Part 22 (1/2)
It was not uncommon a few years ago for a physician, recognizing consumption, to send his patient away, partly because he honestly believed the climate of Arizona or Colorado or the Sandwich Islands was better than that where the patient lived, and partly, without doubt, because he was glad to get rid of a disease which he knew it was not in his power to cure. To-day, unless the patient can go to a properly equipped and maintained sanitarium, physicians recognize that conditions may be as beneficial at home as elsewhere and, provided the three factors mentioned--good food, rest, and fresh air--can be obtained, the chances for recovery are better because of better care at home than elsewhere.
But fresh air is essential, and this means that the patient must spend twenty-four hours a day in the open. He must eat and sleep out of doors.
He must not go into the house when it rains, nor when it snows, and even with the thermometer at zero he must still stay out, wrapping himself up, to be sure, so that his body is not cold, but breathing into his lungs the life-giving, vitalizing, oxygen-bearing air. The side porch of a house may be very easily transformed into a room with a cot bed and an easy chair, where the consumptive may stay continually, and while it is convenient to have a window or a door opening from the porch into a room where the patient may be dressed and bathed, this is not essential, although customary in sanitariums. If no side porch exists, it is possible to build such a porch, and the picture shows how such a construction may be added to even a small house in the city (Fig. 75).
If this is out of the question, the windows of a room may be left open all the time, or the patient may lie on a bed, the head of which either extends through the window or is arranged to admit fresh air by a specially devised window tent.
Educational campaigns have been vigorously prosecuted for the past ten years, and gradually through the world is spreading a growing appreciation of the dangers of this disease. The effect of this increasing knowledge is reflected by a continually decreasing number of deaths in proportion to the population. The following diagram (Fig. 76) shows how this law is obeyed in New York State, the downward tendency of the line since 1890 being very plainly marked.
[Ill.u.s.tration: FIG. 75.--Outdoor sleeping porch for tuberculosis patients.]
The results being so manifest, the prophecy of Dr. Biggs of New York, written in 1907, is certainly justified:--
”In no other direction can such large results be achieved so certainly and at such relatively small cost. The time is not far distant when those states and munic.i.p.alities which have not adopted a comprehensive plan for dealing with tuberculosis will be regarded as almost criminally negligent in their administration of sanitary affairs and inexcusably blind to their own best economic interests.”
[Ill.u.s.tration: FIG. 76.--Mortality from pulmonary tuberculosis. Deaths per 100,000 population.]
_Pneumonia.--The germ._
In New York State in the year 1908, the largest number of deaths from any specific disease was due to consumption, the number of deaths in the rural population alone being 2906. The next largest number of deaths in the rural communities, and always a close second to consumption, was from pneumonia, the number being 2191; so that pneumonia justly ranks as highly important in the list of diseases which are at present most deadly in their effect on the human race and against which a vigorous fight should be made.
While pneumonia, like tuberculosis, is due to the action of a specific organism, the germ itself is not so generally infectious; that is, the germ has not the power of remaining vigorous when out of the human body in the same way as has the germ of consumption. Like tuberculosis, the germ is expectorated and remains virulent when dried into dust, but the germ is much more sensitive to temperature changes and does not live longer than two or three hours when dried and exposed to the sun. It is, very curiously, a normal resident in the mouths of at least one third of all healthy persons, and it is only necessary for the body of these persons to become weakened for the germ to be able to secure a foothold and produce the disease. Unlike tuberculosis, which attacks chiefly those in the vigor of life, from fifteen to forty-five years of age, pneumonia attacks generally the very young and the very old; those under five and those over forty-five, the time of life when the vital resistance is the least.
_Weather not the cause of pneumonia._
One of the sources formerly believed to be largely responsible for pneumonia, that is, exposure to severe weather, is curiously negatived by the fact that children and old people are not those generally exposed to weather. Perhaps no fallacy in any disease has been more prevalent than that pneumonia is usually contracted by exposure to wet or to cold.
It has, indeed, been noticed that the disease has been practically non-existent under conditions where it would be prevalent if exposure alone were the cause. For instance, in the Arctic zone, where the temperatures are very low and where no adequate provision against the rigors of a severe climate are possible, pneumonia is practically unknown. During Napoleon's retreat from Moscow, when thousands of soldiers died from physical exposure, from frost bite and starvation, where if exposure were the predisposing cause of pneumonia, it would have raged as an epidemic, it seldom appeared, proving this opinion.
Perhaps one reason why the disease has been supposed to result from exposure is the undoubted fact that it is chiefly prevalent in the winter and spring rather than in the summer. This argument is, however, modified by the fact that the majority of cases do not occur in January or February when the temperature is lowest, but in March, when the opening of spring is in sight. The reason for this is evident when we remember that the cause of the disease is a germ, generally present in the body and needing only a reduced vitality for its successful inroad on the human system. When, therefore, a person shuts himself up in an overheated house, without ventilation, takes insufficient exercise, and lives with an apparently determined effort to do everything possible to reduce his bodily vigor, then it is no wonder that the germ, almost in exultation, finds an opportunity for successful development.
_Preventives in pneumonia._
Much as in tuberculosis, then, the best remedy and the best prevention for pneumonia is a careful attention to the needs of the body in order that it may preserve its normal vigor. Regular hours, sufficient sleep, and good food will, in most cases, keep the body in such a condition that pneumonia need not be dreaded, no matter what the exposure or what the temperature. Further than this, if the disease does once start and gain a foothold in the lungs, the best cure is, as with tuberculosis, a plentiful supply of oxygen or fresh air in order to remove the toxins formed by the disease and give the lung tissue an opportunity to recover.
Formerly medical men treated pneumonia by confining the patient in an overheated room in which steam was generated, with the idea that the lungs would be most helped by an atmosphere of moist heat. Now, a pneumonia patient is supplied with all the fresh air possible, the windows of the sick room, even in winter, being kept continually open, and every effort being made to give the patient fresh air even when every breath means a shooting pain, and apparently untold suffering. In some of the New York City hospitals, the ward for pneumonia patients is on the roof, and children and babies suffering with pneumonia are at once taken there, even with snow piled all around the tent in which they are kept. The nurses and physicians are obliged to don fur coats, and heavy blankets must be provided to keep the patients from freezing to death; but the pneumonia germ, under these conditions, is worsted almost as if by magic, and within a few hours after leaving the warm wards of the hospital the patients start on the road to recovery.
The remedy, then, for the 2000 cases of pneumonia which occur in New York State each year, is an improved regulation of the health conditions of the separate families throughout the state--a better hygienic regulation of the everyday life. Care must be taken to provide better ventilation in the houses, more fresh air in the sitting room and in the sleeping rooms, more outdoor life in the winter time, and more exercise by which the blood circulation will be kept active. Then more varied and more suitable food must be consumed, food which will be capable of absorption by the tissues and not clog the intestines and poison the system. More bathing, by which the pores of the skin can be relieved of the organic matter which otherwise clogs them and prevents their effective action in the removal of waste products, must be indulged in.
With these three factors properly evaluated, with more fresh air, with better food, with ample bathing, pneumonia need not be dreaded, since then it would attack only those few whose const.i.tutional vigor was impaired, and in the course of a generation or two the number of these would be so decidedly diminished that pneumonia would find no one susceptible.
_Infection of pneumonia._
It must not be forgotten that a pneumonia patient is a source of infection quite as much as is a tuberculous patient, and the same precautions against infection should be followed. The nurse should be particularly careful not to infect herself. She should be careful to exercise enough self-control always to get daily exercise and fresh air and must, as a matter of self-protection, avoid overfatigue. The eating utensils, food refuse, and soiled clothing may all be infectious and must be sterilized by boiling as soon as removed from the sick room. The severe epidemics which have occurred from pneumonia have occurred in camps where sanitary conditions are grossly violated. Under such conditions pneumonia has become a most alarming epidemic, sometimes called the black death. In a single house, however, disinfection of the wastes of the patient and a proper care of the personal hygiene of the rest of the family will avoid the spread of the disease, and if the patient has sufficient vitality, sustained by good food and fresh air, he will recover without serious after affects.
CHAPTER XVII
_TYPHOID FEVER_
The two diseases already described, tuberculosis and pneumonia, are by far the most serious of all the infectious diseases, being responsible in New York State alone, in 1908, as already stated, for 5727 deaths. No other infectious disease even approximates the virulence and deadliness of these two, and while some of the const.i.tutional disorders, such as Bright's disease, diarrhoea, and irregularity of the circulation, each result in from 2000 to 3000 deaths, the cause and prevention of these are so little understood as to baffle the hygienist. There are a number of contagious diseases which, while comparatively unimportant in the number of deaths, yet are of concern because the cause of the disease is so well known that the means of prevention is quite within our power. Of these, typhoid fever, in New York State in 1908, among the rural population alone resulted in 437 deaths, a rate of 18.7 per 100,000 population. The facts substantiate the a.s.sumption that for every person dying with typhoid fever there are ten cases of it, so it is a fair statement that in the rural part of New York State, in 1908, there were not far from 5000 persons afflicted with this disease.
Perhaps one of the reasons why so determined a fight against this particular disease, involving only 5000 cases of illness during the year, has been made, is on account of the length of the illness in each case and on account of the fact that the disease usually attacks those in the very prime of life, from 15 to 40 years. It is also to be economically considered by reason of the loss of time involved in an illness of nearly two months and the loss of money implied in the nursing, doctors, and medicine. The movement against the disease is most encouraging because the line of attack is well known, and there is, humanly speaking, no reason at all why the disease should not be stamped out.