Another method of contracting tuberculosis is by means of animals, such as cows, used for food and milking, which are known to be subject to this disease. It has been shown in some localities that one cow out of every twenty-five was affected with tubercular disease. This suggests the importance of having competent veterinarians to examine not only the meat which is sold, but also the cows used for milking purposes. Where there is the slightest doubt as to the nature of the meat or milk, the former should be thoroughly cooked and the latter sterilized before using.
In this connection it would be well to refer to the subject of spitting in street cars and in public places. While this nuisance is the subject of danger to every one in the street cars, especially in winter, when the windows are closed and a large amount of impurities is inhaled, it is more particularly so to ladies, whose skirts, in spite of every care, are soiled by the filthy expectoration, thus making them subject not only to the inhalation in the car, but also to carrying the infectious material to their homes.
The danger of this condition is not merely speculative. It has been bacteriologically demonstrated that the organisms of various contagious diseases thus find a lodging place in our cars and public places, and experiments on animals, in which the inoculation has developed diseases, have shown that these organisms retain their vitality in these places and may propagate disease under favorable conditions.
A factor in the spread of diseases of the throat and mouth that should not be overlooked is kissing. Unfortunately, this matter has usually been treated with much levity, and where a sanitarian is bold enough to condemn the habit he is frequently made the subject of all forms of ridicule in the public press.
The tender lining of the lips, mouth, and throat, and its large blood supply, make it peculiarly susceptible to contagion, and I have no doubt that the habit of kissing is responsible for many cases of infection. Last year I noticed a lady coming from a house from which a diphtheria flag was flying, who walked to the corner to take the street car, when a nurse with a small child approached. The lady without hesitation stooped down and kissed the little child. As it is well known that a healthy person may transmit a disease without incurring the disease himself, this lady voluntarily risked the danger of inflicting this disease upon the innocent child. It is not an uncommon thing for nurses to kiss the children under their charge, and here in New Orleans even the colored nurses sometimes practice this habit, occasionally with the permission of the parents. In fact, a fashionable lady on one occasion told me, when I remonstrated with her about this, that she feared to hurt the feelings of the old nurse, who had been a valuable servant in the family for many years.
How often this habit is productive of evil results is of course only speculation. I recall, however, an instance in which two small children of one family developed a specific disease which originated in the mouth and affected the whole system. Examination proved this to have been caused by a nurse, a white woman, who had been in the habit of kissing the children. If women will voluntarily incur risks by using kissing as a form of salutation in all stages of acquaintanceship, I would at least request that the innocent children be spared the possible consequences.
The subject of the hygiene of the ear is so intimately connected with conditions influencing the nose and throat, which have already been explained, that but few words are needed to cover this part of my subject. In general, the best care of the ear is to leave it alone. Ear scoops are injurious; the ear should be cleaned simply on the outside, and nothing, as a rule, should be inserted into the external canal. I have seen many cases of abscess and the most severe inflammation due to endeavors to clean the ear with the omnipresent hairpin and other objects used for this purpose. The use of cotton in the ear in general is to be condemned. It produces an artificial condition in the outer canal of the ear which reduces its physical resistance and makes it more liable to injury from exposure. The ear is sometimes injured by the entrance of cold water. This happens occasionally during ordinary bathing, but more frequently in outdoor bathing and in swimming. In surf bathing, where the water is thrown up with considerable force, it is much more liable to enter the external orifice of the ear, and severe inflammation may originate from this cause.
Salt water has been claimed to be more injurious than fresh, but my personal experience leads me to believe that it is more a question of temperature than of the quality of the water. Some years ago a large reservoir was built by an educational institute near this city, the water, which was quite cold even in summer, being supplied by an artesian well. The tank was used for bathing purposes, but earache soon became so frequent among the boys that the use of the reservoir for this purpose had to be entirely abandoned. In ordinary bathing, the entrance of water into the ear can easily be avoided. In swimming or surf bathing it is advisable to use a pledget of lamb's wool to close the opening of the ears. Ordinary cotton soon becomes saturated and is of no use in this connection, but the wool, which is slightly oily, forms an excellent protection in these cases.
The "running ear" is a diseased condition which should not be tampered with by the inexperienced, but which should not be neglected. The old idea that the child will outgrow it, or that it is a secretion of the head which if interfered with would prove dangerous, has been fruitful of many cases of deafness and even more serious complications.
Another condition to which I would call your attention is the incipient development of deafness in children. Where the capacity of hearing is quickly lowered from the normal to fifty per cent, it is so striking that the patient is much distressed and even confused. But when this change takes place insidiously from day to day, it is frequently not observed by either the patient or those around him until it has greatly advanced. Children thus affected hear only with difficulty and by straining certain small muscles of the ear, which soon become fatigued, and the child becomes listless and inattentive. I have seen numerous cases in which children have been severely punished for inattention, when this was due to defective hearing. Watchfulness and early attention in these cases will frequently prevent the more serious forms of deafness.