But a marked and cheering change has come over our attitude to this wing of the battle of life. So far from regarding it as in any sense necessary to revert to barbarism, still less to savagery, for either the prevention or the cure of disease, we have discovered by the most convincing, practical experience, that we can, in the first place, with the assistance of the locomotive and trolley, combined with modern building skill and sanitary knowledge, put even our city-dwellers under conditions, in both home and workshop, which will render them far less likely to contract tuberculosis than if they were in a peasant's cottage or the average farmhouse or merchant's house of a hundred years ago, to say nothing of the cave, the dugout, or the hut of the savage.
In the second place, instead of simply "going back to nature" and living in brush-shelters on what we can catch or shoot, it takes all the resources of civilization to place our open-air patients in the ideal conditions for their recovery. Let any consumptive be reckless enough to "go back to nature," unencircled by the strong arm of civilized intelligence and power, and unprotected by her sanitary shield, and nature will kill him three times out of five. There could not be a more dangerous delusion than the all-too-common one—that all that is necessary for the cure of consumption is to turn the victim loose among the elements, even in the mildest and most favorable of climates.
He must be fed upon the most abundant and nutritious of foods, even the simplest being milk of a richness which is given by no kind of wild cattle, and which, indeed, only the most carefully bred and highly civilized strains of domestic cattle are capable of producing; eggs such as are laid by no wild bird or by any but the most highly specialized of domestic poultry at the season of the year when they are most required; steaks and chops, hams and sides of bacon, sugar and fruits and nuts, which simply are not produced anywhere outside of civilization, and often only in the most intelligent and progressive sections of civilized communities.
Put him upon even the average diet of many people in this progressive and highly civilized United States the year round,—with its thin milk, its pulpy, half-sour butter, its tough meat, its half-rancid pickled pork, its short three months of really fresh vegetables and good fruit, and six months of eternal cabbage, potatoes, dried apples, and prunes,—and he will fail to build up the vigor necessary to fight the disease, even in the purest and best of air.
The saddest and most pitiful tragedies which the consumptive health-resort physician can relate are those of wretched sufferers,—even in a comparatively early stage of the disease,—whose misguided but well-meaning friends have raised money enough to pay their fare out to Colorado, California, Arizona, or New Mexico, and expect them to get work on a ranch, so as to earn their living and take the open-air treatment at the same time.
Three things are absolutely necessary for a reasonable prospect of cure of consumption. One is, abundance of fresh air, day and night. Another, abundance of the best quality of food. And the third, absolute—indeed, enforced—rest during the period of fever. Let any one of these be lacking, and your patient will die just as certainly as if all three were. Not one in five of those who go out to climates with even a high reputation as health-resorts—expecting to earn their own living or to "rough it" in shacks or tents on three or four dollars a week, doing their own cooking and taking care of themselves—recovers. They have a four-to-one chance of recovery in any climate in which they can obtain these three simple requisites, and a four-to-one chance of dying in any climate in which any one of these is lacking.
Instead of nature being able to cure the consumptive unaided, as a matter of fact she has neither the ability nor the inclination to do anything of the sort. There is no class of patients whose recovery depends more absolutely upon a most careful and intelligent study and regulation of their diet, of every detail of their life throughout the entire twenty-four hours, and of the most careful adjustment of air, food, heat, cold, clothing, exercise, recreation, by the combined forces of sanitarian, nurse, and physician. So that, instead of feeling that only by reverting to savagery can consumption be prevented, we have no hesitation in saying that it is only under civilization, and civilization of the highest type, that we have any reasonable prospect of cure.
Finally, we are getting over our misgivings as to the intentions of the hereditary brigade. It is certainly not our enemy, and may probably turn out to be one of our best friends.
Our first sidelight on this question came in rather a surprising manner. It was taken for granted, almost as axiomatic, that if the conditions of savage life were such as to discourage, if not prevent, tuberculosis, certainly, then, the race which had been exposed to these conditions for countless generations would have a high degree of resisting power to the disease. But what an awakening was in store for us! No sooner did the army surgeon and medical missionary settle down in the wake of that extraordinary world-movement of Teutonic unrest, which has resulted in the colonization of half the globe within the past two or three hundred years, than it was discovered that, although the hunting or nomad savage had not developed tuberculosis, and the disease was emphatically born of civilization, yet the moment that these healthy and vigorous children of nature were exposed to its infection, instead of showing the high degree of resisting power that might be expected, they died before it like sheep.
From all over the world—from the Indians of our Western plains, the negroes of our Southern States, the islanders of Polynesia, New Zealand, Hawaii, Samoa—came reports of tribes practically wiped out of existence by the "White Plague" of civilization. To-day the death-rate from tuberculosis among our Indian wards is from three to six times that of the surrounding white populations. The negro population of the Southern States has nearly three times the death-rate of the white populations of the same states. Instead of centuries of civilization having made us more susceptible to the disease than those savages who probably most nearly parallel our ancestral conditions of a thousand to fifteen hundred years ago, we seem to have acquired from three to five times their resisting power against it. Not only this, but those races among us which have been continuous city-dwellers for a score of generations past have acquired a still higher degree of immunity.