Preventable Diseases

by Woods Hutchinson

It seems incredible now, but such was the light in which smallpox was regarded by physicians of the Arabian and mediæval schools: a natural oozing forth of "peccant humors" in the blood of the young, a disagreeable, but perfectly natural, and even necessary, process. For if the patient did not get rid of these humors either he would die or his growth would be seriously impaired. Now smallpox has become little more than a memory in civilization, and consumption is due to follow its example.

Sanitary pioneers had already begun casting about eagerly for light upon the influence of housing, of drainage, of food, in the causation of tuberculosis, when a new and powerful weapon was suddenly placed in their hands by the infant science of bacteriology. This was the now world-famous discovery by Robert Koch that consumption and other forms of tuberculosis were due to the attack of a definite bacillus. No tubercle bacillus—no consumption.

At first sight this discovery appeared to be anything but encouraging. In fact, it seemed to make the situation and the outlook even more hopeless. And when within a few years it was further demonstrated in rapid succession that most of the diseases of the spine in children, of the group of symptoms associated with enlarged glands or kernels in the neck and known as "scrofula" or struma, most cases of hip-joint disease, of white swelling of the knee, a large percentage of chronic ulcerations of the skin known as lupus, a common form of fatal bowel disease in children, and many instances of peritonitis in adults, together with fully half of the fatal cases of convulsions in children, were due to the activity of this same ubiquitous bacillus, it looked as if the enemy were hopelessly entrenched against attack. And when it was further found that a similar bacillus was almost as common a cause of death and disease in cattle, particularly dairy cattle, and another in domestic fowls, it looked as if the heavens above and the earth beneath were so thickly strewn and so hopelessly infested with the germs that to war against them, or hope to escape from them, was like fighting back the Atlantic tides with a broom.

But this chill of discouragement quickly passed. Our foe had come down out of the clouds, and was spread out in battle array before us, in plain sight on the level earth. We were ready for the conflict, and proposed to "fight it out on this line if it takes all summer." It was not long before we began to see joints in the enemy's armor and weaknesses in his positions. Then, when we lowered our field-glasses and turned to count our forces and prepare for the defense, we discovered with a shock of delighted relief that whole regiments of unexpected reinforcements had come up while we were studying the enemy's position. These new allies of ours were three of the great, silent forces of nature, which had fallen into line on either side and behind us, without hurry and without excitement, without even a bugle-blast to announce their coming.

The first was the great resisting power and vigor of the human organism, which we had gravely underestimated. The second, that power of adaptation to new circumstances, including even the attack of infectious diseases, which we call "survival of the fittest." The third, that great, sustaining, conservative power of nature—heredity. More cheering yet, these forces came, not merely fully armed, but bearing new weapons fitted for our hands. The vigor and unconquerable toughness of the human animal presented us with three glittering weapons, sunshine, food, and fresh air.

"If the deadly bacillus breaks through the lines, put me in the gap! With these weapons, with this triad, I will engage to hurl him back, shattered and broken." "Equip your vanguard with them, and the enemy will never break the line."

The survival of the fittest held out to us two weapons of strange and curious make, one of them labeled "immunity," the other "quarantine." "Give me a little time," she said, "and with the first of these I will make seven-tenths of the soldiers in your army proof against the spears of the enemy, as Achilles was when dipped in the Styx. With the other, surround and isolate every roving band of the enemy that you can find; drive him out of the holes and caves in which he lives, into the sunlight. Hold him in the open for forty-eight hours, and he will die of light-stroke and starvation. Divide and conquer!"

These reinforcements of ours have proved no mere figure of speech. They have won many a battle for us already upon the tented field. They have not merely made good their promises, but gone beyond them, and we are only just beginning to appreciate their true worth, and how absolutely we can rely upon them.

The first outpost of the enemy was captured with the sunshine-food-air weapons, and a glorious victory it was,—great in itself, and even more important for its moral effect and its encouragement for the future. To pronounce an illness "consumption" had been from time immemorial equivalent to signing a death-warrant. Even the doctors could hardly believe it, when the first open-air enthusiasts began to claim that they had actually cured cases of genuine consumption. For long there was a tendency to mutter in the beard, "Well, it wasn't genuine consumption, or it wouldn't have got better."

But after a period of incredulity this gave way to delighted confidence. The open-air method would cure, and did cure, and the patients remained cured for years afterward. Our first claims were barely for twenty-five or thirty per cent of the threatened victims. Then we were able to increase it to fifty per cent; sixty, seventy, and finally eighty were successively reached. But with the increase of our power over the cure of this disease came a realization of our knowledge of its limitations. It quickly proved itself to be no sovereign and universal panacea, which would cure all cases, however desperate, or however indiscriminately it was applied. And emphatically it had to be mixed with brains, on the part both of the physician and of the patient.