The Crusade Against the White Plague by G. H. HEALD

Review and Herald Publishing Association · Takoma Park Station, Washington, D. C. · Oct 22, 1908

The Crusade Against the White Plague

By G. H. HEALD

G. H. HEALD, M. D.

(Concluded)

We have learned many things about tuberculosis since the discovery of the tubercle bacillus by Koch. We know that tuberculosis is a disease that thrives especially in overcrowded and badly ventilated homes or tenements, particularly where the inmates are poorly nourished. We have believed that tuberculosis is transmissible to humans through tuberculous milk or meat, though this has been denied for some years by Koch and his followers. We have known that the disease can not be cured by medicine, and that the main reliance in the treatment of consumption must be abundance of pure air day and night,—the outdoor life,—abundance of nourishing food, and rest or properly graduated exercise. We have learned that consumption is readily cured or arrested if this treatment is given in time. We have learned that most consumptives—those especially among the poor—neglect to go to a physician and attend to a “cold” until it is too late to be favorable for cure. We have learned the necessity of establishing various means for helping those in the tenement districts where consumption has its most fruitful breeding-grounds. These facts have been known and made use of in practise, and the recent congress merely emphasizes their importance. Among the points emphasized at the recent congress are these:—

The thermal death-point for the tubercle bacillus is 140° F. for twenty minutes; in other words, Pasteurization, properly carried out, is a reliable procedure for the destruction of tubercle bacilli in milk.

Tubercle bacilli are destroyed by direct sunlight in a remarkably short time, provided they are in a thin layer, and even by diffused light in from one day to a week. It is the dark corners that harbor the bacilli, and this leads tuberculosis to be designated as the house disease.

We have returned not to a belief in inherited tuberculosis, but we realize more than ever that individuals differ materially in their susceptibility to the disease, and that this susceptibility is partly, at least, a matter of heredity and race.

In addition to hereditary predisposition the acquired predisposition which comes through unhygienic living, poor surroundings, etc., is an important factor in the production of the disease. Often this is almost an unavoidable result of extreme poverty.

We generally think of susceptibility and immunity as contrasting terms; but Dr. Flick distinguishes between a lessened immunity and an increased susceptibility. The former, he says, is the condition of the Irish, who do not take consumption readily, but when they do, die of it. The latter is the condition of the Jews, who readily contract tuberculosis, but nearly always die of something else. The Irishman, strong and full-chested, is quickly overcome with tuberculosis if he gets it. The Jew, flat-chested and sickly, often has tuberculosis nearly all his life, but rarely dies of it.

Numerous autopsies lead some to assert that practically every one over thirty years of age has had tuberculosis at some time. If this is so, tuberculosis is an extremely curable disease, provided one gets into right conditions in the proper time. Perhaps nearly all the human race are somewhat like the Jews, in that they have through long contact inherited more or less tolerance for the disease.

Evidence in favor of the infection from throat, stomach, and intestines is becoming more conclusive, thus making a proper supervision of the milk supply the more important.

The human, the bovine, and the avian, or bird, tubercle bacilli are different types of the same organism, modified by generations of existence in different hosts; and under certain conditions any of these forms may infect man. This was the most hotly contested question of the congress, on which Koch and the German delegation maintained that the bovine bacillus can not to any appreciable extent affect humans; but recent experimentation discredits this belief; and the congress passed a resolution to this effect, which was a most severe blow to Dr. Koch and his supporters.

But, as one physician is reported to have said, the lives of thousands of infants are of more value than the reputation of one physician. It might hurt German dairy interests; but if it saves baby lives, it is in the interest of humanity.

It seems that man is infected by two distinct types of the tubercle bacillus, the human type causing infection of lungs, intestines, and larynx; the bovine type causing infection of glands, peritoneum, joints, membranes of the brain (meningitis), skin (lupus), and acute miliary tuberculosis. More generally the human type is found in older persons, and in children the bovine. The two types are antagonistic, so that a person having one type of the disease is protected against the other.

Tuberculosis is found to be very frequent in swine that are fed dairy refuse, or that feed after cows in the field, or that have access to the manure pile. It is known that all discharges of tuberculous cows contain large numbers of tubercle bacilli.

Flies are a dangerous means of tuberculosis transmission, and the remedies suggested are:—

Destroy all discharges of the consumptive.
Destroy all flies, and clean up their breeding places.
Screen food.

Children are more generally infected with the disease than was formerly supposed, owing to the difficulty of detection. By newer methods it is discovered that where older members of the household harbor the disease, one or more of the children almost invariably have become infected.

Professor Fisher sounded a warning against the overfeeding of consumptives as practised in many sanitariums, and especially against the overuse of proteid food. He cited the successful reduction of the menu in one sanatorium, lessening the expense, pleasing the patients (who were not forced to overeat, but allowed to eat according to their appetites), and giving satisfactory results in the matter of cure.

It is coming to be recognized that carefully graduated exercise is as important as rest in the treatment of the consumptive, but this exercise should always be under skilled observation, and should never be carried to the point of autoinoculation, that is, causing poisons to be thrown out from the tuberculous process into the blood current, as manifested by loss of appetite, fever, etc.

The great value of children’s playgrounds and school gardens was emphasized as a means of encouraging the open-air life among children. The open-air treatment has proved a remarkable aid in the cure, not only of lung tuberculosis, but of joint and bone tuberculosis in children, even in advanced cases,—such children as were considered hopeless under older methods.

While much can be done by segregating consumptives, and by teaching them how not to infect others, it is being realized that infinitely more can be accomplished by teaching the children in the schools who are not yet infected how to avoid infection, and how to live hygienically so as to increase vital resistance against the germ.

Takoma Park, D. C.