First, and most fundamental of all, came the consoling discovery that though there could be no consumption without the bacillus, not more than one individual in seven, of fair or average health, who was exposed to its attack in the form of a definite infection, succumbed to it; and that, as strongly suggested by the post-mortem findings already described, even those who developed a serious or fatal form of the disease had thrown off from five to fifteen previous milder or slighter infections. So that, to put it roughly, all that would be necessary practically to neutralize the injuriousness of the bacillus would be to prevent about one-twentieth of the exposures to its invasion which actually occurred. The other nineteen-twentieths would take care of themselves. The bacilli are not the only ones who can be numbered in their billions. If there are billions of them there are billions of us. We are not mere units—scarcely even individuals—except in a broad and figurative sense. We are confederacies of billions upon billions of little, living animalcules which we call cells. These cells of ours are no Sunday-school class. They are old and tough and cunning to a degree. They are war-worn veterans, carrying the scars of a score of victories written all over them. They are animals; bacteria, bacilli, micrococci, and all their tribe are vegetables. The daily business, the regular means of livelihood of the animal cell for fifteen millions of years past has been eating and digesting the vegetable. And all that our body-cells need is a little intelligent encouragement to continue this performance, even upon disease germs; so that we needn't be afraid of being stampeded by sudden attack.
The next cheering find was that the worst enemies of the bacillus were our best friends. Sunlight will kill them just as certainly as it will give us new life. The germs of tuberculosis will live for weeks and even months in dark, damp, unventilated quarters, just precisely such surroundings as are provided for them in the inside bedrooms of our tenements, and the dark, cellar-like rooms of many a peasant's cottage or farmhouse. In bright sunlight they will perish in from three to six hours; in bright daylight in less than half a day. This is one of the factors that helps to explain the apparent paradox, that the dust collected from the floors and walls of tents and cottages in which consumptives were treated was almost entirely free from tuberculous bacilli, while dust taken from the walls of tenement houses, the floors of street-cars, the walls of churches and theatres in New York City, was found to be simply alive with them. One of the most important elements in the value of sunlight in the treatment of consumption is its powerful germicidal effect.
CHAPTER VII
TUBERCULOSIS, A SCOTCHED SNAKE
II
Closely allied to the discovery that sunlight and fresh air are fatal to the microörganisms of tuberculosis came the consoling fact that these bacilli, though most horribly ubiquitous and apparently infesting both the heavens above and the earth beneath, had neither wings nor legs, and were absolutely incapable of propelling themselves a fraction of an inch. They do not move—they have to be carried. More than this, like all other disease-germs, while incredibly tiny and infinitesimal, they have a definite weight of their own, and are subject to the law of gravity. They do not flit about hither and thither in the atmosphere, thistledown fashion, but rapidly fall to the floor of whatever room or receptacle they may be thrown in. And the problem of their transference is not that of direct carrying from one victim to the next, but the intermediate one of infected materials, such as are usually associated with visible dust or dirt. In short, keep dust or dirt from the floor, out of our food, away from our fingers or clothing or anything that can be brought to or near the mouth, and you will practically have abolished the possibility of the transference of tuberculosis. The consumptive himself is not a direct source of danger. It is only his filthy or unsanitary surroundings. Put a consumptive, who is careful of his sputum and cleanly in his habits, in a well-lighted, well-ventilated room, or, better still, out of doors, and there will be exceedingly little danger of any other member of his family or of those in the house with him contracting the disease. Wherever there is dirt or dust there is danger, and there almost only. Thorough and effective house-reform—not merely in tenements, alas! but in myriads of private houses as well—would abolish two-thirds of the spread of tuberculosis.
It is not necessary to isolate every consumptive in order to stop the spread of the disease. All that is requisite is to prevent the bacilli in his sputum from reaching the floor or the walls, to have both the latter well lighted and aired, and, if possible, exposed to direct sunlight at some time during the day, and to see that dust from the floor is not raised in clouds by dry sweeping so as to be inhaled into the lungs or settle upon food, fingers, or clothing, and that children be not allowed to play upon such floors as may be even possibly contaminated. These precautions, combined with the five-to-one resisting power of the healthy human organism, will render the risk of transmission of the disease an exceedingly small one. To what infinitesimal proportions this risk can be reduced by intelligent and strict sanitation is illustrated by the fact, already alluded to, of the almost complete germ-freeness of the dust from walls and floors of sanitorium cottages, and by the even more convincing and conclusive practical result, that scarcely a single case is on record of the transmission of this disease to a nurse, a physician, or a servant, or other employee in an institution for its cure.
There is absolutely no rational basis for this panic-stricken dread of an intelligent, cleanly consumptive, or for the cruel tendency to make him an outcast and raise the cry of the leper against him: "Unclean! Unclean!"
It cannot be too strongly emphasized that consumption is transmitted by way of the floor; and if this relay-station be kept sterile there is little danger of its transmission by other means.