Harriet L. Hennessy

“ The bacillus attacks every organ and tissue of the body, but some much more frequently than others. The commonest seats of tuberculous disease are the lungs, lymphatic glands, bones, serous membranes, mucous membranes, intestines and liver. Before the discovery of the bacillus its effects in different parts of the body received separate names and were classified as distinct diseases. For instance, tuberculosis of the lung was called "consumption" or "phthisis," of the bones and lymphatic glands "struma" or "scrofula," of the skin "lupus," or the intestinal glands "tabes mesenterica." ”

“ A great deal has been done in most countries for the dissemination of popular knowledge by forming societies, holding conferences and meetings, issuing cheap literature, and so forth. It is an important item in the general campaign against tuberculosis, because popular intelligence and support are the most powerful levers for setting all other forces in motion. ”

“ Several cases are recorded of healthy persons having contracted the disease after occupying rooms in which consumptive persons had previously lived. It is a legitimate inference that spitting in public is an important means of disseminating tuberculosis, though it may be noticed that international prevalence by no means corresponds with this disgusting practice, which is a perfect curse in Great Britain, and far more common both there and in the United States than on the continent of Europe. ”

“ The results of this modern treatment of tuberculous disease of the skin and of the lymphatic glands has been highly gratifying, for not only has the infected tissue been completely removed, but the resulting scars have been far less noticeable than they would have been had less radical measures been employed. One rarely sees now a network of scars down the neck of a child, showing how a chain of tuberculous glands had been allowed to work out their own cure. ”

“ Observations on animals similarly tend to disprove the existence of congenital tuberculosis (Nocard) . The theory that the germs may remain latent in the offspring of tuberculous parents (Baumgarten) is unsupported by evidence. The occurrence of disease in such offspring is ascribed to infection by the parents, and this view is confirmed by the fact that the incidence in consumptive families is greater on female children, who are more constantly exposed to home infection, than on the male (Squire) . ”

“ Tuberculosis in the Lower Animals.—Most creatures, including worms and fishes, are experimentally susceptible to tuberculosis, and some contract it spontaneously. It may be called a disease of civilization. Domesticated animals are more susceptible than wild ones, and the latter are more liable in captivity than in the natural state. Captive monkeys, for instance, commonly die of it, and of birds the most susceptible are farmyard fowls, but it is practically unknown in animals in the wild state. ”

“ The prevalence of tuberculosis in cattle is of importance from the point of view of prevention of the probability that abdominal tuberculosis, which is a very fatal form of the disease in young children, and has not diminished in prevalence like other forms, is caused by the ingestion of tuberculous milk. ”

“ The well-known susceptibility of the Irish has been attributed to the moisture of the climate, under-feeding, and the residual inferiority of a population drained by the emigration of a large number of able-bodied adults. That there is some added factor is shown by the fact that the above mortality of 339 in those having Irish mothers, in 1901, was greater by 31% than that of the Irish in Ireland at the same period. ”

“ Every case, except the most acute, bears signs of Nature’s effort in this direction; and complete success is not at all uncommon, even under the ordinary conditions of life. Perhaps it was not always so: the ominous character popularly attributed to consumption may once have been justified, and the power of resistance, as we see it now, may be the result of acquired immunity or of the gradual elimination of the susceptible. ”

“ The nature of the occupations and the density of population in any given area tend to its increase or otherwise, and the comparative immunity enjoyed by uncivilized races is due to their open-air life and to the sanitary advantages derived from the comparatively frequent changes of the sites of their camps and villages. ”

“ In proportion as progress is slow the breaking-down and destructive process is replaced by one in which the formation of fibrous tissue is the chief feature. It may be regarded as Nature's method of defence and repair. In tuberculosis of the lungs, for instance, we have at one end of the scale acute phthisis or "galloping consumption," in which a large part or even the whole of a lung is a mass of caseous tubercle, or is honeycombed with large ragged cavities formed by the rapid destruction of lung tissue. ”

“ In the next stage the cells forming the tubercle undergo the degenerative change known as "caseation," which merely means that they assume in the mass an appearance something like cheese. In point of fact, they die. This degeneration is believed to be directly caused by a toxin produced by the bacilli. The further progress of the disease varies greatly, probably in accordance with the resisting power of the individual. ”

“ Their general aim is the avoidance of infection, and they include (1) the provision of special institutions—hospitals, sanatoria and dispensaries; (2) the prevention of spitting; (3) the notification of consumption; (4) the administrative control of tuberculosis in animals; (5) the dissemination of popular knowledge concerning the nature of the disease.
The greatest stress is laid upon the prevention of spitting, because the germs are contained in the sputum of consumptive persons, and are scattered broadcast by expectoration. ”

“ The power of the sun in high altitudes is so great that the treatment can be continued even when the snow is on the ground. Not only is the sun-treatment applicable to pulmonary tuberculosis, but also to the tuberculosis of joints, even in advanced cases. The treatment has to a great extent replaced surgical procedure in tuberculosis of joints, but it requires to be persevered in over a considerable period of time. It should be remembered that the benefits of fresh air are not confined to sanatoria. ”

“ Segregation of these races in fixed areas has shown an increased incidence of tuberculosis, and when living under civilized conditions they fail to exhibit any natural immunity. Altitude has an apparent influence on the frequency of phthisis, the rarity of the disease at high altitudes in Switzerland having been demonstrated, and a like protective influence is enjoyed by certain elevated districts in Mexico, notwithstanding the insanitary conditions of the towns thereon. ”

“ Stefansky found the disease in 5% of the rats caught in Odessa, and Lydia Rabinowitch obtained similar results in rats caught in Berlin. But there are evidently degrees of natural resistance also. Horses are more confined than cattle in the United Kingdom, yet they are far less affected; and on the other hand, cattle running free in the purest air may take the infection from others. Professor McEacharn of Montreal states that he has seen tuberculosis prevalent in ranch cattle, few of which were ever under a roof, ranging on the foothills of the Rocky Mountains in Montana. ”

“ If the superstitious dread of the outer air, particularly at night, could be abolished in ordinary life, more would be done for public health than by the most costly devices for eluding microbes. Not only consumption, but the other respiratory diseases, which are equally destructive, are chiefly fomented by the universal practice of breathing vitiated air in stuffy and overheated rooms. ”

“ While no race is exempt from tuberculosis, certain races afford a greater case incidence. E. Baldwin states that the mortality from consumption in recently immigrated races in the United States is much greater than in those of longer residence. It was found that among those whose mothers were of foreign birth the rate was—in Russians 71.8, Germans 167, Scottish 172.5, French 187.7 and Irish 339.6, while in native-born Americans it was 112.8. ”

“ On this view the answer to the question, Can the bovine bacillus affect man? is obviously in the affirmative. The same answer must also be given to those who hold the theory that human and bovine tubercle bacilli are different in kind, since the ' bovine kind ' are readily to be found as the causal agents of many fatal cases of human tuberculosis. ”

“ The distribution of tuberculosis is universal, and it is coincident with Distribution and Mortality. the existence of the human race in the habitable regions of the globe. Its comparative absence in the Arctic regions seems more due to the sparsity of population than to climatic effect. Indeed, it has been shown that climate has much less effect in its prevalence than has been formerly thought to be the case, the conclusion of Hirsch being that “ the mean level of the temperature has no significance for the frequency or rarity of phthisis in any locality.” ”

“ In England, where more than 14 millions of the population belong to friendly societies, it is estimated that the sick pay of consumptive members costs three times as much as the average sick pay to members dying of other causes. ”

“ The last has been carried to rather extravagant lengths in some institutions, where the patients are stuffed with food whether they want it or not. The sanatorium movement on the German model is rapidly extending in all countries. For those who are able to do so advantage may be taken of the combined sanatorium and sun treatment. In certain high altitudes in Switzerland, which are favoured by a large amount of sunshine and a small percentage of moisture, much benefit has been derived from the exposure of the unclothed body to the sun’s rays. ”

“ Whatever measures may be taken for the public protection, individuals can readily protect themselves from the most serious danger by boiling milk; and unless the source is beyond suspicion, parents are recommended, in the present state of knowledge, so to treat the milk given to young children. ”

“ In proportion as resistance is small and progress rapid the cheesy tubercles tend to soften and break down forming abscesses that burst when superficial and leave ulcers, which in turn coalesce, causing extensive destruction of tissue. ”

“ Act 1878 and the Infectious Diseases Prevention Act 1890 should apply to tuberculosis. By this act also the county councils were enabled to establish hospitals and dispensaries for the treatment of tuberculosis and were empowered to borrow money or levy a poor rate for the erection of sanatoria for the treatment of persons from their respective counties suffering from the disease. ”

“ The example has been followed in other countries to a certain extent, and a good many of these establishments have been provided in Great Britain and elsewhere; but they are, for the most part, of a private character for the reception of paying patients. Germany has extended these advantages to the Working classes on a large scale. ”