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methods. We no longer need a cure for that which has practically ceased to exist. Why can't we do the same with tuberculosis? We can. Why don't we?
Consumptives are being bred hourly, more rapidly than they can be cared for, much less cured, by any present arrangements of any kind whatsoever. Special hospitals and sanitaria can not be built fast enough to meet the essential requirements, now or for the future. Even were it possible to make the demand for hospitals equal to the supply of patients, the economic drain on the public purse could not long be borne. The load would prove greater than any community could sustain. For economic, as well as for practical sanitary reasons, we shall have to change the policies devised for the immediate future, and adopt instead some method of checking, at the very source, the increasing annual crop of consumptives. Those afflicted must, of course, be cared for: but an increase in the number of hospitals will not stamp out the disease. We reap what we sow; let us cease to sow the seeds of consumption, and there will be no harvest to store, in sickly human form, in the numerous and expensively projected, special hospitals. We must reconsider our plans, for they are built on sands, and devote more of our time and at
tention to stamping out the disease at its source, by methods that have hitherto never been considered.
Optimists who claim to know, are forever making the assertion, in vague, undefined ways, that tuberculosis will be stamped out completely within ten years. And it should be. But not one of them seems to think it necessary to take the public into his confidence long enough to so much as hint at any definite method by which this much desired consummation is to be accomplished. Most of them do go so far, however, as to be loud in their continuous demands for more money. It would be a pleasure, and perhaps a revelation to those who are accustomed to contribute, to know exactly, by itemization, what these medical prophets do, and intend to do, with the many munificent contributions. But, any money is useless for the purpose intended, unless some sane, definite, logical method be presented, with the sole object of combating the disease at its very fountain-head. Who of the great public has ever heard of such a plan? One man, at the head of the health department of one of our foremost cities, thinks that an appropriation by the city, of about $22,000,000, would be about the right amount as a beginning in the extermination of the disease, to be
followed by appropriations of like amount for the next fifteen years. This makes a total of $330,000,000. Rather big figures for a modest health-officer to deal with! Yet he presents no definite plan of campaign, nor states in any detail whatever how this huge sum is to be expended. These figures apply to his one city alone. With the present lackof-method style of campaign against the disease, ten times that, or any other sum, would be useless. However, if the expenditure suggested should bring the result predicted, the price paid would not be too high. But why follow vague prophecies, when the desired end should be attained by an expenditure of $100,000, or less, annually, in the instance cited, by adopting a practicable, common-sense method, with the probability of completely exterminating the disease in less than five years?
It is generally conceded that if consumption can be "caught early," discovered at the beginning and "taken in time," the consumptive stands a very good chance of being cured. This statement should pass unchallenged. But there are two great difficulties in the way of discovering the disease "at the very beginning." The first pertains to the physician. Not one physician in ten can diagnose the disease in its earliest stages. This is no reflection on the average medical man, for even the eleventh physician, who is probably an "expert," is sometimes mistaken. The other difficulty is "in the very nature of things," and pertains to the patient himself. Not one person in fifty so much as even thinks of consulting a physician, until the disease becomes troublesome to himself, and fairly apparent to his friends. As a result of these two difficulties, pertaining alike to physician
and patient, the disease is usually pretty well established by the time it is discovered, and often past the stage of probable cure.
But granted that the disease is discovered in time, what then? Brown, for instance, having been told that he has tuberculosis, takes a sensible view of the situation, and packs off at once for Arizona, where he pitches a tent in the desert, as a more or less permanent abode. One would imagine the conditions under which he lives to be ideal for his purpose. The air is dry and warm; the sky always blue, and the only time he spends in his tent is during the heat of mid-day, and when he retires to his blanket for the night. For a time he improves, and makes no change in the location of his tent for months. Then as time rolls on, he takes a turn for the worse, and in less than a year is dead. Why? Jones is another victim of the disease, who also makes up his mind to go to Arizona. He has an idea of his own that he can get along without any tent, and sleeps with only the stars above, rolled up in his blanket. Having no tent as a fixed abode, he naturally moves from place to place each clay, sleeping on new and different ground each night. That is an important point. Jones ends by being cured. Why? Just one more instance, after which these "whys" will be explained. Smith has the disease, and goes to the West. He makes a rapid gain from the start, and feels and looks in perfect health long before a year is gone. He returns home, satisfied that he is cured. His friends congratulate him, and life looks sweeter than ever before. In less than four months he is once more in the tenacious clutches of the disease. It is time to consider, at this point, some reason for these different terminations, as an explanation of these three instances will throw much needed light on the cure and prevention of tuberculosis.
In any discussion of tuberculosis, one important fact must be constantly kept in mind: consumption is contagious. It is useless to dodge this statement. Yet it is the most difficult fact to drive into the public mind. Owing to the slow development of the disease, it is difficult for its victims to understand how or where they contracted it. This slow development is unfortunate. If tuberculosis developed its symptoms in a few days, like cholera or yellow-fever, it would have been stamped out in all communities long since. Further, it is seldom, or never, "caught" on the highways or by-ways, from some consumptive passer-by; nor from occasional travel on railways or street-cars; nor from the casual wind or dust of the streets. One does not have to go so far from home to find the real source of the contagion. It is safe to say that nine persons out of ten who have the disease, contracted it in their own homes, or, more specifically, in the very rooms in which they are accustomed to live and breathe. In short, tuberculosis is first,
last and all the time, a "house" disease. A realization of the vast importance of this one fact, simplifies the problem of the prevention and cure of tuberculosis to such an extent, that the mind of a child should be able to solve it. Any physician who has had any experience worth considering, can call to memory innumerable instances of houses which he knows to be nothing less than veritable breeding-places for tuberculosis,— houses in which family after family, healthy enough when they moved into one of these plague-ridden dwellings, has sacrificed victim after victim, too often in the name of heredity, to the devastating ravages of this most treacherous of plagues.
With this hint as a key to the problem, let us try to answer the three "whys" which arose in the typical instances of Brown, Jones and Smith. In the first place, not one of these three should ever have contracted the disease. Secondly, the three of them could have been cured at home, and Brown should never have died. Let us explain.
Before Brown had contracted the disease, he had moved in the month of May, into a house in another part of the town where he had always lived. By fall, he had contracted tuberculosis. It was discovered later, that several different families, who had occupied this same house in succession, had lost in turn several members from tuberculosis. No attempt had ever been made to disinfect the house. As already stated, Brown went to Arizona, pitched his tent on a certain spot, and never made any change from that one spot until his death. Note that fact. As a result, the soil over which he slept, night after night, became saturated with the accumulated germs which he expelled in coughing, so that he was continually, at night, re-breathing into his system, the very "seeds" which cause the disease. He was re-poisoning himself nightly, and didn't know it. His system would have been able to throw off the original "germ-poison" which it contracted, but it was not strong enough to withstand a new dose of the poison every night. Had he changed the location of his tent daily, he could have slept each night in an atmosphere practically germ-free. There is a new lesson in this. The open-air treatment is all right, but it must be carried out by right methods. All early cases of consumption which have failed to recover by outdoor treatment, must lay the blame to faulty, incomplete methods in carrying out the details of the treatment. Jones, who recovered, you will remember, did change his location every day, having no tent to bother him, and in doing so, avoided the fatal mistake of Brown. How about Smith? The case of Smith is of the greatest importance. He had recovered, you will remember, and returned to his home feeling fine,—back to what? To the very same plagueridden room in which he had first contracted the disease,—a room reeking with tubercular germ-life, and which had been occupied, it was learned later, by five different consumptives at various times. The disease got a hold on him a second time, for the simple reason that he came back to the original source of his disease. He should have sought new quarters; or else the house, and particularly the room he occupied, should have
been disinfected, before being occupied by him or any one else. These three cases cited are but typical instances. There are thousands upon thousands of Browns, and Joneses, and Smiths, living and dying this very day, whose story, if told in its true light, would match exactly the simple, but pathetic history, of these three men.
Before taking up the important matter of prevention and cure, the temptation is strong to give some detailed criticism as to what has been thus far accomplished as a result of legislative enactment in its specific bearing on tuberculosis. Much could be said on the mooted question of the "tuberculin test" of dairy herds, but lack of space forbids. Aside from that, any legislation enacted, or even so much as suggested, has pertained almost exclusively to the "spitting nuisance," and the use of the public drinking cup. These crusades are certainly harmless enough, and do good in the way of inculcating good manners and etiquette, but how about their utility as regards actual results? Any one. after a moment's thought, can answer that question, but we wish to consider it in the light of information derived from existing conditions in other countries. In the cities of the most enlightened of European countries, antispitting ordinances are unnecessary, because the people there are not addicted to the habit. This is true of London, Paris, Berlin and Vienna. Another thing, no European in the cities mentioned ever thinks of using any but his own drinking cup. This is not said for the purpose of praising Europeans at the expense of our own belittlement, but merely as a prelude to the statement that the European mortality from tuberculosis is as great as ours, and in some instances, greater. The conclusion drawn is, if all legislation thus far enacted against the spread of tuberculosis were stringently enforced to the very letter, we would note little or no diminution in the ravages of the disease.
The simpler the method for the prevention or cure of a disease, the better,— but the more difficult it is to secure its
adoption. The extreme simplicity of a method is often against it. People are so accustomed to "taking something" for all ills of the flesh, that it is not easy for them to change their habits of thought on the subject. Besides, the public is so used to having something mysteriously complicated thrust at it, at so much per "thrust," that it is almost impossible to bring this same public to the realization that any one is sufficiently interested in the welfare of the people, to offer them something for nothing. And too often they are quite right. Fortunately, the idea here presented offers no opportunity for any material gain.
No one would move into a house which had not been disinfected, in which the very last occupants had just gone through a siege of small-pox. It is important to bear this in mind, whenever one moves into new quarters. Did the last occupants have consumption, or did they not? Nobody knows, or takes the trouble to learn. It is of vast importance to the family about to move in. The only way for the latter to be on the