When ordinary forms of living bacteria get into the tissues of the body, a very complex cellular mechanism, not fully understood, usually results in their destruction and ultimate removal. In the presence of the tubercle bacillus the body cells are often able to build a dense enclosing wall around the affected region, shutting it off from the rest of the body. This is one of the modes of natural cure. The body cells are sometimes able, if sustained by nourishing food and an abundance of fresh air, to carry on, year after year, a successful struggle with the invading germs, so that the usefulness and enjoyment of life are but little interfered with. Finally, a certain proportion of human beings seem to be endowed at birth with some as yet unknown quality in the cells or fluids of the body which naturally unfits them for the life uses of the tubercle bacillus, and so renders the individual for longer or shorter periods practically immune.
Others, on the contrary, are, as we have seen, from birth unusually susceptible. This inherited susceptibility to the incursions of the tubercle bacillus, should this find lodgment in the body from without, by no means always reveals itself in any apparent lack of vigour or robustness of the body. Still, any habit or mode of life which diminishes the bodily vigour, whether in those predisposed to this malady or in the apparently immune, and gives it a leaning toward disease, diminishes, as a rule, the chances of a successful contest with the bacillus. And so it is that in spite of the wide distribution of these fateful germs in frequented places, and the tendency of certain vulnerable persons to succumb to their ravages, so many people are not affected by them, and so many, although not altogether escaping their malign influence, are yet able to wrest at least a moiety of life from the hand of the great destroyer.
The degree of success which may attend our crusade against tuberculosis will largely depend upon the wide diffusion of the knowledge of its communicability by means of the sputum dried and powdered and floating in the air as dust, and the intelligent persistence with which the morbid material may be safely cared for at its sources. The resolute avoidance by consumptives of the not only filthy but dangerous practice of spitting upon floors or streets, or anywhere else except into proper receptacles; the use of receptacles which may be and are frequently and thoroughly cleansed, and, best of all, of water-proof paper cups, which with their contents may be burned; or, when circumstances require, the receiving of the dangerous material on cloths or Japanese paper napkins, which may be destroyed by fire, and not on more valuable handkerchiefs on which the sputum is allowed to dry while in use or before disinfection and washing; scrupulous care by others of the sputum of those too ill to care for it themselves—these are the comparatively simple means from which we may most confidently expect relief. The details of these precautions and their adaptation to the special circumstances of those suffering from the disease can be most wisely left to the physician, and though of paramount importance, need not further engage our attention here.
To the consumptive himself these measures are not without a vital significance. For his chances of recovery may be in no small degree diminished if he be more or less constantly liable to a fresh infection from material which he has once got rid of, and which should have been destroyed.
The great volumes of fresh, moving air which we encounter out-of-doors in properly cleansed streets usually so greatly dilutes the dust, of whatever kind, that little apprehension need be felt from its presence. When, however, in crowded cities, the streets are, as is nearly always the case, save for a few favored localities, filthy, and but fitfully cared for; when choking dust clouds must be encountered by the citizen during the haphazard and slatternly essays at cleaning made by untrained and irresponsible sweepers; we cannot ignore a danger from street dust which may well incite grave apprehension. The citizen can, if he must, run from the presence of cloud-enwrapped machines furiously whirled along half-sprinkled pavements; he may avoid a block on which the hand-sweepers, in the absence or in disregard of rules, ply their nefarious brooms over unwet surfaces, because too indolent or indifferent to sprinkle them—these things he can do if he be not willing or ready to apply the citizen's remedy for municipal misrule.
But it is in rooms either of dwelling or assembling places that the ill effects of infectious dust are most potent, because the air is here not so constantly renewed as it is out-of-doors, and is liable to be breathed over and over again. Dust which gets into houses does not readily leave them, unless special and intelligent means be directed to its removal. We do not usually realize that, though the air itself in inhabited rooms is constantly changing more or less rapidly by diffusion, by draughts, or by purposed ventilation, fine dust particles are not removed under the same influences in proportionate degree. They cling more or less tenaciously to all surfaces on which they have settled, and especially to fabrics, so that currents of abundant force and sufficient distribution to change the air may and usually do leave the lodged dust particles almost entirely undisturbed.
One of the most threatening tendencies of modern times in matters of health is that of overcrowding in cities, and the great element of danger from this overcrowding is not only and not chiefly the insufficiency of air in living-rooms and the lack of ready means for its renewal, but the accumulation in this air of infectious germs floating with the dust. Abundant water supply and good sewerage have rendered possible and measurably safe, so far as the ordinary waste of life is concerned, the building of vast tenements which swarm with people. But the means of getting pure air, and especially of disposing of infectious material often floating in it when it is confined, have not at all kept pace with the demands of health and cleanliness.
But when we return to larger and more liberally furnished dwellings of the well-to-do classes, we are not reassured, for in some respects the rich are sadly handicapped by the “tyranny of things.” Of course, long and thick piled carpets afford persistent lurking-places for infectious as well as other dust. Certainly heavy hangings in a measure hinder the detergent action of the sunlight, shut the used air in and the fresh air out, and shelter floating matter which might otherwise escape. Without doubt, complex upholstery with roughened fabrics increases the difficulties in the maintenance of cleanliness. But the usage of the householder in these matters will, after all, depend upon whether his practical devotion be most at Fashion's or Hygeia's shrine. We may hope for the coming of a time when clean, clear, airy, simply furnished living-rooms shall replace the stuffy, fabric strewn apartments in which the fashionable citizen so much delights to-day.
In one particular, however, the devotion to cleanliness may be unreservedly insistent, and that is that in the cleaning of living-rooms, whether occupied by the sick or the well, the distinct and recognized purpose of the operation shall be to remove, and not simply to stir up, the ever-gathering dust. The past few years, so beneficently signalized by the exploitation of the new germ lore, have seen marked departures from the traditional sweepings and dustings of a past era; and the emancipation of the housekeeper, and incidentally of the household, from the thrall of the pestiferous feather duster seems fairly under way. Still, some of the old barbarous travesties upon cleaning widely persist. The dry broom still seeks out in the deep recesses of the carpets not the coarser particles of dirt alone, but the hordes of living germs which were for the time safely ensconced, and among these such malignant forms as the chances of the day have gathered. These all are set awhirl in the air; some collect upon salient points of the fittings and furnishings; many stay with the operator, to vex for hours the delicate breathing passages or the deeper recesses of the lungs. Then in the lull which follows, gravity reasserts its sway, and the myriad particles, both the living and the dead, slowly settle to the horizontal surfaces, especially to the carpets. Then the feather duster comes upon the scene, and another cyclone befalls. The result of it all is that the dust has finally been forced to more or less completely abandon the smooth and shining surfaces where it would be visible, and is largely caught in the surface roughness of the carpets or upholstery or hangings, ready at the lightest footfall or the chariest touch to dance into the air again, and be taken into the lungs of the victims of the prevailing delusion—the delusion that the way to care for always obnoxious and offensive and often dangerous dust is not to get it out of the house, but to keep it stirring in the air until at last it has settled where it does not vex the eye.
By the use of moist tea leaves in the sweeping of carpets, by the use of soft-textured fabrics, frequently shaken out-of-doors, or by moist cloths or chamois in dusting, much useless dust-scattering may be avoided. But no matter what the means employed, the final purpose of every household cleaning should be to get the dust, not afloat, but away.