"All that I know, I owe to my mother."
Abraham Lincoln.

HOW WE CATCH DISEASE

A simple explanation of how we "catch" disease may be interesting and profitable. Let us take, for example, a case of consumption. In order to "catch" consumption it is necessary to breathe into our lungs the germ of consumption.

How do we "catch" these germs?

If a consumptive patient spits or expectorates on the street, or on the floor of a railroad car, or in a room, or store, or theater, after a time the spittle becomes dry, and because of the wind or a breeze which may be caused by opening or shutting a door, or it may be the skirts of women walking about, the dried sputum in which the germs are becomes mixed with the dust of the air. If we happen to be around, just at the particular time when the germs are blown into the air, we may breathe into our lungs enough of them to produce consumption. If we are in good health, and if we do not happen to get too large a dose of the bacteria at one time (and that is only a matter of luck), we can overcome them, as will be shown shortly. If, however, we are not in good health, if we are just recovering from some serious or depressing disease, such as Grippe, the bacteria will overcome our reserve vitality, and consumption will graft itself on our weakened system.

How do these germs work?

They lodge on some part of the lung tissue and burrow into it. They make a nest for themselves and begin work immediately. They live on the lung tissue, they multiply rapidly, they produce—as a result of their activity—a poisonous substance. Because of their eating up, as it were, the lung tissue we often find holes (cavities) in the lungs of consumptives. By breeding rapidly they require more and more room, so they invade more and more of the lung tissue and destroy it. The poisonous substance which they produce is absorbed by the blood. Its effect on the blood is to weaken it, and when the blood becomes weak the vitality declines, so that the patient loses weight, appetite, and strength. The poison also produces fever, and so the long, weary fight goes on till death claims the patient.

What Happens If We Inhale These Bacteria, and Consumption Does Not Develop.—In order to understand the answer to this question it is necessary to explain certain facts concerning the white blood cells. The white blood cells can pass through a blood vessel and back into it again without leaving any hole in the wall of the blood vessel.

The function of the white blood cells is to wander around and if they discover any stray bacteria, whose presence is undesirable, it is their duty to get rid of it as quickly as possible. The white blood cell may therefore be likened to a detective whose duty it is to arrest any suspicious character who comes into the city. When a white blood cell discovers a strange microbe it immediately surrounds and encloses it within itself, just as your hand can enclose any small object, such as a cent or a dime. It then promptly goes to the nearest blood vessel, enters it, and is carried away in the blood stream. If we are in good health our blood cells are alert, active, and capable of defending us against any invading foe in the form of a microbe or bacteria. If we are not in good health the bacteria may overcome the white blood cells. If we inhale a large number of the consumptive bacteria at one time, and they succeed in getting into the lung substance, they are immediately met by an army of blood cells, all bent on capturing them. An actual battle is fought and the deciding factor of the battle will be the condition of the patient. If there is plenty of strength and reserve force, if the patient is in good health, the blood cells will win the battle; if the condition of the patient is poor, the blood cells will lose the battle and tuberculosis, or consumption, has its beginning in that patient from the time the blood cells lose their fight. We know the battle has been lost because the well-known symptoms of the disease soon appear. The blood cells do not retreat when defeated; they go on fighting to the best of their ability. Whether they ever succeed in overcoming the bacteria, depends upon the treatment the patient gets, and his personal conduct. We give him a maximum of fresh air and sunlight because these are the great enemies of all kinds of bacteria. We force his feeding and try to stimulate his appetite, hoping thereby to give him strength so that his blood cells will fight actively in his interest. We take steps to reduce his fever so that his strength may not be wasted and burned up. If we succeed, with the necessary active coÖperation of the patient, the blood cells finally overcome the bacteria and the patient recovers from the disease.

This is the story of the invasion of almost every disease. It is the story of the white blood cell.

The white blood cell is active in another way and it is a very interesting way. When you cut yourself the blood cells immediately surround the entire cut. They line up like an army defending a city. They form a perfect wall, millions of them, ready to pounce upon all enemies in the form of bacteria or microbes, that have the temerity to try to creep into the wound unseen.

This is the reason that so very few of the hundreds of little surface wounds and scratches which every one gets, ever become infected or go wrong in any way.

When a microbe does get inside, under the skin, and becomes active, as they sometimes will, the white blood cell, appreciating that it cannot defeat the enemy, begins to build a wall around him and locks him in. This compels the enemy to limit his activity within the wall, which he does, and so an abscess is formed, which bursts when the bacteria fill it so full that the wall gives way and empties the poison out on the surface of the skin, thus saving the body from the poison of the microbe which would spread all through the body, were it not for the wall formed by the active, busy little white blood cell.

The foregoing simple explanation of "how we catch disease" will no doubt be suggestive to the interested and careful reader. The first and most obvious question that suggests itself is: If we "catch" tuberculosis by inhaling germs from some other person's dried spittle, why are consumptives allowed to spit where it will do harm? Consumptives are not allowed to spit where it will do harm, but they do and they always will.

Every department of health in every civilized corner of the globe has secured the enactment of laws making spitting unlawful in any public place. Every sanitary society, every agency whose aim is to work in the interest of public health, has actively aided, and is aiding, in the propaganda for a better universal understanding of the principles of sanitation and hygiene. The individual must be educated to understand the tragic need of such a law. You cannot legislate virtue into the public conscience. It is a profound reflection upon human intelligence to appreciate that the great white plague, for the stamping out of which so many thousands of lives are annually sacrificed, and so much money is spent, could be forever stamped out, if the human race would agree absolutely to stop spitting.

It is the duty of every person to take an active personal interest in this crusade of education and emancipation. We appreciate and concede that a large number of those afflicted with consumption do not willfully spit, knowing that others may be affected as a consequence. They do it in ignorance. Our aim is to educate the victim to an understanding of the true condition. The knowledge must be carried into every home, and the story must be told in a simple, convincing way, to attain results. The mothers of the country can aid to a very considerable degree, in this commendable work. Every mother can tell her children the story of how disease is caught. She can tell them that the danger spots of infection are where people congregate together, in church, school, theater, street-cars, and railroad trains. She can teach them to breathe through their nostrils, especially when in these public places, because the nostrils are so constructed that they act as a sieve or strainer, they clean the air we breathe, and when we blow the nose after being in one of these places we blow out thousands of germs and other impurities which would have gone straight into the lungs if we had breathed through the mouth. She can teach them the value of deep breathing when in the open air, and of standing and walking erect so as to get all the lung space possible. By constantly reminding children of these little points you will be amazed at the progressive improvement which goes on both in their bodies and in their minds. They will become little missionaries, they will tell the story to others, and a real good can be accomplished in this simple way, that will grow in strength and vigor as the years roll round.

The next suggestive feature in the reading of "How we catch disease," is the significant emphasis which is put upon sunlight and fresh air in the treatment of consumption. Sunlight, as already stated, is the great enemy of microbes and germs of all kinds. Where sunlight is, germs do not want to be. How wrong, therefore, is the habit of lowering the shades, when the sun shines into your home, because it "spoils the carpet." Let it spoil the carpet; it is much cheaper to buy a new carpet than to pay for a funeral. Let the sunlight stream into your rooms for the few hours it can every day. Germs love the dark, sunless corners where the dust is. Housewives should, therefore, go into the dark corners with a moist duster, and wipe them clean, then boil the duster and hang it in the sunlight to dry until needed again. If you choose to use a feather duster instead, as the lazy woman does, you only chase the dust and the germs from one corner to another, and in doing so you afford yourself the opportunity of swallowing a few germs in the passing. One may, therefore, be punished in an unexpected way for being lazy.

For the very excellent reason that corners and angles are unsanitary, there are to be no more of them in the construction of houses and office buildings of the better class. They are being built with "round" corners; even the ceiling and walls, and floor and walls, meet in a curve,—no square crevice or corner where dust or germs can gather.

If we add moisture to a sunless spot, we have the ideal environment for germs to breed and flourish in. There is always moisture or humidity in the air if the altitude is low, and if it is near the ocean, or any large body of water, the moisture is relatively greater. For this reason we send patients with pulmonary disease to the mountains, where the altitude is much higher, where there is no moisture, and consequently where there are practically no germs. We cannot move our homes to the mountains, however, so what must we do to get rid of the moisture and the germs where we are compelled to live? What do we do with the family wash when it is wet? We hang it up in the yard, in the sun and in the breeze, because we know from experience that the wind and the sun soon dry anything wet. They do more; they freshen everything, so that anything exposed to the sun and air smells fresh and sweet and is fresh and sweet and pure. So to make our homes sweet and fresh and dry we must chase the stale air away, and the moisture with it, by opening our windows and letting in the sunlight and the breeze, every day, and for as long as possible every day. Open windows and sunlight and fresh air,—all you can get,—this is the song of health, the joy of life, the only agents that will keep the eager, busy, little white blood cell healthy and willing and alert. This is the reason you must keep the windows of your bedrooms open at night, as well as by day, so you and your children will get fresh, pure, sweet air, and not stale, moist, germ-laden air to breathe.

FACTS ABOUT TUBERCULOSIS

Tuberculosis, or consumption, is a disease of poor air, dusty quarters, insufficient nourishment, and, above all, of ignorance with regard to its dangers and what we now know of the possibilities of its cure. The more we know about it the better chance there is to cure it, and better still, prevent it.

Not very long ago the death rate from consumption was one in six, that is, every sixth person who died in this country died as a result of tuberculosis in some form. It is now about one in eight. This is a remarkable decrease—about one-third of its former ratio of victims are now spared. Not so very long ago the disease was regarded as practically fatal; now it is classified as one of the eminently curable diseases. The universal dissemination of this knowledge will do much to rob the "Great White Plague" of its terrors.

Investigation and observation have demonstrated that there is in the great majority of people a definite tendency successfully to throw off the disease. It is a curious and astonishing fact, which we have learned from the study of the results of autopsies; we find, in nearly every instance, that every person in whom death occurred after thirty had had consumption at one time and resisted it and died of some other disease. We mean by this that at some time, in all likelihood during one of the "colds" of childhood, every one of us contracted consumption, but because of our vitality we successfully resisted and conquered it. In other words, the white blood cells won their fight.

This knowledge is of great value; it taught the scientists who were studying the characteristics of the disease that there were conditions, possible of attainment, under which the human organism could definitely and victoriously defeat the invasion of the tubercle bacilli.

The public mind, until recently, was imbued with the fallacy that the disease was hereditary. It was thought that if it "ran in the family" the victims of it were almost certain to die. We know definitely now that consumption is not hereditary, and that, instead of death being certain in a patient in whose family it has been, this fact alone ensures the victim a much better prospect of cure than if it had never existed in the family. The explanation of this seeming paradox is quite logical from a medical standpoint. The theory of the vaccine treatment of disease is that if you infuse into the blood the products of the germs of certain diseases, the individual in whose blood the vaccine has been put, will wholly resist that particular disease, or if he acquires it, it will be in a mild and more modified form. If a family for a number of generations has had various members die of tuberculosis, the blood stream of the family will have become so impregnated with the toxins, or poisons, of the disease, that, in time, a certain immunity will have been established. Consequently, tuberculosis in an individual, the blood of whose ancestors has been accustomed or habituated to the poison of the disease, will run a milder course, be more modified in its type, and will respond to treatment easier than in an individual whose family history is free from the taint of tuberculosis.

In proof of this principle, it is a well-known fact that consumption runs a rapid, fatal course among those nations which have not hitherto been exposed to it. The death rate among our American Indians when it was first introduced among them was enormous.

The same truth applies to syphilis. The blood of the civilized race has become so thoroughly syphilized, that it is no longer so susceptible to the disease as it once was: and the disease as we know it to-day does not manifest the same virulency as it did years ago, or as it does in a race in whom it is grafted for the first time.

These ideas of the curability of the disease and of its non-heredity are extremely important and supremely suggestive. Tuberculosis takes only the quitters and the supine. Anyone who will fight bravely against the disease can always resist its ravages for many years, if not to the extent of living out a normal life.

The Tendency to Disease.—Mothers should understand just what is meant by "the tendency to disease." We assert that consumption is not hereditary, but we know that certain individuals are born with the tendency to tuberculosis. Just what does this mean?

Let us suppose a tubercular mother gives birth to a child. It would be foolish to assume that this child comes into the world with a normal standard of resistance; but it is certain he is not tubercular and doomed at the moment of his birth. He may be what is ordinarily termed a weak, puny, sickly infant, but the germ of disease is not implanted in his constitution. If he is taken from his mother, taken away from the tubercular environment, and brought up under the best hygienic and sanitary surroundings, it is possible for him to become a robust, healthy, normal man.

The tendency to disease in this case will not materialize. If, however, we permit him to remain with his tubercular mother, to nurse her milk, to live in what necessarily is an unhygienic and unsalutary environment—the presence of the consumptive mother renders it so—the probability is that the tendency to disease, which in his case is the tendency to weak lungs, will materialize, because of his weak resistance, poor nourishment, and unfavorable surroundings. If, therefore, his method of living does not contribute to building up and strengthening what is in the first place a weak structure, the structure itself will, during the first strain put upon it, give way, and naturally the weak spot will be the point of election for the invasion of disease. This strain may be one of the infantile diseases,—scarlet fever, or measles, or whooping cough, or it may be bronchitis. Instead of convalescing from these conditions, as a normally constituted child will, this child, whose potential resistance is below standard, will fail to reach the rallying point, will afford a fertile field for germ invasion, and will develop tuberculosis,—not directly, however, as a result of having had a tubercular mother, but because he was not removed from the tubercular environment and given a fair chance. The high infant mortality is, to a very large extent, caused directly by this "tendency to disease," plus unfavorable environment, and this is wherein the eugenic propaganda has found its field of promise and is unassailable reason for active existence.

Let us take another illustration, so that mother may have a full understanding of the far-reaching effect of the "tendency to disease."

We cannot justly assume a child to have outlived its hereditary tendencies until it has reached the period of its full growth, physically, mentally, and morally. We know that this period is about the twenty-third year. Now a young girl of eighteen, or even twenty, who is successfully resisting an inherited tendency, is likely to reach her full physical and mental growth, providing she does not subject her vitality to a serious physical strain, or providing she is not the victim of a serious illness. Suppose this young girl marries and becomes pregnant; this condition immediately changes the fighting or resisting equation; she is no longer conserving her strength and energy; she is spending it out, wasting it so far as it applies to her own upbuilding. The percentage in favor of a successful fight against the inherited tendencies is greatly reduced, and as a matter of fact, statistics show—as is fully explained in the article on "The Evils of Early Marriage"—that many of these young mothers succumb to disease as a result of pregnancies at this period of immaturity, when they could have otherwise lived. The "tendency to disease" has therefore an economic value and the state should build along the line of the conservation of health in its broadest sense.

The Best Treatment for Tuberculosis.—The most important factor in the present-day treatment of consumption is the right kind of nourishment. This cannot be emphasized too strongly. In the first edition of this work, it was stated that the most important factor in the treatment of this disease was fresh air. The author has had very good reasons to change his opinion radically in this respect.

So emphatically may this truth be asserted that it is now not at all necessary to seek a change of climate in the hope that such a change may aid the patient. It must not, however, be understood that this reasoning applies to charitable cases. If the patient is so situated that it is not possible to provide a proper environment, a change may do good. It is not the change of air that is responsible for the improvement, however, though it no doubt contributes in these cases; it is the altered environment.

Patients who in their own homes enjoy sanitary and hygienic care; who may have a room of ample size for their exclusive use, which is thoroughly aired, day and night; who are provided with the "right kind of nourishment," and who will obey implicitly the rules which the physician, who is conversant with this particular method of treatment, will lay down, may be assured that a prompt response will ensue. The intelligent reader will understand that this statement does not apply to patients in the last stages of the disease. The assertion, however, must rightly be regarded as revolutionary. It is not what we were taught—it emphasizes, nevertheless, what every physician already knows, that, theoretically, consumption is a disease that should respond to treatment. That we have not had greater success with it in the past, must be attributed to our method of treatment. The fact that most of us have had the disease, and have recovered, conclusively demonstrates its curability. Those individuals who fail to recover promptly do not possess the vitality to throw it off spontaneously. If at this time—the real beginning of the disease—it is discovered, and the right treatment instituted, we immediately supply the organism with the ingredients it is deficient in and we are justified in looking for favorable results if the patient adheres to the instructions.

The second essential in the treatment of consumption is an abundance of fresh, pure air. We therefore direct the patient to remain in the open as much as is possible. If circumstances permit him to sleep out-of-doors, so much the better; if not, he must sleep in a room with the windows open to the fullest extent, winter and summer. There are no exceptions to this rule. If it storms, the outside blinds may be closed, but the windows must remain open. The city air is just as efficient for our purpose as is the air of any other vicinity—the point is, to get enough of it from a mechanical standpoint. The advantages from sending patients away, even under the old belief, were more than discounted by conditions incident to the new environment that were detrimental to their progress. Now that we know it is not necessary or essential to procure any other kind or quality of air than exists in any city, all our efforts may be concentrated in the interest of the patient in directing the "right kind of nourishment" and in supervising his conduct. In few instances is it necessary to prescribe any medicine.

In exceptional cases the cough may require some sedative remedy, especially if it disturbs the patient at night. Experience has taught us, however, that to live twelve hours in the open air and to sleep with the windows wide open, will do more for the cough than any medicine we possess.

Pleuritic complications may cause pain, but this feature is best aided and permanently relieved by fresh air also. Very recently there were made exhaustive experiments in this connection in St. Thomas' Hospital, London, England. It was decided to subject patients to open-air tests for pleuritic pains in the course of consumption. This particular hospital is situated on the River Thames, in a notoriously damp and foggy part of the city; despite this drawback it was conclusively shown that the patients who lived night and day on the balconies breathing this heavy, murky, damp atmosphere, were relieved of their pains quicker, and more permanently, than those who were shielded in the wards of the hospital.

Inasmuch as the patient must be adequately nourished, his cure depends upon the condition of the stomach. It is known that the germ works more actively in a patient who is losing weight. When the germ is very active, its poisons, circulating in the blood, cause fever and fever results in tissue waste. We must therefore bend every effort toward overcoming this tendency. If we can get the patient to take sufficient food and if he digests it thoroughly, the weight will increase, the fever will subside, and the tissue waste will stop. Patients must be extremely careful, therefore, what they put into their stomachs. Only simple, tasty, highly nutritious food should be taken, and digestive energy should not be wasted on less nutritious materials. For this reason incalculable harm has been done by indiscriminate medicine-taking. Medicines exert a bad influence on the stomach and those patients who take them lose their appetites. Drugs should never be taken except for a definite purpose and only on the advice of a physician. These patients should particularly be guarded against the use of advertised patent medicines. They are always bad, and never under any circumstances are they of any advantage, as is clearly shown in the chapter on "Patent Medicines." Thousands of persons die of consumption every year who would have lived had they not taken such remedies.

The following article is sent out by the New York Department of Health as a Circular of Instruction regarding Tuberculosis.

INFORMATION FOR CONSUMPTIVES AND THOSE LIVING WITH THEM

Consumption Is Chiefly Caused by the Filthy Habit of Spitting.—Consumption is a disease of the lungs, which is taken from others, and is not simply caused by colds, although a cold may make it easier to take the disease. It is caused by very minute germs, which usually enter the body with the air breathed. The matter which consumptives cough or spit up contains these germs in great numbers—frequently millions are discharged in a single day. This matter, spit upon the floor, wall or elsewhere, dries and is apt to become powdered and float in the air as dust. The dust contains the germs, and thus they enter the body with the air breathed. This dust is especially likely to be dangerous within doors. The breath of a consumptive, except when he is coughing or sneezing, does not contain the germs and will not produce the disease. A well person catches the disease from a consumptive only by in some way taking in the matter coughed up by the consumptive.

Consumption can often be cured if its nature be recognized early and if proper means be taken for its treatment. In a majority of cases it is not a fatal disease.

It is not dangerous to live with a consumptive, if the matter coughed up by him be promptly destroyed. This matter should not be spit upon the floor, carpet, stove, wall, or sidewalk, but always, if possible, in a cup kept for that purpose. The cup should contain water so that the matter will not dry, or better, carbolic acid in five per cent. watery solution (six teaspoonfuls in a pint of water). This solution kills the germs. The cup should be emptied into the water closet at least twice a day, and carefully washed with boiling water.

Great care should be taken by consumptives to prevent their hands, face, and clothing from becoming soiled with the matter coughed up. If they do become thus soiled, they should be at once washed with soap and hot water. Men with consumption should wear no beards at all, or only closely cut mustaches. When consumptives are away from home, the matter coughed up should be received in a pocket flask made for this purpose. If cloths must be used, they should be immediately burned on returning home. If handkerchiefs be used (worthless cloths, which can be at once burned, are far better), they should be boiled at least half an hour in water by themselves before being washed. When coughing or sneezing small particles of spittle containing germs are expelled, so that consumptives should always hold a handkerchief or cloth before the mouth during these acts; otherwise the use of cloths and handkerchiefs to receive the matter coughed up should be avoided as much as possible, because it readily dries on these and becomes separated and scattered into the air. Hence, when possible, the matter should be received into cups or flasks. Paper cups are better than ordinary cups, as the former with their contents may be burned after being used. A pocket flask of glass, metal, or pasteboard is also a most convenient receptacle to spit in when away from home. Cheap and convenient forms of flasks and cups may be purchased at many drug stores. Patients too weak to use a cup should use moist rags, which should at once be burned. If cloths are used they should not be carried loose in the pocket, but in a waterproof receptacle (tobacco pouch), which should be frequently boiled. A consumptive should never swallow his expectoration.

A consumptive should have his own bed, and, if possible, his own room. The room should always have an abundance of fresh air—the window should be open day and night. The patient's soiled wash-cloths and bed linen should be handled as little as possible when dry, but should be placed in water until ready for washing.

Rooms should be cleaned daily, but in order to prevent the raising of dust, all floors must be well sprinkled before sweeping, and all dusting, etc., done with damp cloths.

If the matter coughed up be rendered harmless, a consumptive may frequently not only do his usual work without giving the disease to others, but may also thus improve his own condition and increase his chances of getting well.

Rooms which have been occupied by consumptives should be thoroughly cleaned, scrubbed, and whitewashed, painted, or papered before they are again occupied. Carpets, rugs, bedding, etc., from rooms which have been occupied by consumptives, should be disinfected. Such articles, if the Department of Health be notified, will be sent for, disinfected, and returned to the owner free of charge, or, if he so desires, they will be destroyed.

When consumptives move they should notify the department of health. Consumptives are warned against the many widely advertised cures, specifics, and special methods of treating consumption. No cure can be expected from any kind of medicine or method except the regularly accepted treatment, which depends upon pure air, an out-of-door life, and nourishing food.

Consumptives having an opportunity of entering a sanatorium, should do so at once.