( Originally Published 1917 )
Tuberculosis, the Great White Plague.—One of the communicable diseases is so much more common and so much more deadly than any of the others that it deserves a special chapter. This is tuberculosis, sometimes called the Great White Plague.
Tuberculosis is caused by a bacterium, which may grow in a great many different parts of the body, although it is most likely to be found in the lungs, causing tuberculosis of the lungs, or consumption. The germ does not grow all through the lungs in this disease but here and there at special points, where there form hard little knots or tubercles, from which the disease was named.
Tuberculosis of the bones is not uncommon among children, and a great many of the lame people we see on the streets are crippled from this cause.
The course of this disease is very slow, and it may take months or years to develop. When the germ is first gaining headway against the natural defenses of the body, the per-son begins to feel tired and weak, to lose weight and appetite, to feel feverish toward evening, and, in the case of consumption, to have a cough that does not yield to treatment.
If proper steps are not taken to check the disease, it continues and grows worse. People between eighteen and forty-five suffer particularly from tuberculosis. It causes the death of about one third of all the people who die between these ages, and each year it kills about 150,000 people in the United States—more than were killed in battle in the whole Civil War.
How the Germ of Tuberculosis Spreads.—The primary cause of tuberculosis is always the microbe itself. This germ is discharged in the spray and sputum coughed out by consumptives, and in most cases of the disease, infection results from getting these human discharges into the mouth. Sometimes the germ is inhaled in dust, but it is more frequently transferred from one person to another by the various kinds of contact described in Chapter XXI.
A great many cattle suffer from tuberculosis, and children may become infected by drinking the milk of tuberculous cows.
How to Prevent the Spread of the Germ of Tuberculosis. . To prevent the spread of tuberculosis, it is necessary, first of all, to prevent the spread of the germs discharged from the mouths of consumptives; and second, to pasteurize the milk of all cows not certainly known to be free from the disease.
The careless consumptive is a great danger to his family and associates, but one who is always careful to destroy his sputum and to avoid coughing out mouth spray into the air, need not be a menace to the health and life of others. The consumptive should always cough into a cloth or hand-kerchief, or a paper napkin which can be burned, and all sputum should be received in paper cups and burned at the end of the day. If handkerchiefs are used, they should not be put into a laundry bag or basket with other soiled linen, but should be boiled for twenty minutes in a strong soap-suds solution. When all these precautions are taken, it is not dangerous to live or work with a careful consumptive.
All rooms or apartments that have been occupied by persons suffering from tuberculosis should, upon the removal of the patient, be thoroughly cleansed and renovated by-airing and exposing to sunlight, if possible, by washing woodwork and plain furniture, and by scrubbing the floor with soap and water. Renovation or repapering and painting is sometimes also desirable.
Vital Resistance and Tuberculosis.—Tuberculosis is a disease in which vital resistance plays an especially important part. The germ is unfortunately very common; in fact, almost every individual, sooner or later, is slightly infected with it.
This does not mean that every one has tuberculosis, in the sense of suffering from actual disease. The human body has a considerable power of defending itself against this invader, and a few germs entering the healthy body are quickly overcome. It is when a great many germs are taken in, and particularly when the strength is reduced by attacks of other diseases, or when resistance is lowered by intemperate habits, by living and working in overheated rooms, by eating insufficient food, or by breathing sharp dust particles, that the invisible enemy overcomes the 'defenses of the body.
People who have recovered from tuberculosis, and those in whose family there has been a case, should be especially on guard against allowing their vital resistance to become weakened.
How to Build up Vital Resistance against Tuberculosis. Tuberculosis is primarily a disease of those who work too hard and get too little food, of those who live in dark, unventilated tenements and work in dusty factories, of those who do not get enough exercise, fresh air, and sunlight.
We can largely control tuberculosis by applying the ordinary principles of hygiene. Knowledge of the calorie-value and cost of food makes it possible to secure a nourishing diet even with a small income. Fresh, cool air can generally be secured by opening the windows. Every effort should be made to have the bedroom well ventilated, and to keep the windows open at night all the year round. Sufficient sleep could be enjoyed by most people, if they would realize that one cannot work all day and play half the night. Indoor workers can get at least some outdoor exercise by walking to their place of work.
Industrial Tuberculosis.—Among the most important causes of tuberculosis are the unsanitary conditions of factory life. An overheated, unventilated workshop is certain to lower vital resistance and make the worker an easy prey to the tuberculosis germ, particularly if he is weakened by long hours of labor. An especially dangerous thing about some industries is the fact that the air of the workshops is full of fine particles of mineral or metallic dust. These dust particles are inhaled and injure the delicate tissues of the lung, so that tuberculosis germs find it easy to grow there. The workers in some of these industries—granite workers and grinders, for instance—are two or three times as likely to contract tuberculosis as are people who work at less dangerous trades.
In all such places there should be special pipes with exhaust fans to draw off the dust from the air. Where this cannot be done, the worker should wear a respirator over his mouth to keep out the deadly dust particles.
Alcohol and Tuberculosis.—Alcohol, of course, lowers vital resistance against disease of all sorts, and since vital resistance plays so important a part in the fight against tuberculosis, the effect of alcohol is especially serious in this disease. Again and again we find that alcohol has been the thing that has weakened a man so that he could no longer defend himself against this enemy which is always waiting. The avoidance of alcoholic drinks is an essential part of the campaign against the Great White Plague. The International Congress of Tuberculosis recognized this fact when it adopted the resolution: "We strongly emphasize the necessity and importance of combining the fight against tuberculosis with the struggle against alcoholism."
The Cure of Tuberculosis.—Just as the tuberculosis germ fails to gain a real foothold in the body of a thoroughly healthy person, so by proper hygienic treatment it can be conquered even after it has begun its work.
There are no medicines, in the ordinary sense, that will cure tuberculosis. All so-called "Consumption Cures" are frauds which waste the money of their victims and do immeasurable harm by the loss of precious time. The cure for tuberculosis is hygienic living under the advice of a competent physician—properly directed rest and exercise, plenty of fresh air, and a sufficient amount 'of wholesome food. If such treatment is taken early in the disease, tuberculosis can generally be cured.
The cure does not depend on any special climate, as was once thought to be the case. With proper treatment, people get well in all parts of the United States, and the strain and expense of a long journey are usually unnecessary. Treatment can be carried out best, however, in a sanatorium or hospital established especially for the cure of tuberculosis. In such a hospital, where there is constant medical supervision and nursing care, the patient stands a far better chance of recovery than anywhere else. The care of the patient in a hospital also ensures the protection of family and friends, who might be in danger of infection if the patient were cared for carelessly in the home.
Where, for any reason, hospital treatment is impossible, the cure can often be taken at home, if the advice of the physician is carefully followed. A tuberculous patient should always sleep alone and, whenever possible, should have a separate bedroom. Both the bedroom and the living room should have as much sunlight as possible, and should always have an abundance of fresh air. The windows should be open day and night.
Many consumptives have benefited greatly from sleeping out of doors—in tents, on roofs, or on piazzas (see Fig. 58). A sleeping porch, protected from storms by an awning, can be built at small expense. If sleeping out of doors is not feasible, a window tent -maybe substituted; this is particularly suitable for winter. With plenty of bed clothing and a woolen hood over the head, tuberculous patients often sleep out of doors all winter when the temperature is well below zero, and seem to benefit by it.
The Importance of Early Treatment.—The main thing is to begin the treatment of tuberculosis as soon as possible. In the family or immediate circle of each person known to have active tuberculosis, there is generally another early, unrecognized case. If such cases could be discovered, they could easily be cured. The time to put out a fire, or to control a disease, is before it gets well under way. When tuberculosis has gone far, it cannot usually be checked, but if the disease is attacked early there is every reason to be hopeful. Any one who has a cough that hangs on, or who feels run-down and tired without knowing why, or who grows feverish in the afternoon, should consult a physician at once, so that if the enemy is present it may be discovered in time.
The Campaign against Tuberculosis.—Since about 1895, a strong, organized campaign has been carried on against tuberculosis by the establishment of sanatoria and hospital, dispensaries, open-air schools, and day camps; by the work of Boards of Health in finding early cases of the disease and getting treatment for them; and by the education of the public through exhibits, lectures, and in other ways, as to the measures whereby the disease can be controlled.
The result of this campaign, and of a general improvement in living conditions, is that the death rate from tuberculosis has been reduced to about one half of what it was fifty years ago. There is still much to be done, however, for even to-day tuberculosis remains the largest single cause of preventable disease.
QUESTIONS FOR DISCUSSION AND REVIEW
1. What causes tuberculosis? From what does it get its name?
2. What part of the body is most often affected in this disease? What other parts of the body are sometimes affected?
3. Is tuberculosis caught from other people? In what ways does it differ from other communicable diseases, such as tonsilitis or measles?
4. What are some of the first symptoms of tuberculosis?
5. Between what ages does it usually develop?
6. What percentage of deaths are caused by it?
7. Explain how tuberculosis may be carried from one person to another by "Fingers." By "Food" By "Flies."
8. What can the patient do to save others from getting tuberculosis? What can the family do? What can you do?
9. What effect does vital resistance have upon tuberculosis?
10. Do you suppose that you have ever had a tubercle bacillus in your body? Why have you not developed tuberculosis?
11. People who work in close, dark places where the air is bad are likely to contract tuberculosis. Why?
12. People who work beyond their strength with insufficient food often have tuberculosis. Why?
13. Those whose work makes it necessary for them to breathe, constantly, air which is full of sharp particles are very likely to develop tuberculosis. Why?
14. If there is a big factory in your town, find out about the lighting, air, rest rooms, and general care of the employees. How can you justify increasing the running expenses of the factory for sanitation?
15. What effect does the use of alcohol have upon the development of tuberculosis?
16. Why can a tuberculosis cure be carried out better in a sanatorium than at home?
17. Why is it necessary to begin treatment in the very earliest stages of the disease?
18. How can the education of the public help to wipe out tuberculosis?
19. A laundress had to support her husband, who was con-fined to his bed with tuberculosis. They lived in one room, and she had to do the washing, drying, and ironing in that place. What harm would this do to the husband? What danger was there to others?
20. Has there ever been a Red Cross Seal Campaign in your town? Find out all you can about it.