Preventable Diseases

by Woods Hutchinson

In the first place, the likelihood of a cure depended, with almost mathematical certainty, upon the earliness of the stage at which it was begun. Eight or ten years ago the outlook crystallized itself into the form which it has practically retained since: of cases put under treatment in the very early stage, from seventy to ninety per cent were practical cures; of ordinary so-called "first-stage" cases, sixty to seventy per cent; second-stage cases, or those in whom the disease was well developed, thirty to sixty per cent; and well-advanced cases, fifteen to thirty per cent of apparent cures. The crux of the whole proposition lies in the early recognition of the disease by the physician, and the prompt acceptance of the diagnosis by the patient, and his willingness to drop everything and fight intelligently and vigorously for his life. Physicians are now thoroughly awake on this point, and are concentrating their most careful attention and study upon methods of recognition at the earliest possible stages. At the same time those magnificent associations for the study and prevention of tuberculosis, international, national, state, and local,—the greatest of which, the International Tuberculosis Congress, has just honored America, by meeting in Washington,—are straining every nerve to educate the public to understand the importance of recognizing the earliest possible symptoms of this disease, no matter how trivial they may appear, and making every other consideration bend to the fight.

This new Word of Power, the open-air treatment, alone has transformed one of the most hopeless, most pathetic, and painful fields of disease into one of the most cheerful and hopeful. The vantage-ground won is something enormous. No longer need the family physician hang back, in dread and horror, from allowing himself even to recognize that the slow loss of weight, the increasing weakness, the flushed evening cheek, and the restless sleep, are signs of this dread malady. Instead of shrinking from pronouncing the patient's doom, he knows now that he has everything to gain and nothing to lose by promptly warning him of his danger, even while it is still problematical. On the other hand, the patient need no longer recoil in horror when told that he has consumption, and either go home to set his house in order and make his will, or hunt up another medical adviser who will take a more cheerful view of his case. All that he has to do is to turn and fight the disease vigorously, intelligently, persistently, with the certain knowledge that the chances are five to one in his favor; and that's a good fighting chance for any one.

Even should there be reasonable ground for doubt as to the positive nature of the disease, he has nothing to lose and everything to gain by taking the steps required to cure it. There is nothing magical or irrational, least of all injurious, in any way about them. Simply rest, abundant feeding, and plenty of fresh air. Even if the bacillus has not yet lodged in his tissues, this treatment will relieve the conditions of depression from which he is suffering, and which would sooner or later render him a favorable lodging-place for this omnipresent, tiny enemy.

If he has the disease the treatment will cure it. If he hasn't got it, it will prevent it; and the gain in vigor, weight, and general efficiency will more than pay him for the time lost from his business or his study. It always pays to take time to put yourself back into a condition of good health and highest efficiency.

It was early recognized that the campaign could not be won with this weapon alone. Inexpressibly valuable and cheering as it was, it had obvious limitations. The first of these was the obvious reflection that it was idle to cure even eighty per cent of all who actually developed tuberculosis, unless something were done to stop the disease from developing at all. "Eighty per cent of cures," of course, sounds very encouraging, especially by contrast with the almost unbroken succession of deaths before. But even a twenty per cent mortality from such a common disease, if it were to proceed unchecked, would make enormous inroads every year upon our national vigor.

Secondly, it was quickly seen that those who recovered from the disease still bore the scars; that while they might recover a fair degree of health and vigor, yet they were always handicapped by the time lost and the damage inflicted by this slow and obstinate malady; that many of them, while able to preserve good health under ideal conditions, were markedly and often distressingly limited in the range of their business activities for years after, and even for life. Finally, that as these cases were followed further and further, it was found that even after becoming cured they were sadly liable to relapse under some unexpected strain, or to slacken their vigilance and drop back into their former bad physical habits; while the conviction began to grow steadily upon men who had devoted one, two, or more decades to the study of this disease in the localities most resorted to for its cure, that the general vigor and vitality of these cured consumptives were apt to be not of the best; that their duration of life was not equal to the average; and that, even if they escaped a return of the disease, they were apt to go down before their normal time under the attack of some other malady. In short, cure was a poor weapon against the disease as compared with prevention.

But before this, a careful study of the enemy's position and investigation of our own resources had brought another most important and reassuring fact to light, and that is, that while a distressingly large number of persons died of tuberculosis, these represented only a comparatively small percentage of all who had actually been attacked by the disease. One of the reasons why consumption had come to be regarded as such a deadly disease was that the milder cases of it were never recognized. It was, and is yet, a common phrase in the mouths of both the laity and of the medical profession: "He was seriously threatened with consumption"; "She came very near falling into a decline,"—but they recovered. If they didn't die of it, it wasn't "real" tuberculosis. Now we have changed all that, and have even begun to go to the opposite extreme, of declaring with the German experts, "Jeder Mann ist am ende ein bischen tuberkulöse." (Every one is some time or another a little bit tuberculous.) This sounds appalling at first hearing, but as a matter of fact it is immensely encouraging. Our first suspicion of it came from the records of that gruesome, but pricelessly valuable, treasure-house of solid facts in pathology—the post-mortem room, the dead-house. Systematic examinations of all the bodies brought to autopsy in our great hospitals and elsewhere revealed at first thirty, then, as the investigation became more minute and skillful, forty, sixty, seventy-five per cent of scars in the apices of the lungs, remains of healed cavities, infected glands, or other signs of an invasion by the tubercle bacillus. Of course, the skeptic challenged very properly at once:—

"But how do you know that these masses of chalky-material, these enlarged glands, are the result of tuberculosis? They may be due to some half-dozen other infections."

Almost before the question was asked a test was made by the troublesome but convincing method of cutting open these scars, dividing these enlarged glands, scraping materials out of their centre, and injecting them into guinea pigs. Result: from thirty to seventy per cent of the guinea pigs died of tuberculosis. In other cases it was not necessary to inoculate, as scrapings or sections from these scar-masses showed tubercle bacilli, clearly recognizable by their staining reaction.

Here, then, we have indisputable evidence of the fact that the tubercle bacillus may not only enter some of the openings of the body,—the nostrils, the mouth, the lungs,—but may actually form a lodgment and a growth-colony in the lungs themselves, and yet be completely defeated by the antitoxic powers of the blood and other tissues of the body, prevented from spreading throughout the rest of the lung, most of the invaders destroyed, and the crippled remnants imprisoned for life in the interior of a fibroid or chalky mass.