother who is consumptive or whose milk is of poor quality. Care is to be observed in the selection of wet-nurses. All the various articles which are sold under the name of infants' food should be discarded. Many of these are fraudulent; that is, they are not what they purport to be. But admitting that, if properly prepared, they are safe substitutes for milk and the simple farinaceous foods, there can be no guarantee for their proper preparation; and the risk is too great to rely upon articles which cannot be readily tested and for the genuineness of which dependence must be placed on irresponsible dealers.38 There is need of much caution respecting the purity of milk, especially in cities. Much harm is not infrequently done by over-care in children's diet—that is, by denying articles which they crave, and restricting them to those which they do not like. In this matter the instincts are not to be set aside, especially in early life, when perversions of appetite and taste have not been acquired. Not infrequently from undue caution the quantity of food is restricted, and children suffer from insufficient alimentation; this is more likely to occur in our country among the wealthy than among the poorer classes. Other prophylactic provisions pertaining to exercise, out-of-door life, clothing, etc. need not here be considered.
38 Vide "Address by A. Jacobi on Infant Diet," Transactions of the New York State Medical Society, 1882.
In order to combat the various causes which have been named, knowledge of hygienic laws must be diffused among all classes. There is a lamentable lack of information and of interest as regards matters of hygiene among the more intelligent classes. But it is not sufficient to enlighten these: the knowledge must be extended, as far as practicable, to those who, in this point of view, are lower in the scale. Many persons of wealth fall in this category. The causes which are purely personal can be reached only by information diffused by means of publications, lectures, and intercourse with medical men and others. Here is a rich field for missionary labors. To overcome certain of the causes, however, the intervention of legislative authority is necessary. With reference thereto health boards, properly constituted and invested with adequate powers, should be organized in States, counties, and cities. In this way it is practicable by the prevention of phthisis to lessen greatly the rate of mortality.
Protection against the communication of the disease requires to be specially noticed. Occupying the same bed with phthisical patients and sleeping in the same room, if the latter be not enjoined by the dictates of humanity, are objectionable. They are to be objected to on the score of unhygienic influences, physical and moral, irrespective of the doctrine of a tuberculous contagium, and of course still more in view of the probabilities in favor of this doctrine. Care should be taken to exclude from the table the meat of tuberculous animals. In addition to the purity of milk in other regards, it should be ascertained that the supply is not from cows affected with tuberculous disease. Obviously, this is especially of importance with reference to infants who are bottle-fed and in childhood, when generally milk forms a much larger proportion of the diet than in after years. The ventilation of apartments occupied by phthisical patients should be attended to with reference to the possibility of the disease being communicated by the inhalation of particles of tubercle; and it may not be a needless precaution to introduce a disinfectant into the vessels which receive the matter expectorated.