Preventable Diseases

by Woods Hutchinson

Practically all that is needed to break this link is the absolute suppression of what is universally and overwhelmingly regarded as not merely an unsanitary and indecent, but a filthy, vulgar, and disgusting habit—promiscuous expectoration. There is nothing new or unnatural in this repression, this tabu on expectoration. In fact, we are already provided with an instinct to back it. In every race, in every age, in every grade of civilization, the human saliva has been regarded as the most disgusting, the most dangerous and repulsive of substances, and the act of spitting as the last and deepest sign of contempt and hatred; and if directed toward an individual, the deadliest and most unbearable insult, which can be wiped out only by blood. Primitive literature and legend are full of stories of the poisonousness of human saliva and the deadliness of the human bite. It was the "bugs" in it that did it. It is most interesting to see how science has finally, thousands of years afterward, shown the substantial basis of, and gone far to justify, this instinctive horror and loathing.

Not merely are the fluids of the human mouth liable to contain the tubercle bacillus, and that of diphtheria, of pneumonia, and half a dozen other definite disorders, but they are in perfectly healthy individuals, especially where the teeth are in poor condition, simply swarming with millions of bacteria of every sort, some of them harmless, others capable of setting up various forms of suppuration and septic inflammation if introduced into a wound, or even if taken into the stomach. Even if there were no such disease as tuberculosis a campaign to stamp out promiscuous expectoration would be well worth all it cost.

Of course, as a counsel of perfection, the ideal procedure would be promptly to remove each consumptive, as soon as discovered, from his house and place him in a public sanatorium, provided by the state, for the sake of removing him from the conditions which have produced his disease, of placing him under those conditions which alone can offer a hopeful prospect of cure, and of preventing the further infection of his surroundings. The only valid objections to such a plan are those of the expense, which, of course, would be very great. It would be not merely best, but kindest, for the consumptive himself, for his immediate family, and for the community. And enormous as the expense would be, when we have become properly aroused and awake to the huge and almost incredible burden which this disease, with its one hundred and fifty thousand deaths a year, is now imposing upon the United States,—five times as great as that of war or standing army in the most military-mad state in Christendom,—the community will ultimately assume this expense. So long, however, as our motto inclines to remain, "Millions for cure, but not one cent for prevention," we shall dodge this issue.

There can be no question but that each state and each municipality of more than ten thousand inhabitants ought to provide an open-air camp or colony of sufficient capacity to receive all those who are willing to take the cure but unable to meet the expense of a private institution; and, also, some institution of adequate size, to which could be sent, by process of law, all those consumptives who, either through perversity, or the weakness and wretchedness due to their disease, or the apathy of approaching dissolution, fail or are unable to take proper precautions.

When we remember that the careful investigations of the various dispensaries for the treatment of tuberculosis in our larger cities, New York, Boston, Cleveland, report that on an average twenty to thirty per cent of all children living in the same room or apartment with a consumptive member of their family are found to show some form of tuberculosis, it will be seen how well worth while, from every point of view, this provision for the removal and sanatorium treatment of the poorer class of these unfortunates would be. These dispensaries now have, as a most important part of their campaign against the disease, one or more visiting nurses, who, whenever a patient with tuberculosis is brought into the dispensary, visit him in his home, show him how to ventilate and light his rooms as well as may be, give practical demonstrations of the methods of preventing the spread of the disease, advise him as to his food, and see that he is supplied with adequate amounts of milk and eggs, and, finally, round up all the children of the family and any adults who are in a suspicious condition of health, and bring them to the dispensary for examination. Distressing as are these findings, reaching in some cases as high as fifty and sixty per cent of the children, they have already saved hundreds of children, and prevented hundreds of others from growing up crippled or handicapped.

It must be remembered that the tubercle bacillus causes not merely disease of the lungs in children but also a large majority of the crippling diseases of the bones, joints, and spine, together with the whole group of strumous or scrofulous disorders, and a large group of intestinal diseases and of brain lesions, resulting in convulsions, paralysis, hydrocephalus, and death. The battle-ground of the future against tuberculosis is the home.

We speak of the churchyard as "haunted," and we recoil in horror from the leper-house or the cholera-camp. Yet the deadliest known hotbed of horrors, the spawning ground of more deaths than cholera, smallpox, yellow fever, and the bubonic plague combined, is the dirty floor of the dark, unventilated living-room, whether in city tenement or village cottage, where children crawl and their elders spit.

It is scarcely to the credit of our species that for convincing, actual demonstrations of what can be done toward stamping out tuberculosis, by measures directed against the bacillus alone, we are obliged to turn to the lower animals. By a humiliating paradox we are never quite able to put ourselves under those conditions which we know to be ideal from a sanitary point of view. There are too many prejudices, too many vested interests, too many considerations of expense to be reckoned with. But with the lower animals that come under our care we have a clear field, free from obstruction by either our own prejudices or those of others. In this realm the stamping out of tuberculosis is not merely a rosy dream of the future but an accomplished fact, in some quarters even an old story. Two illustrations will suffice, one among domestic animals, the other among wild animals in captivity. The first is among pure-bred dairy cattle, the pedigreed Jerseys and Holsteins. No sooner did the discovery of the bacillus provide us with a means of identification, than the well-known "perlsucht" of the Germans, or "grapes" of the English veterinarians—both names being derived from the curious rounded masses or nodules of exudate found in the pleural cavity and the peritoneum (around the lungs and the bowels), and supposed to resemble pearls and grapes respectively—were identified as tuberculosis, and cows were found very widely infected with it. This unfortunately still remains the case with the large mass of dairy cattle. But certain of the more intelligent breeders owning valuable cattle proceeded to take steps to protect them.

The first step was to test their cows with tuberculin, promptly weeding out and isolating all those that reacted to the disease. It was at first thought necessary to slaughter all these at once. But it was later found that, if they were completely isolated and prevented from communicating the disease to others, this extreme measure was necessary only with those extensively diseased. The others could be kept alive, and if their calves were promptly removed as soon as born, and fed only upon sterilized or perfectly healthy milk, they would be free from the disease. And thus the breeding-life of a particularly valuable and high-bred animal might be prolonged for a number of years. They must, however, be kept in separate buildings and fields, and preferably upon a separate farm from the rest of the herd.

Those cows found healthy were given the best of care, including a marked diminution of the amount of housing or confinement in barns, and were again tested at intervals of six months, several times, to weed out any others which might still have the infection in their systems. In a short time all signs of the disease disappeared, and no other cases developed in these herds unless fresh infection was introduced from without. To guard against this, each farm established a quarantine station, where all new-bought animals, after having been tested with tuberculin and shown to be free from reaction, are kept for a period of at least a year, for careful observation and study, before being allowed to mix with the rest of the herd. It is now a common requirement among intelligent breeders of pedigreed cattle to demand, as a formal condition of sale, their submission to the tuberculin test, or the certificate of a competent veterinarian that the animal has been so tested without reacting. Protected herds have now been in existence under these conditions, notably in Denmark, where the method was first reduced to a system under the able leadership of Professor Bang, of Copenhagen, for ten years with scarcely a single case of tuberculosis developing. Only a fraction of one per cent of calves from the most diseased mothers are born diseased.