Let us suppose a tubercular mother gives birth to a child. It would be foolish to assume that this child comes into the world with a normal standard of resistance; but it is certain he is not tubercular and doomed at the moment of his birth. He may be what is ordinarily termed a weak, puny, sickly infant, but the germ of disease is not implanted in his constitution. If he is taken from his mother, taken away from the tubercular environment, and brought up under the best hygienic and sanitary surroundings, it is possible for him to become a robust, healthy, normal man.
The tendency to disease in this case will not materialize. If, however, we permit him to remain with his tubercular mother, to nurse her milk, to live in what necessarily is an unhygienic and unsalutary environment—the presence of the consumptive mother renders it so—the probability is that the tendency to disease, which in his case is the tendency to weak lungs, will materialize, because of his weak resistance, poor nourishment, and unfavorable surroundings. If, therefore, his method of living does not contribute to building up and strengthening what is in the first place a weak structure, the structure itself will, during the first strain put upon it, give way, and naturally the weak spot will be the point of election for the invasion of disease. This strain may be one of the infantile diseases,—scarlet fever, or measles, or whooping cough, or it may be bronchitis. Instead of convalescing from these conditions, as a normally constituted child will, this child, whose potential resistance is below standard, will fail to reach the rallying point, will afford a fertile field for germ invasion, and will develop tuberculosis,—not directly, however, as a result of having had a tubercular mother, but because he was not removed from the tubercular environment and given a fair chance. The high infant mortality is, to a very large extent, caused directly by this "tendency to disease," plus unfavorable environment, and this is wherein the eugenic propaganda has found its field of promise and is unassailable reason for active existence.
Let us take another illustration, so that mother may have a full understanding of the far-reaching effect of the "tendency to disease."
We cannot justly assume a child to have outlived its hereditary tendencies until it has reached the period of its full growth, physically, mentally, and morally. We know that this period is about the twenty-third year. Now a young girl of eighteen, or even twenty, who is successfully resisting an inherited tendency, is likely to reach her full physical and mental growth, providing she does not subject her vitality to a serious physical strain, or providing she is not the victim of a serious illness. Suppose this young girl marries and becomes pregnant; this condition immediately changes the fighting or resisting equation; she is no longer conserving her strength and energy; she is spending it out, wasting it so far as it applies to her own upbuilding. The percentage in favor of a successful fight against the inherited tendencies is greatly reduced, and as a matter of fact, statistics show—as is fully explained in the article on "The Evils of Early Marriage"—that many of these young mothers succumb to disease as a result of pregnancies at this period of immaturity, when they could have otherwise lived. The "tendency to disease" has therefore an economic value and the state should build along the line of the conservation of health in its broadest sense.
The Best Treatment for Tuberculosis.—The most important factor in the present-day treatment of consumption is the right kind of nourishment. This cannot be emphasized too strongly. In the first edition of this work, it was stated that the most important factor in the treatment of this disease was fresh air. The author has had very good reasons to change his opinion radically in this respect.
So emphatically may this truth be asserted that it is now not at all necessary to seek a change of climate in the hope that such a change may aid the patient. It must not, however, be understood that this reasoning applies to charitable cases. If the patient is so situated that it is not possible to provide a proper environment, a change may do good. It is not the change of air that is responsible for the improvement, however, though it no doubt contributes in these cases; it is the altered environment.
Patients who in their own homes enjoy sanitary and hygienic care; who may have a room of ample size for their exclusive use, which is thoroughly aired, day and night; who are provided with the "right kind of nourishment," and who will obey implicitly the rules which the physician, who is conversant with this particular method of treatment, will lay down, may be assured that a prompt response will ensue. The intelligent reader will understand that this statement does not apply to patients in the last stages of the disease. The assertion, however, must rightly be regarded as revolutionary. It is not what we were taught—it emphasizes, nevertheless, what every physician already knows, that, theoretically, consumption is a disease that should respond to treatment. That we have not had greater success with it in the past, must be attributed to our method of treatment. The fact that most of us have had the disease, and have recovered, conclusively demonstrates its curability. Those individuals who fail to recover promptly do not possess the vitality to throw it off spontaneously. If at this time—the real beginning of the disease—it is discovered, and the right treatment instituted, we immediately supply the organism with the ingredients it is deficient in and we are justified in looking for favorable results if the patient adheres to the instructions.
The second essential in the treatment of consumption is an abundance of fresh, pure air. We therefore direct the patient to remain in the open as much as is possible. If circumstances permit him to sleep out-of-doors, so much the better; if not, he must sleep in a room with the windows open to the fullest extent, winter and summer. There are no exceptions to this rule. If it storms, the outside blinds may be closed, but the windows must remain open. The city air is just as efficient for our purpose as is the air of any other vicinity—the point is, to get enough of it from a mechanical standpoint. The advantages from sending patients away, even under the old belief, were more than discounted by conditions incident to the new environment that were detrimental to their progress. Now that we know it is not necessary or essential to procure any other kind or quality of air than exists in any city, all our efforts may be concentrated in the interest of the patient in directing the "right kind of nourishment" and in supervising his conduct. In few instances is it necessary to prescribe any medicine.
In exceptional cases the cough may require some sedative remedy, especially if it disturbs the patient at night. Experience has taught us, however, that to live twelve hours in the open air and to sleep with the windows wide open, will do more for the cough than any medicine we possess.
Pleuritic complications may cause pain, but this feature is best aided and permanently relieved by fresh air also. Very recently there were made exhaustive experiments in this connection in St. Thomas' Hospital, London, England. It was decided to subject patients to open-air tests for pleuritic pains in the course of consumption. This particular hospital is situated on the River Thames, in a notoriously damp and foggy part of the city; despite this drawback it was conclusively shown that the patients who lived night and day on the balconies breathing this heavy, murky, damp atmosphere, were relieved of their pains quicker, and more permanently, than those who were shielded in the wards of the hospital.