Part 7 (1/2)

”But how do you know that these ma.s.ses of chalky-material, these enlarged glands, are the result of tuberculosis? They may be due to some half-dozen other infections.”

Almost before the question was asked a test was made by the troublesome but convincing method of cutting open these scars, dividing these enlarged glands, sc.r.a.ping materials out of their centre, and injecting them into guinea pigs. Result: from thirty to seventy per cent of the guinea pigs died of tuberculosis. In other cases it was not necessary to inoculate, as sc.r.a.pings or sections from these scar-ma.s.ses showed tubercle bacilli, clearly recognizable by their staining reaction.

Here, then, we have indisputable evidence of the fact that the tubercle bacillus may not only enter some of the openings of the body,--the nostrils, the mouth, the lungs,--but may actually form a lodgment and a growth-colony in the lungs themselves, and yet be completely defeated by the ant.i.toxic powers of the blood and other tissues of the body, prevented from spreading throughout the rest of the lung, most of the invaders destroyed, and the crippled remnants imprisoned for life in the interior of a fibroid or chalky ma.s.s.

It gave one a distinct shock at the meeting of the British Medical a.s.sociation devoted to tuberculosis, some ten years ago, to hear Sir Clifford Allb.u.t.t, one of the most brilliant and eminent physicians of the English-speaking world, remark, on opening his address, ”Probably most of us here have had tuberculosis and recovered from it.”

Here is evidently an a.s.set of greatest and most practical value, which changes half the face of the field. Instead of saving, as best we may, from half to two-thirds of those who have allowed the disease to get the upper hand and begin to overrun their entire systems, it places before us the far more cheering task of building up and increasing this natural resisting power of the human body, until not merely seventy per cent of all who are attacked by it will throw it off, but eighty, eighty-five, ninety! We can plan to stop _consumption by preventing the consumptive_.

A very small additional percentage of vigor or of resisting power--such as could be produced by but a slight improvement in the abundance of the food-supply, the lighting and ventilating of the houses, the length and ”fatiguingness” of the daily toil--might be the straw which would be sufficient to turn the scale and prevent the tuberculous individual from becoming consumptive.

Here comes in one of the most important and valuable features of our splendid sanatorium campaign for the cure of tuberculosis, and that is the nature of the methods employed. If we relied for the cure of the disease upon some drug, or ant.i.toxin, even though we might save as many lives, the general reflex or secondary effect upon the community might not be in any way beneficial; at best it would probably be only negative. But when the only ”drugs” that we use are fresh air, suns.h.i.+ne, and abundant food, and the only ant.i.toxins those which are bred in the patient's own body; when, in fact, we are using for the cure of consumption _precisely those agencies and influences which will prevent the well from ever contracting it_, then the whole curative side of the movement becomes of enormous racial value. The very same measures that we rely upon for the cure of the sick are those which we would recommend to the well, in order to make them stronger, happier, and more vigorous.

If the whole civilized community could be placed upon a moderate form of the open-air treatment, it would be so vastly improved in health, vigor, and efficiency, and saved the expenditure of such enormous sums upon hospitals, poor relief, and sick benefits, that it would be well worth all that it would cost, even if there were no such disease as tuberculosis on earth.

This is coming to be the real goal, the ultimate hope of the far-sighted leaders in our tuberculosis campaign,--to use the cure of consumption as a lever to raise to a higher plane the health, vigor, and happiness of the entire community.

Enormously valuable as is the open-air sanatorium as a means of saving thousands of valuable and beloved lives, its richest promise lies in its function as a school of education for the living demonstration of methods by which the health and happiness of the ninety-five per cent of the community who never will come within its walls may be built up.

Every consumptive cured in it goes home to be a living example and an enthusiastic missionary in the fresh-air campaign. The ultimate aim of the sanatorium will be to turn every farmhouse, every village, every city, into an open-air resort. When it shall have done this it will have fulfilled its mission.

Our plan of campaign is growing broader and more ambitious, but more hopeful, every day. All we have to do is to keep on fighting and use our brains, and victory is certain. Our Teutonic fellow soldiers have already nailed their flag to the mast with the inscription:--

”No more tuberculosis after 1930!”

So much for the serried ma.s.ses of the centre of our anti-tuberculosis army, upon which we depend for the heavy, ma.s.s fighting and the great frontal attacks. But what of the right and the left wings, and the cloud of skirmishers and cavalry which is continually feeling the enemy's position and cutting off his outposts? Upon the right stretch the intrenchments of the bacteriologic brigade, with the complicated but marvelously effective weapons of precision given us by the discovery of the definite and living cause of the disease, the _Bacillus tuberculosis_. Upon the left wing lie camp after camp of native regiments, whose loyalty until of very recent years was more than doubtful,--heredity, acquired immunity, and the so-called improvements of modern civilization, steam, electricity, and their kinsmen.

To the artillerymen of the bacteriologic batteries appears to have been intrusted the most hopeless task, the forlorn hope,--the total extermination of a foe so tiny that he had to be magnified five hundred times before he was even visible, and of such countless myriads that he was at least a billion times as numerous as the human race. But here again, as in the centre of the battle-line, when we once made up our minds to fight, we were not long in discovering points of attack and weapons to a.s.sault him with.

First, and most fundamental of all, came the consoling discovery that though there could be no consumption without the bacillus, not more than one individual in seven, of fair or average health, who was exposed to its attack in the form of a definite infection, succ.u.mbed to it; and that, as strongly suggested by the post-mortem findings already described, even those who developed a serious or fatal form of the disease had thrown off from five to fifteen previous milder or slighter infections. So that, to put it roughly, all that would be necessary practically to neutralize the injuriousness of the bacillus would be to prevent about one-twentieth of the exposures to its invasion which actually occurred. The other nineteen-twentieths would take care of themselves. The bacilli are not the only ones who can be numbered in their billions. If there are billions of them there are billions of us.

We are not mere units--scarcely even individuals--except in a broad and figurative sense. We are confederacies of billions upon billions of little, living animalcules which we call cells. These cells of ours are no Sunday-school cla.s.s. They are old and tough and cunning to a degree.

They are war-worn veterans, carrying the scars of a score of victories written all over them. _They_ are animals; bacteria, bacilli, micrococci, and all _their_ tribe are _vegetables_. The daily business, the regular means of livelihood of the animal cell for fifteen millions of years past has been eating and digesting the vegetable. And all that our body-cells need is a little intelligent encouragement to continue this performance, even upon disease germs; so that we needn't be afraid of being stampeded by sudden attack.

The next cheering find was that the worst enemies of the bacillus were our best friends. Sunlight will kill them just as certainly as it will give us new life. The germs of tuberculosis will live for weeks and even months in dark, damp, unventilated quarters, just precisely such surroundings as are provided for them in the inside bedrooms of our tenements, and the dark, cellar-like rooms of many a peasant's cottage or farmhouse. In bright sunlight they will perish in from three to six hours; in bright daylight in less than half a day. This is one of the factors that helps to explain the apparent paradox, that the dust collected from the floors and walls of tents and cottages in which consumptives were treated was almost entirely free from tuberculous bacilli, while dust taken from the walls of tenement houses, the floors of street-cars, the walls of churches and theatres in New York City, was found to be simply alive with them. One of the most important elements in the value of sunlight in the treatment of consumption is its powerful germicidal effect.

CHAPTER VII

TUBERCULOSIS, A SCOTCHED SNAKE

II

Closely allied to the discovery that sunlight and fresh air are fatal to the microorganisms of tuberculosis came the consoling fact that these bacilli, though most horribly ubiquitous and apparently infesting both the heavens above and the earth beneath, had neither wings nor legs, and were absolutely incapable of propelling themselves a fraction of an inch. They do not move--_they have to be carried_. More than this, like all other disease-germs, while incredibly tiny and infinitesimal, they have a definite weight of their own, and are subject to the law of gravity. They do not flit about hither and thither in the atmosphere, thistledown fas.h.i.+on, but rapidly fall to the floor of whatever room or receptacle they may be thrown in. And the problem of their transference is not that of direct carrying from one victim to the next, but the intermediate one of infected materials, such as are usually a.s.sociated with visible dust or dirt. In short, keep dust or dirt from the floor, out of our food, away from our fingers or clothing or anything that can be brought to or near the mouth, and you will practically have abolished the possibility of the transference of tuberculosis. The consumptive himself is not a direct source of danger. It is only his filthy or unsanitary surroundings. Put a consumptive, who is careful of his sputum and cleanly in his habits, in a well-lighted, well-ventilated room, or, better still, out of doors, and there will be exceedingly little danger of any other member of his family or of those in the house with him contracting the disease. Wherever there is dirt or dust there is danger, and there almost only. Thorough and effective house-reform--not merely in tenements, alas! but in myriads of private houses as well--would abolish two-thirds of the spread of tuberculosis.

It is not necessary to isolate every consumptive in order to stop the spread of the disease. All that is requisite is to prevent the bacilli in his sputum from reaching the floor or the walls, to have both the latter well lighted and aired, and, if possible, exposed to direct sunlight at some time during the day, and to see that dust from the floor is not raised in clouds by dry sweeping so as to be inhaled into the lungs or settle upon food, fingers, or clothing, and that children be not allowed to play upon such floors as may be even possibly contaminated. These precautions, combined with the five-to-one resisting power of the healthy human organism, will render the risk of transmission of the disease an exceedingly small one. To what infinitesimal proportions this risk can be reduced by intelligent and strict sanitation is ill.u.s.trated by the fact, already alluded to, of the almost complete germ-freeness of the dust from walls and floors of sanitorium cottages, and by the even more convincing and conclusive practical result, that scarcely a single case is on record of the transmission of this disease to a nurse, a physician, or a servant, or other employee in an inst.i.tution for its cure.

There is absolutely no rational basis for this panic-stricken dread of an intelligent, cleanly consumptive, or for the cruel tendency to make him an outcast and raise the cry of the leper against him: ”Unclean!

Unclean!”

It cannot be too strongly emphasized that consumption is transmitted _by way of the floor_; and if this relay-station be kept sterile there is little danger of its transmission by other means.