Rural Hygiene Part 21

Sunlight is more positive than the wind, and the exposure to direct sunlight of a bottle filled with disease germs will kill them all in two or three hours. The surface layers of a pond never have as many bacteria in them as the lower layers, partly on account of the sedimentation, but largely because they are killed by the direct action of sunlight. The bacillus of consumption and bacillus of diphtheria are both killed in an hour or so by direct sunlight. This is one reason why living rooms should have sunny exposure and why, on the other hand, disease thrives in dark tenements.

The soil is the third natural method of disinfection, not because the soil itself destroys bacteria, but because in the soil are to be found millions of non-harmful germs and these germs are hostile to the disease-producing germs, so that they destroy their virulence. It is on this principle that the wastes from typhoid fever patients are buried in the garden, the presumption being that the bacteria there present will destroy the typhoid fever germs before they can escape and do any harm.

While this action undoubtedly exists, it is not positive enough to depend upon, and disinfection by the use of chemicals should always be practiced.

CHAPTER XVI

_TUBERCULOSIS AND PNEUMONIA_

These two common widespread diseases affecting the lungs may be discussed together, although they are not closely related in origin or effects.

_Tuberculosis._

That form of tuberculosis known as consumption is at present the most prevalent and the most dreaded of all infectious diseases. In 1908, in the Registration Area of the United States (about one half of the whole country), it caused 67,376 deaths. Deaths from other infectious diseases are shown in the following table, together with the population:--

TABLE XVIII. SHOWING DEATHS FROM VARIOUS INFECTIOUS DISEASES IN THE UNITED STATES, 1908

Population of Registration Area 45,028,767 Deaths in Registration Area 691,574 Deaths from tuberculosis 67,376 Deaths from pneumonia 61,259 Deaths from diarrhoea (chiefly of babies) 52,213 Deaths from cancer 33,465 Deaths from typhoid fever 11,375 Deaths from diphtheria and croup 10,052 Deaths from scarlet fever 5,577 Deaths from whooping cough 4,969 Deaths from measles 4,611 Deaths from smallpox 92 Deaths from hydrophobia 82 Deaths from leprosy 11 Deaths from bubonic plague 5 Deaths from yellow fever 2

Pneumonia is second in fatality, the two diseases of pneumonia and tuberculosis carrying off 128,635 persons, or about one fifth of all persons dying in the year. While these have both been great plagues to humanity from the very earliest days, it is only within the last ten years that their ravages have been appreciated and, especially with tuberculosis, their causes actively combated. There are two phases to be considered in discussing tuberculosis or consumption, namely, first, the method of prevention and second, the method of cure. It follows also that, since the cure of advanced cases is impossible and since every case which exists is a menace to the health of the community on account of the danger of the spread of the disease, the prevention is far more important than the cure.

Until the discovery by Robert Koch, in 1882, of the germ causing consumption, little could be done in the way of prevention, but since that time, only one quarter of a century ago, we have learned and applied the knowledge that, in the vast majority of cases, the disease is spread by the sputum of consumptive patients, which becomes dry, forms dust, and so is carried into the air to be breathed by persons not otherwise affected. It seems so simple a method, then, to prevent the spread of consumption. All that need be done is to take care of the expectorations of persons suffering with the disease. It is thoroughly believed by experts that if this were done carefully and faithfully, the disease would be stamped out within a few years, and the slogan of a certain sanitary organization is "Complete Control of Tuberculosis in 1915." Too much emphasis cannot be placed on the direct and simple method of infection, and while other factors enter, as will be shown later, a thorough recognition and control of tuberculosis sputum would practically stamp out the disease.

The following circular, issued by the Committee on the Prevention of Tuberculosis of the Charity Organization Society of New York City, indicates the procedures advised by them to prevent the spread of the disease and, as will be seen, the essence of the axioms there expressed are summed in the words "Don't spit!":--

DON'T GIVE CONSUMPTION TO OTHERS.

DON'T LET OTHERS GIVE IT TO YOU.

_How to prevent Consumption._

The spit and the small particles coughed up and sneezed out by consumptives, and by many who do not know that they have consumption, are full of living germs too small to be seen.

THESE GERMS ARE THE CAUSE OF CONSUMPTION.

DON'T SPIT on the sidewalks; it spreads disease, and it is against the law.

DON'T SPIT on the floors of your rooms or hallways.

DON'T SPIT on the floors of your shop.

WHEN YOU SPIT, spit in the gutters or into a spittoon.

Have your own spittoons half full of water, and clean them out at least once a day with hot water.

DON'T cough without holding your handkerchief or your hand over your mouth.

DON'T live in rooms where there is no fresh air.

DON'T work in rooms where there is no fresh air.

DON'T sleep in rooms where there is no fresh air.

Keep at least one window open in your bedroom day and night.

Fresh air helps to kill the consumption germ.

Fresh air helps to keep you strong and healthy.

DON'T eat with soiled hands; wash them first.

DON'T NEGLECT A COLD or a cough.

To be sure, the precept of "Don't spit," as applied in cities, has other reasons for enactment than to prevent tuberculosis. Spitting is a filthy habit, and its practice should be decried on the score of cleanliness whether on the streets or in any public place, so that the signs now seen in street cars and railroad trains, in halls and office buildings, are intended not altogether for consumptive patients, but also for those who need laws to force them to observe ordinary rules of cleanliness and decency. It is, however, the main step towards doing away with consumption, and the faithful observance of the injunction ought to be insisted upon quite as much in the individual home as in a city street or public building. Case after case has been cited of instances where one consumptive patient in a family has spread the disease through the household, and, at intervals of a year or so, one after another of the family has succ.u.mbed to the attacks of the consumptive germ, when by proper precautions and suitable care of the sputum of the first sick person, the other deaths might have been prevented.

_Individual resistance to tuberculosis._

There is a remarkable difference in the ability of individuals to withstand the attacks of this disease, and it will be found always that the first to succ.u.mb are those whose vitality has been in some way depleted. The women of the family, who are generally confined to the house, who do not have their lungs reenforced by a continual influx of fresh air, who are tired and worn out with their household duties, give themselves an easy prey to the attacks of the bacteria, while the men and boys, who are more outdoors, who are vigorous and strong, throw off the attack and are not affected.

It is a significant fact that by examination, dead bodies, so far as was known, not afflicted with tuberculosis in life, have, to the extent of 60 per cent, been found to have evidences of consumption in their lungs; that is, the edges of the lungs have been found affected, although the vitality of the individual was such that the action of the germ had been stayed before any serious injury was done. Most of us, at one time or another, have had, unknowingly, mild cases of consumption. It would be strange, indeed, if we did not, in view of all the tuberculous infection flying around in the air. But most of us are able to successfully combat the disease, so that the germs are destroyed before they are able to affect the entire body.

The other part of prevention consists in building up and holding up the vitality of the individual to a point where the vital forces can successfully oppose the attacks of the germs. Probably the decrease in the number of cases of consumption in the last quarter of a century has been due quite as much to the improved sanitary conditions of living, whereby the germs have been unable to secure a foothold in the individual, as to any precautionary measures taken against the germ itself.

_Precautions by the consumptive._

But the chief factor in the future restriction of the disease, as in the past, must be the disinfection of the germs immediately after they are thrown off from the consumptive patient, and it is well worth while to emphasize just what the consumptive should do or have done for him in order that he may not be responsible for the further spread of the disease. In the first place, when he spits, he must appreciate and act on the fact that the sputum is alive with consumptive germs, each one of which may possibly transmit the disease to whoever may come in contact with it. The patient must keep in mind continually that this sputum is poison, a deadly poison, and that it is his duty to see that every particle of it is disinfected or destroyed by one of the methods already indicated. He may expectorate into a vessel filled with a carbolic acid solution or he may expectorate into a vessel filled with water which may afterwards be boiled. He may use a cloth or paper, like a j.a.panese napkin, which may later be burned in the fire. But, above all things, he must not expectorate anywhere and everywhere, regardless of the consequences.

The consumptive patient must not cough without holding a handkerchief over his mouth, since small particles of sputum may become dislodged and distributed in this way.

The eating utensils used by a consumptive patient must not in any way be allowed to infect other people. The consumptive must have his own dishes reserved exclusively for him, and they must be, after each meal, carefully disinfected. With these precautions and with avoidance of such practices as kissing or otherwise directly infecting others, there is no reason why a consumptive patient should be in any way an object of dread or why he should not live with his family in as much comfort as he can obtain, in perfect safety to himself and to them.

_Cure of consumption._

The chief factor in the cure of consumption is the time at which the attempt at cure is started. Consumption is not an incurable disease, as was once thought, and there is no reason for so considering it. There is no such thing as galloping or quick consumption as distinguished from slow or lingering consumption, since the consumptive germ is the same in all people. The same germ may act differently in different people, and if one's power of resistance, as happens with those accustomed to drinking liquor, is low, the action of the germ is rapid, although the disease is identical with the form in which death comes only after years and years. If taken in time, that is, before the germ has so infected the body as to be beyond all possible restraint, as large a proportion of consumptive patients may recover as of patients from typhoid fever or diphtheria or any other infectious disease, but the cure must be started early. For instance, at one of the sanitariums in the Adirondacks, out of 267 patients admitted, who had the disease in an incipient stage, complete recovery was had in 219 cases, the disease was arrested in the case of 42 others, and in only 6 was the treatment not effective. Where the disease had become advanced, however, it was found that out of 192 cases, only 32 apparently recovered and 140 were improved to some extent. These are the significant facts in an inst.i.tution for incipient cases only, where advanced cases, such as are met with by the practicing physician, are not received.

Unfortunately, the ordinary physician does not always recognize the disease in its first stages, and a person may suffer for months with consumption, and even pa.s.s the time when the cure of the disease would be possible, without its being recognized. Such sick persons are treated for catarrh, for an obstinate cold and bronchitis, for grippe or malaria, whereas a proper diagnosis of the disease would be a recognition of the early stages of consumption and thus would prompt the patient to start at once on the necessary methods for cure. Nor is it possible to recognize the disease by any one definite indication. The cough which was once thought to be the deciding symptom is very often absent until the last stages of the disease. Expectoration of blood is similarly one of the last symptoms, exhibited only when too late for remedial measures. The presence of the tuberculosis bacillus or "T. B."

in the sputum is also not generally found until the tissue of the lungs has become well advanced towards destruction, too late for remedy.

Experts in diagnosis attach great importance to family history, and have learned to expect the disease in persons when exposure to contagion is inevitable. They will recognize the disease from evidence not discernible to regular pract.i.tioners. For instance, if one member of a family is known to be affected, any chronic indisposition in another member, involving, perhaps, a daily rise in the temperature of the body, not sufficient to arouse alarm, but apparent in the listless behavior of the person, may be enough to suggest the beginning of the disease. An expert may detect the clogging up of the lung tissue by an examination of the lungs themselves, and probably this direct examination, with a record of the daily rise and fall of temperature, particularly if the suspected patient has a listless feeling and a gradual loss of weight, would be sufficient to suggest the ordinary remedies.

The three remedies, which are nature's own methods, are good food, fresh air, and rest. It is difficult to say which of these three items is the most important. Certainly no hope of building up the resistance of the patient against the inroads of the disease can be expected unless the patient is thoroughly nourished. One of the sad facts in connection with those unfortunates whose fight against tuberculosis is nearly over and who in desperation have fled to Arizona, hoping that the dry air might afford relief, is that the lack of nourishing food, inevitable in those deserts, hastens on the disease, so that the expected benefits from the dry air are entirely offset. Likewise, in tenement-house districts in cities, the fight against consumption is practically useless because of the impossibility of securing for those starved or underfed helpless ones the nourishing food necessary. In the country, this part of the treatment ought to be the simplest, and yet one fears that the habit of eating through nine months of the year only salted and dried foods has not furnished patients in the country with the kind of nourishment necessary. Experience indicates that eggs and milk should be the bulwark on which the patient must depend for food, and in the sanitariums of New York State it is not uncommon for patients to be stuffed with two dozen raw eggs every day in addition to other food.

The next important factor is rest, since the effect of tuberculosis is to break down lung tissue, and for the prevention of this it is necessary to give the forces of the body every aid in preventing this destruction. All exercise taken by a tuberculous patient means the withdrawing of that much blood from the lungs, where is the strategic point of the disease, to the part of the body being exercised, and one of the most striking features of sanitarium treatment is the absolute rest enjoined on the patients. Flat on their backs, day and night for months, without so much exercise as walking across the room, is the ordinary treatment, and the effect of disobedience is plainly seen in the rise in temperature or increase in fever which follows a violation of these rules. Even when the patients are allowed to sit up, they do not sit straight, but rest on couches or reclining chairs, so that their heads are down and their feet up, making the pa.s.sage of the blood to the lungs easier. Even where the patient, determined to recover, is not able to place himself in the hands of a hospital physician, he can adopt this important method of arresting the disease by strictly avoiding exercise and exertion of every sort. The Ma.s.sachusetts General Hospital in Boston has tuberculosis clinics, where patients who are not far enough advanced in the disease to require absolute rest are inspected daily, their condition noted, and advice given for the following twenty-four hours.

One of the most common violations of the prescriptions given is overexertion, and yet the rest condition is essential for building up the diseased lung.

The third method of treatment involves fresh air, in order to improve the oxygenating character of the blood. If one remembers that the oxygen in the blood is the chief scavenger of the body and that the vitality of the red corpuscles and their abundance is an essential factor in curing the disease, it will be seen why fresh air is so important. The tendency to-day is to insist on fresh air and to lay less stress on the climate than was formerly done.