Preventable Diseases

One of the darling habits of humanity is to discover that we are facing a crisis. One could safely offer a large prize for a group of ten commencement orations, or political platforms, at least a third of which did not announce this momentous fact. Either we are facing it or it confronts us, and unutterable things will happen unless we "gird up our loins," and vote the right ticket. An interesting feature about these loudly heralded crises is that they hardly ever "crise." The real crisis either strikes us so hard that we never know what hit us, or is over before we recognize that anything was going to happen. And most of our reflections about it are after ones--trying to explain what caused it. In fact, in public affairs, as in medicine, a crisis is a sign of recovery. Its occurrence is an indication that nature is preparing to throw off the disease. Nowhere is this truth more vividly illustrated than in the tuberculosis situation. When, about thirty years ago, the world began to awake from its stupor of centuries, and to realize that this one great disease alone was killing one-seventh of all people born under civilization, and crippling as many more; that its killed and wounded every year cast in the shade the bloodiest wars ever waged, and that it was apparently caused by the civilization which it ravaged,--no wonder that we were appalled at the outlook.

Here was a disease of civilization, caused by the conditions of that civilization. Could it be cured without destroying its cause and reverting to barbarism? Yet this very apprehension was a sign of hope, a promise of improvement. That we were able to feel it was a sign that we were shaking off the old fatalistic attitude toward disease,--as inevitable or an act of Providence. It was brought about by the more accurate and systematic study of disease. We had long been sadly familiar with the fact that death by consumption, by "slow decline," by "wasting" or "slow fever," was frightfully common. "To fall into a decline" and die was one of the standard commonplaces of romantic literature. But that was quite different from knowing in cold, hard figures and inescapable percentages exactly how many of the race were killed by it. It is one of the striking illustrations of the advantages of good bookkeeping. Boards and departments of health had just fairly got on their feet and started an accurate system of state accounts in matters of deaths and births. We were beginning to recognize national health as an asset, and to scrutinize its fluctuations with keen interest accordingly.

We may decry statistics as much as we like, but when we see the effects of a disease set down in cold columns of black and white we have no longer any idea of submitting to it as inevitable. We are going to get right up and do some fighting. "One-seventh of all the deaths" has literally become the war cry of our new Holy War against tuberculosis. Still another stirring phrase of inestimable value in rousing us from our torpor was that coined by the brilliant and lovable physician-philosopher, Oliver Wendell Holmes: "The Great White Plague of the North." This vivid epithet, abused as it may have been in later years, was of enormous service in fixing the public mind on consumption as a definite, individual disease, something to be fought and guarded against. Before that, we had been inclined to look upon it as just a natural failing of the vital forces, a thing that came from within, and was in no sense caused from without. The fair young girl, or the delicate boy whose vitality was hardly sufficient to carry him through the stern battle of life, under some slight shock, or even mental disappointment, would sink into a decline, gradually waste away, and die. What could be done in such a case, except to bow in submission to the inscrutable ways of Providence?

It seems incredible now, but such was the light in which smallpox was regarded by physicians of the Arabian and mediaeval schools: a natural oozing forth of "peccant humors" in the blood of the young, a disagreeable, but perfectly natural, and even necessary, process. For if the patient did not get rid of these humors either he would die or his growth would be seriously impaired. Now smallpox has become little more than a memory in civilization, and consumption is due to follow its example.

Sanitary pioneers had already begun casting about eagerly for light upon the influence of housing, of drainage, of food, in the causation of tuberculosis, when a new and powerful weapon was suddenly placed in their hands by the infant science of bacteriology. This was the now world-famous discovery by Robert Koch that consumption and other forms of tuberculosis were due to the attack of a definite bacillus. No tubercle bacillus--no consumption.

At first sight this discovery appeared to be anything but encouraging. In fact, it seemed to make the situation and the outlook even more hopeless. And when within a few years it was further demonstrated in rapid succession that most of the diseases of the spine in children, of the group of symptoms associated with enlarged glands or kernels in the neck and known as "scrofula" or struma, most cases of hip-joint disease, of white swelling of the knee, a large percentage of chronic ulcerations of the skin known as lupus, a common form of fatal bowel disease in children, and many instances of peritonitis in adults, together with fully half of the fatal cases of convulsions in children, were due to the activity of this same ubiquitous bacillus, it looked as if the enemy were hopelessly entrenched against attack. And when it was further found that a similar bacillus was almost as common a cause of death and disease in cattle, particularly dairy cattle, and another in domestic fowls, it looked as if the heavens above and the earth beneath were so thickly strewn and so hopelessly infested with the germs that to war against them, or hope to escape from them, was like fighting back the Atlantic tides with a broom.

But this chill of discouragement quickly passed. Our foe had come down out of the clouds, and was spread out in battle array before us, in plain sight on the level earth. We were ready for the conflict, and proposed to "fight it out on this line if it takes all summer." It was not long before we began to see joints in the enemy's armor and weaknesses in his positions. Then, when we lowered our field-glasses and turned to count our forces and prepare for the defense, we discovered with a shock of delighted relief that whole regiments of unexpected reinforcements had come up while we were studying the enemy's position. These new allies of ours were three of the great, silent forces of nature, which had fallen into line on either side and behind us, without hurry and without excitement, without even a bugle-blast to announce their coming.

The first was the great resisting power and vigor of the human organism, which we had gravely underestimated. The second, that power of adaptation to new circumstances, including even the attack of infectious diseases, which we call "survival of the fittest." The third, that great, sustaining, conservative power of nature--heredity. More cheering yet, these forces came, not merely fully armed, but bearing new weapons fitted for our hands. The vigor and unconquerable toughness of the human animal presented us with three glittering weapons, sunshine, food, and fresh air.

"If the deadly bacillus breaks through the lines, put me in the gap! With these weapons, with this triad, I will engage to hurl him back, shattered and broken." "Equip your vanguard with them, and the enemy will never break the line."

The survival of the fittest held out to us two weapons of strange and curious make, one of them labeled "immunity," the other "quarantine." "Give me a little time," she said, "and with the first of these I will make seven-tenths of the soldiers in your army proof against the spears of the enemy, as Achilles was when dipped in the Styx. With the other, surround and isolate every roving band of the enemy that you can find; drive him out of the holes and caves in which he lives, into the sunlight. Hold him in the open for forty-eight hours, and he will die of light-stroke and starvation. Divide and conquer!"

These reinforcements of ours have proved no mere figure of speech. They have won many a battle for us already upon the tented field. They have not merely made good their promises, but gone beyond them, and we are only just beginning to appreciate their true worth, and how absolutely we can rely upon them.

The first outpost of the enemy was captured with the sunshine-food-air weapons, and a glorious victory it was,--great in itself, and even more important for its moral effect and its encouragement for the future. To pronounce an illness "consumption" had been from time immemorial equivalent to signing a death-warrant. Even the doctors could hardly believe it, when the first open-air enthusiasts began to claim that they had actually cured cases of genuine consumption. For long there was a tendency to mutter in the beard, "Well, it wasn't genuine consumption, or it wouldn't have got better."

But after a period of incredulity this gave way to delighted confidence. The open-air method would cure, and did cure, and the patients remained cured for years afterward. Our first claims were barely for twenty-five or thirty per cent of the threatened victims. Then we were able to increase it to fifty per cent; sixty, seventy, and finally eighty were successively reached. But with the increase of our power over the cure of this disease came a realization of our knowledge of its limitations. It quickly proved itself to be no sovereign and universal panacea, which would cure all cases, however desperate, or however indiscriminately it was applied. And emphatically it had to be mixed with brains, on the part both of the physician and of the patient.

In the first place, the likelihood of a cure depended, with almost mathematical certainty, upon the earliness of the stage at which it was begun. Eight or ten years ago the outlook crystallized itself into the form which it has practically retained since: of cases put under treatment in the very early stage, from seventy to ninety per cent were practical cures; of ordinary so-called "first-stage" cases, sixty to seventy per cent; second-stage cases, or those in whom the disease was well developed, thirty to sixty per cent; and well-advanced cases, fifteen to thirty per cent of apparent cures. The crux of the whole proposition lies in the early recognition of the disease by the physician, and the prompt acceptance of the diagnosis by the patient, and his willingness to drop everything and fight intelligently and vigorously for his life. Physicians are now thoroughly awake on this point, and are concentrating their most careful attention and study upon methods of recognition at the earliest possible stages. At the same time those magnificent associations for the study and prevention of tuberculosis, international, national, state, and local,--the greatest of which, the International Tuberculosis Congress, has just honored America, by meeting in Washington,--are straining every nerve to educate the public to understand the importance of recognizing the earliest possible symptoms of this disease, no matter how trivial they may appear, and making every other consideration bend to the fight.