Fortunately, just the reverse is the case, and there are few conditions affecting the child, so common and such a fertile source of all kinds of mischief, and at the same time so completely curable, and whose cure will be attended by such gratifying improvement on the part of the little sufferer. In the first place, as has been said, their formation may usually be prevented altogether by intelligent and up-to-date hygienic care of the nose and the throat. In the second place, even after they have occurred and developed to a considerable degree, they can be removed by a trifling and almost painless operation, and, if taken early enough, all their injurious effects overcome. If, however, they have been neglected too long, so that the child has passed the eighth or ninth year before any interference has been attempted, and still more, of course, if it has passed the twelfth or thirteenth year, then only a part of the disturbances that have been caused can be remedied by their removal. So soft and pulpy are these growths, so poorly supplied with blood-vessels or nerves, and so slightly connected with the healthy tissues below them, that they may, in skilled hands, be completely removed by simply scraping with a dull surgical spoon (curette) or curved forceps, but never anything more knife-like than this. In fact, in the first seven years of life, when their removal is both easiest and will do most good, it is hardly proper to dignify the procedure by the name of an operation. It is attended by about the same degree of risk and of hemorrhage as the extraction of a tooth, and by less than half the amount of pain.
But, trifling and free from danger as is the operation, there is nothing in the entire realm of surgery which is followed by more brilliant and gratifying results. It seems almost incredible until one has seen it in half a dozen successive cases. Not merely doctors, but teachers and nurses, develop a positive enthusiasm for it. This was the operation that led to the comical, but pathetic, "Mothers' Riots" in the New York schools. The word went forth, "The Krishts are cutting the throats of your children"; and, with the shameful echoes of Kishineff ringing in their ears, the Yiddish mothers swarmed forth to battle for the lives of their offspring.
It is no uncommon thing to have a child of seven jump three to five inches in height, six to twelve pounds in weight, and one to three grades in his schooling, within the year following the operation. Ten years more of intelligence and hygienic teaching should see this scourge of childhood completely wiped out, or at least robbed of its possibilities for harm. When this is done, at least two-thirds of all cases of deafness, more than half of all cases of arrested development, and three-fourths of those of backwardness in children will disappear.
CHAPTER VI
TUBERCULOSIS, A SCOTCHED SNAKE
I
One of the darling habits of humanity is to discover that we are facing a crisis. One could safely offer a large prize for a group of ten commencement orations, or political platforms, at least a third of which did not announce this momentous fact. Either we are facing it or it confronts us, and unutterable things will happen unless we "gird up our loins," and vote the right ticket. An interesting feature about these loudly heralded crises is that they hardly ever "crise." The real crisis either strikes us so hard that we never know what hit us, or is over before we recognize that anything was going to happen. And most of our reflections about it are after ones—trying to explain what caused it. In fact, in public affairs, as in medicine, a crisis is a sign of recovery. Its occurrence is an indication that nature is preparing to throw off the disease. Nowhere is this truth more vividly illustrated than in the tuberculosis situation. When, about thirty years ago, the world began to awake from its stupor of centuries, and to realize that this one great disease alone was killing one-seventh of all people born under civilization, and crippling as many more; that its killed and wounded every year cast in the shade the bloodiest wars ever waged, and that it was apparently caused by the civilization which it ravaged,—no wonder that we were appalled at the outlook.
Here was a disease of civilization, caused by the conditions of that civilization. Could it be cured without destroying its cause and reverting to barbarism? Yet this very apprehension was a sign of hope, a promise of improvement. That we were able to feel it was a sign that we were shaking off the old fatalistic attitude toward disease,—as inevitable or an act of Providence. It was brought about by the more accurate and systematic study of disease. We had long been sadly familiar with the fact that death by consumption, by "slow decline," by "wasting" or "slow fever," was frightfully common. "To fall into a decline" and die was one of the standard commonplaces of romantic literature. But that was quite different from knowing in cold, hard figures and inescapable percentages exactly how many of the race were killed by it. It is one of the striking illustrations of the advantages of good bookkeeping. Boards and departments of health had just fairly got on their feet and started an accurate system of state accounts in matters of deaths and births. We were beginning to recognize national health as an asset, and to scrutinize its fluctuations with keen interest accordingly.
We may decry statistics as much as we like, but when we see the effects of a disease set down in cold columns of black and white we have no longer any idea of submitting to it as inevitable. We are going to get right up and do some fighting. "One-seventh of all the deaths" has literally become the war cry of our new Holy War against tuberculosis. Still another stirring phrase of inestimable value in rousing us from our torpor was that coined by the brilliant and lovable physician-philosopher, Oliver Wendell Holmes: "The Great White Plague of the North." This vivid epithet, abused as it may have been in later years, was of enormous service in fixing the public mind on consumption as a definite, individual disease, something to be fought and guarded against. Before that, we had been inclined to look upon it as just a natural failing of the vital forces, a thing that came from within, and was in no sense caused from without. The fair young girl, or the delicate boy whose vitality was hardly sufficient to carry him through the stern battle of life, under some slight shock, or even mental disappointment, would sink into a decline, gradually waste away, and die. What could be done in such a case, except to bow in submission to the inscrutable ways of Providence?