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PROPHYLAXIS OF TUBERCULOSIS, FROM THE
STANDPOINT OF THE PHYSICIAN. *

BY J. A. WITHERSPOON, M. D., NASHVILLE.

Mr. President, Ladies and Gentlemen, Fellow Members: The subject for this evening is one of the most important which could be brought before a medical body or before the American people, from the simple fact that it is the most widely spread disease in the world. It is a disease that strikes at the very foundation of any people's prosperity, from the simple fact that it has a peculiar tendency to attack the young. The idea of your committee in preparing for this meeting was an effort to educate the people.

First article of a Symposium held at 72nd Annual Meeting of the Tennessee State Medical Association.

In the first place, I shall try as well as I can in the few moments at my disposal to outline the changed opinion in regard to tubercular troubles. The old idea was that tuberculosis was a necessity; that it was one of those diseases which came down to us by hereditary transmission: that a child born of tubercular parentage could not live, but gradually would shift on down the road of life until he met the end, and that end was tuberculosis. Those of us in the medical profession know that that idea was entirely erroneous. In other words, we know that no man and no woman transmits tubercular infection to the offspring; not one time in thousands of instances does this occur. Now, then, what do we know about it?

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Since Koch's immortal discovery of the great cause of this great white plague," a disease that has decimated thousands, a disease that numbers its victims in much greater numbers than the combined armies of the world ever claimed - when he discovered that that little germ was the actual cause of this trouble, studied its life history, studied methods by which it gained entrance into the body, and studied how it was transmitted from one person to another, in my opinion he bestowed upon the people of the world the greatest discovery since the time of Jenner's immortal discovery of vaccination. What did he teach us? He taught us that a little child, born of tubercular parentage, under proper conditions of sanitation, under proper development by proper hygienic surroundings, under intelligent guidance, could grow and develop into mature manhood or womanhood, live and be a useful citizen, without having this withering blight forever hanging over it. What could be a greater boon to humanity?

We are not here simply for the purpose of curing disease: but the great function of the medical man to-day is to prevent disease, and the sooner we do that, the sooner we will become true benefactors of our race. The longer man practices medicine, if he is an intelligent, careful man, the more he learns that the objects and powers of medicine are very limited in their application; but that when we come to prevent disease, and especially a disease like tuberculosis, then we have no limitation whatever.

I say to you, brother practitioners, in all honesty, that while no man recognizes and honors more than I the wonderful strides that have been made in surgery in the last few years, from the time when Lister first brought out the grand theory of antisepsis, followed by asepsis, the wonderful life-saving methods of skilful surgeons should command the admiration of the world; but it pales into insignificance when we think for a moment what it means to the world to say to them: We have found methods and means by which you do not contract certain diseases requiring the treatment of either the physician or the operation of the surgeon; in other words, prevention is the great battle-cry of progress in medical circles to-day.

How do we hope to prevent tuberculosis? Gentlemen, if we know anything, we know that pulmonary tuberculosis is a disease that never occurs except when directly transmitted from one case to another. We know that every man and every woman and every child that contracts it does it just as surely from another case as a child contracts measles from another case. If we know that, if we know how it is contracted (and I am not trying to deliver a scientific discourse, but am appealing to our side of duty in this line,) - if we know it is caused by infection, as, for instance, the sputum of the tuberculous patient that is allowed to dry and is blown about in the atmosphere, taken into the lungs of healthy persons or those in a weakened or debilitated condition, then we know the best thing to do is to stop that infection when it comes from the lips of the suffering host. If this is true, which we can say to a certainty, then we can at least do something to modify this great scourge of humanity.

How often have we seen a strong, healthy, robust girl, from perfectly healthy parentage, marry some man who had already possibly the infection of this disease in his lungs? How often have we seen a woman month after month discharging her duties as a wife, hanging over a pale and emaciated subject gradually coughing his life away, with sunken cheeks, dilated pupils, standing hour after hour and doing her duty; yet in a comparatively short space of time, unless great care and caution are taken, we notice the flush fade from her cheeks, and gradually a little wasting of

the plump human form. We notice an anemic condition of the lips, a hacking cough, a little incurving of the nails, a slight rise of temperature in the evening, a vivacity that is not natural, and pretty soon she goes as a victim, in my opinion, of neglect on the part of the medical profession. [Applause.] It is our duty

to save such cases as that.

It is not my object to-night to speak of great social problems, as to whether a tuberculous patient should marry or not. I know it is not right. But these are questions beyond us. I do know. as well as I know that I am living, that we have a popular opinion in our favor if we can educate the people regarding their own dangers; if we can let every man, woman, and child know that it is a home-bred disease; that it is an infection which comes directly into the home; that the specific poison can be destroyed; that it will not be disseminated, if destroyed properly, then I say to you, gentlemen, you will find that the politicians of the country who may not listen to what the doctor says, and rarely do what he says so far as carrying out the will of the people, let him be a Senator or Congressman or even a politician in your wards, the voice of the public is truly the voice of his political God. When you educate the people to say, "We have suffered long enough from the dissemination of this disease, this terrific poisoning in our midst, and we demand proper laws, we demand their enforcement," then you will find it will not be difficult to lower the wonderful mortality rate of this disease.

Let us take New York City as an example. Several years ago, when Herman Biggs started there, the mortality of that city from tuberculosis was terrific, and yet under his campaign the mortality dropped to over three quarters of what it was. Why? - Because he inaugurated the system of education by house-tohouse inspection, the report of all tubercular cases, etc., until to-day he has lowered that mortality rate, and New York City has passed laws giving a large amount of money for the building of institutions to take care of these unfortunate victims.

Gentlemen, do you have any idea what percentage of bodies undergoing post-mortem examinations show that they were infected with tuberculosis? Do you know that ten or fifteen per

cent. of the deaths of the country are from tuberculosis; yet experienced observers report finding this disease in sixty per cent. of all post-mortem examinations, whether this disease was the means of destroying life or not? If the disease is so widely prevalent as this, it is time for the medical profession to start to educate the public as to that danger. If you let smallpox break out, or if you let yellow fever break out, even if there be only one case in the community of either disease, it is enough to paralyze business and stop the wheels of commerce. This is especially true of yellow fever. Everybody hurries away, lest the terrific yellow peril should overtake them. Great councils are called together and laws are enforced to the point of shotgun quarantine: yet yellow fever is a mere bagatelle, in that it does not kill one hundred thousandth part as many people as does tuberculosis, a disease that it is our duty to prevent.

I do not wish to consume too much time, but my heart is in this subject. I know of homes in this city and all over this State where this disease is hovering like a withering blight. I know of communities, one in particular, within fifteen miles of Nashville, where I never call without looking for tuberculosis, simply because it is a hotbed of infection. If this is true, what can be done?

I read a paper on this subject before the Nashville Academy of Medicine in which I presented my views, and I shall in a few words outline what I firmly believe, that it is time the medical profession should wake up to their duties to the people; that the medical profession are the natural protectors and guardians of the health of the community in which they live, and if they are not, if a medical man lives in a community where he has not enough influence to be a guardian of the health of that community, I want to say to you he ought to move out of it, or the community ought to move away from him. Let his light be such that it stands out like a beacon-light on all subjects, and let him be careful that his advice is for the protection of suffering humanity.

How are we to do this? I do not think we can do it without systematic education of public opinion, because it must be done