The Progress of the Century

by Unknown

The Plague.—One of the most remarkable facts in connection with modern epidemics has been the revival of the bubonic plague, the most dreaded of all the great infections. During the present century the disease in Europe has been confined almost exclusively to Turkey and Southern Europe. Since 1894, when it appeared at Hong-Kong, it has gradually spread, and there have been outbreaks of terrible severity in India. It has extended to certain of the Mediterranean ports, and during the past summer it reached Glasgow, where there has been a small outbreak. On this hemisphere there have been small outbreaks in certain of the South American ports, cases have been brought to New York, and there have been to November 1st twenty-one cases among the Chinese in San Francisco. Judging from the readiness with which it has been checked and limited in Australia, and in particular the facility with which the recent outbreak in Glasgow has been stamped out, there is very little risk that plague will ever assume the proportions which gave to it its terrible reputation as the “black death” of the Middle Ages. As I have already mentioned, the germ is known, and prophylactic inoculations have been made on a large scale in India, with a certain measure of success.

Tuberculosis.—In all communities the white plague, as Oliver Wendell Holmes calls it, takes the first rank as a killing disease. It has been estimated that of it one hundred and twenty thousand people die yearly in this country. In all mortality bills tuberculosis of the lungs, or consumption, heads the list, and when to this is added tuberculosis of the other organs, the number swells to such an extent that this disease equals in fatality all the other acute infective diseases combined, if we leave out pneumonia. Less than twenty years ago we knew little or nothing of the cause of the disease. It was believed to be largely hereditary. Koch discovered the germ, and with this have come the possibilities of limiting its ravages.

The following points with reference to it may be stated: In a few very rare instances the disease is transmitted from parent to child. In a large proportion of all cases the disease is “caught.” The germs are widely distributed through the sputum, which, when dry, becomes dust, and is blown about in all directions. Tubercle bacilli have been found in the dust of streets, houses, hospital wards, and much-frequented places. A single individual may discharge from the lungs countless myriads of germs in the twenty-four hours. Dr. Nuttall estimated from a patient in the Johns Hopkins Hospital, who had only moderately advanced consumption, that from one and a half to four and a third billions of germs were thrown off in the twenty-four hours. The consumptive, as has been well stated, is almost harmless, and only becomes harmful through bad habits. The germs are contained in the sputum, which, when dry, is widely scattered in the form of dust, and constitutes the great medium for the transmission of the disease. If expectorated into a handkerchief, the sputum dries quickly, particularly if it is put into the pocket or under the pillow. The beard or mustache of a consumptive is smeared with the germs. Even in the most careful the hands are apt to be soiled with the germs, and in those who are dirty and careless the furniture and materials which they handle readily become infected. Where the dirty habit prevails of spitting on the floor, a room, or the entire house, may contain numbers of germs. In the majority of all cases the infection in tuberculosis is by inhalation. This is shown by the frequency with which the disease is met in the lungs, and the great prevalence of tuberculosis in institutions in which the residents are restricted in the matter of fresh air and a free, open life. The disease prevails specially in cloisters, in jails, and in asylums. Infection through milk is also possible; it is doubtful whether the disease is transmitted through meat. So widespread are the germs that post-mortem examination has shown that a very large number of persons show slight signs of the disease who have never during life presented any symptoms; in fact, some recent investigations would indicate that a very large proportion of all persons at the age of forty have somewhere in their bodies slight tuberculous lesions. This shows the importance of the individual predisposition, upon which the older writers laid so much stress, and the importance of maintaining the nutrition at its maximum.

One of the most remarkable features of modern protective medicine is the widespread interest that has been aroused in the crusade against tuberculosis. What has already been accomplished warrants the belief that the hopes of even the most enthusiastic may be realized. A positive decline in the prevalence of the disease has been shown in many of the larger cities during the past ten years. In Massachusetts, which has been a hot-bed of tuberculosis for many years, the death-rate has fallen from forty-two per ten thousand inhabitants in 1853 to twenty-one and eight-tenths per ten thousand inhabitants in 1895. In the city of Glasgow, in which the records have been very carefully kept, there has been an extraordinary fall in the death-rate from tuberculosis, and the recent statistics of New York City show, too, a similar remarkable diminution.

In fighting the disease our chief weapons are: First, education of the public, particularly of the poorer classes, who do not fully appreciate the chief danger in the disease. Secondly, the compulsory notification and registration of all cases of tuberculosis. The importance of this relates chiefly to the very poor and improvident, from whom, after all, comes the greatest danger, and who should be under constant surveillance in order that these dangers may be reduced to a minimum. Thirdly, the foundation in suitable localities by the city and by the State of sanatoria for the treatment of early cases of the disease. Fourthly, provision for the chronic, incurable cases in special hospitals.

Diphtheria.—Since the discovery of the germ of this disease and our knowledge of the conditions of its transmission, and the discovery of the antitoxin, there has been a great reduction in its prevalence and an equally remarkable reduction in the mortality. The more careful isolation of the sick, the thorough disinfection of the clothing, the rigid scrutiny of the milder cases of throat disorder, a more stringent surveillance in the period of convalescence, and the routine examination of the throats of school-children—these are the essential measures by which the prevalence of the disease has been very markedly diminished. The great danger is in the mild cases, in which the disease has perhaps not been suspected, and in which the child may be walking about and even going to school. Such patients are often a source of widespread infection. The careful attention given by mothers to the teeth and mouth of children is also an important factor. In children with recurring attacks of tonsillitis, in whom the tonsils are enlarged, the organs should be removed. Through these measures the incidence of the disease has been very greatly reduced.

Pneumonia.—While there has been a remarkable diminution in the prevalence of a large number of all the acute infections, one disease not only holds its own, but seems even to have increased in its virulence. In the mortality bills, pneumonia is an easy second to tuberculosis. It attacks particularly the intemperate, the feeble, and the old, though every year a large number of robust, healthy individuals succumb. So frequent is pneumonia at advanced periods of life that to die of it has been said to be the natural end of old men in this country. In many ways, too, it is a satisfactory disease, if one may use such an expression. It is not associated with much pain, except at the onset, the battle is brief and short, and a great many old persons succumb to it easily and peacefully.

We know the cause of the disease; we know only too well its symptoms, but the enormous fatality (from twenty to twenty-five per cent.) speaks only too plainly of the futility of our means of cure, and yet in no disease has there been so great a revolution in treatment. The patient is no longer drenched to death with drugs, or bled to a point where the resisting powers of nature are exhausted. We are not without hope, too, that in the future an antidote may be found to the toxins of the disease, and of late there have been introduced several measures of great value in supporting the weakness of the heart, a special danger in the old and debilitated.

Hydrophobia.—Rabies, a remarkable, and in certain countries a widespread, disease of animals, when transmitted to a man by the bite of rabid dogs, wolves, etc., is known as hydrophobia. The specific germ is unknown, but by a series of brilliant observations Pasteur showed (1) that the poison has certain fixed and peculiar properties in connection with the nervous system; (2) that susceptible animals could be rendered refractory to the disease, or incapable of taking it, by a certain method of inoculation; and (3) that an animal unprotected and inoculated with a dose of the virus sufficient to cause the disease may, by the injection of proper anti-rabic treatment, escape. Supported by these facts, Pasteur began a system of treatment of hydrophobia in man, and a special institute was founded in Paris for the purpose. When carried out promptly the treatment is successful in an immense majority of all cases, and the mortality in persons bitten by animals proved to be rabid, who have subsequently had the anti-rabic treatment, has been reduced to less than one-half per cent. The disease may be stamped out in dogs by careful quarantine of suspected animals, and by a thoroughly carried out muzzling order.

Malaria.—Among the most remarkable of modern discoveries is the cause of malarial fever, one of the great maladies of the world, and a prime obstacle to the settlement of Europeans in tropical regions. Until 1880 the cause was quite obscure. It was known that the disease prevailed chiefly in marshy districts, in the autumn, and that the danger of infection was greatest in the evening and at night, and that it was not directly contagious. In 1880 a French army surgeon, Laveran, discovered in the red blood-corpuscles small bodies which have proved to be the specific germ of the disease. They are not bacteria, but little animal bodies resembling the amœba—tiny little portions of protoplasm. The parasite in its earliest form is a small, clear, ring-shaped body inside the red blood-corpuscle, upon which it feeds, gradually increasing in size and forming within itself blackish grains out of the coloring matter of the corpuscle. When the little parasite reaches a certain size it begins to divide or multiply, and an enormous number of these breaking up at the same time give off poison in the blood, which causes the paroxysms of fever. During what is known as the chill, in the intermittent fever, for example, one can always find these dividing parasites. Several different forms of the parasites have been found, corresponding to different varieties of malaria. Parasites of a very similar nature exist abundantly in birds. Ross, an army surgeon in India, found that the spread of this parasite from bird to bird was effected through the intervention of the mosquito. The parasites reach maturity in certain cells of the coats of the stomach of these insects, and develop into peculiar thread-like bodies, many of which ultimately reach the salivary glands, from which, as the insect bites, they pass with the secretion of the glands into the wound. From this as a basis, numerous observers have worked out the relation of the mosquito to malaria in the human subject.