Consumption a curable and preventable disease; what a layman should know about it

Front matter

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HEALTH SCIENCES STANDARD

Contents

PAGE

Introduction, . 9

What Consumption is, I5

Introduction

WHEN Pasteur gave the world his great discovery that fermentation is due to life, he blazed the way for exact knowledge about disease which since has been pursued with great success. From the knowledge that fermentation was due to a living organism to the theory that disease was due to a living organism was but a step — and a step easily taken, inasmuch as some men had already suspected that disease was but an episode in organic nature. Well-directed research soon displaced theory with fact.

Pasteur himself was the first to extend his discovery into the domain of disease by demonstrating that disease which affected wine was due to the parasitic life of minute organisms so small as to require a powerful lens to reveal them to the naked eye. Next, he v/as able to show that disease

I o Introduction

which destroyed the silk worm was likewise due to the parasitic life of micro-organisms, as such minute living things came to be called. Other laborers entered the field, and one by one diseases yielded up their secrets.

We now know the definite cause of many diseases, each a microscopic organism endowed with life and the essential qualities of all living things. These are birth, growth, reproduction, and death. Of some diseases the cause still lies hidden. We have not yet been able to bring to light the organisms which produce them although by analogy we have good reason to believe that such organisms exist. In time we will know all.

The new knowledge about disease which has come into the world is destined to revolutionize everything. The microscope is making us acquainted with a kingdom in nature which we did not dream of before, and which is as important for the mainten-

Introduction 1 1 ance of the existing state of things as are the animal and vegetable kingdoms.

This kingdom is a veritable fairy land. Its inhabitants are more numerous than the sands of the sea, and as varying in their functions as are the inhabitants of the animal and vegetable kingdoms. They are all so minute that they cannot be seen with the naked eye. Some of them have functions which are useful to us, and some have functions which are prejudicial to us.

Many of the wonderful phenomena in nature which in the past have been mysteries to us are caused by denizens of this kingdom. Indeed, only a few of them work serious harm to man, and even the harm which these do is not out of harmony with nature as a whole.

The world as we see it can be maintained only by harmonious succession of life and death. The animal and vegetable kingdoms to a great extent depend each upon death in the other for the mainten-

1 2 hitroduction

ance of life, and the microscopic kingdom which is now being revealed to us seems to stand in the relationship of go-between, transforming each into food for the other.

It is quite possible that the micro-organisms which now produce what is known as disease originally only attacked dead organic tissue. Their primary function may have been to transform dead organic matter into inorganic matter. As living organic matter degenerated, thus approaching nearer and nearer to dead organic matter, they gradually may have acquired the power of growth upon living organic matter. Such a theor}^ is the more plausible since we know that all micro-organisms which cause disease find congenial soil in a living organism in direct ratio to deterioration of the latter from a normal standard.

If man by reason of his deviation from the laws of nature through self-will has brought disease upon himself he has the

Introduction 1 3 power in the intelligence which God has given him likewise to rid himself of such disease. This power now becomes available for the first time in the history of the world through the new knowledge about the microscopic world. The micro-organisms which work harm to man can be singled out and destroyed. This is the task which science presents to man for the twentieth century.

Consumption, from the dawn of history to the present day, has been one of the worst scourges of mankind. Not only has it afflicted man himself but every kind of brute creation with which man is closely associated. It strikes at man's life in a way that brings mental anguish as well as physical suffering, and it deals him out sorrow and want when it cannot reach him with death. It has been a shackle to his progress in civilization, a mildew upon his physical evolution, and a leaven of decay to his morality. In the past it has shown

1 4 Introduction

itself an unconquerable foe. What a victory for the human mind at last to have brought this enemy to bay!

Science has laid before the world the cause of consumption with mathematical exactness, and has given such an insight into the lives of the micro-organisms which produce it that it is possible to plan a campaign against the disease which is sure to end in victory for the human race. It now remains for the world to avail itself of the knowledge which science has given it, and for every man, woman, and child to enHst in the army which is to fight the battle. This little volume is sent forth to seek recruits and prepare them for the crusade against this disease.

CHAPTER I What Consumption is

CONSUMPTION is a disease which is caused by the growth of certain micro-organisms in the tissues of our bodies. These micro-organisms grow in us in the same way as wheat, timothy, and clover grow in a field. The micro-organisms concerned with the production of consumption are the tubercle bacillus, the streptococcus, and the staphylococcus. The tubercle bacillus is the chief or head of the house, and the streptococcus and staphylococcus are associates.

Consumption is a complicated disease, or, perhaps more correctly speaking, a mixture of diseases. The picture of human suffering, distress, and bodily decay which we recognize as consumption has been named for its most striking symptom — waste of the body.

The word consumption means burning up — destruction. In all ages and in all languages the disease has been named for this symptom. The Greeks called it phthisis, which means wasting. This name is still retained by the Latin races and to some extent is used in English. The Germans call it Auszehrung, which likewise means w^asting. The disease is accompanied with burning fever and profuse sweats. These symptoms quite naturally give a fitting background to the picture of consumption or destruction. The body is melted away under the consuming fire. A racking cough goes with the disease and helps in the work of destruction by carrying off the wasted tissue. The hectic flush is but the glow of the burning fire within.

In olden tim.es consumption was looked upon as a simple uncomplicated disease,

What Consumption is 17

beginning and ending with the same symptoms. Nothing was known of its cause and there were all kinds of surmises as to what it might be due to. Hippocrates thought it came from some subtle poison generated in the air and carried by certain winds. No doubt this was the accepted opinion of his day.

In countries in which very cold weather occurred during winter and in which rapid changes of temperature took place in summer, it was ascribed to cold. This opinion still is held by many. In more modern times most people have attributed the disease to an inherited tendency to decay. It is quite possible that this view sprang from a strained interpretation of the Bible where it speaks of the sins of the father being visited upon the son to the third and fourth generations.

For all of the strange views about the

disease held in the past plausible reasons

could be found in the course which the 2 disease ran from its beginning to its end as then understood. But as only the end of the disease was recognized, all reasoning upon its source, being based upon incomplete observation, necessarily was false.

Consumption now is known to be a complicated disease of very long duration, which, like the butterfly and many other insects, looks different and acts very differently according to the stage of its existence. During its pupal stage, when it is known as merely tuberculosis, it is hard to detect, because it creates so little disturbance as not even to attract the attention of the person afflicted. It may exist in this stage for many years.

Usually it is brought to light by some such micro-organism as the influenza bacillus, the pneumococcus and the micro-organisms which cause what are commonly termed *' colds." As a rule, it is through one or the other of these micro-

What Consumption is 19

organisms that the streptococcus and staphylococcus are introduced to it ; and generally it is during the struggle of one's system against these micro-organisms that the wicked partnership between the tubercle bacillus and the streptococcus and staphylococcus is formed. It is only after the formation of this partnership that true consumption exists and becomes recognizable to the layman. Even the average physician does not recognize it earlier.

The striking symptoms of consumption which attract the attention of everyone are due to the poison produced by the streptococcus and staphylococcus. This poison is absorbed into the blood and affects the nervous system.

The streptococcus and the staphylococcus are micro-organisms which occur almost everywhere in nature. They look like little balls strung out in chains or bunched like grapes, and are given their respective names because of their respective resemblance to these objects. When they get into the tissues of the body, they break down these tissues into pus. Fortunately they are unable to attack normal tissue. It seems that they cannot even gain admission into a living organism except through tissue which has been injured either by the application of physical force of some kind or by the growth of some other micro-organism.

CHAPTER II What Tuberculosis is

TUBERCULOSIS, scientifically speaking, is the implantation and growth of the tubercle bacillus in the tissues of a human being or an animal. The tubercle bacillus is a rod-shaped micro-organism, about one-six-thousandth of an inch in length and about one- hundred-thousandth of an inch in thickness.

Naturalists place the tubercle bacillus in the vegetable kingdom. Bacteriologists, as the men who study the forms and habits ■ of micro-organisms are called, classify it as a facultative saprophyte. By this is meant that the micro-organism usually exists as a parasite upon a human being or some animal, but that it has the power of growing upon such substances as gelatine, boiled potato, and the like, when proper

22 Crusade against Ticberculosis

conditions of temperature, light, and rest are given it.

A saprophyte is a micro-organism which grows upon dead organic matter. A parasite is a micro-organism which grows on living organic matter. This living organic matter is called the host. Only when the tubercle bacillus grows as a parasite in the tissues of a human being or animal is the process termed tuberculosis.

The word tuberculosis is derived from the little Latin word tubeVy which means a root or lump. It came to be applied to the disease which it now designates by reason of the manner in which certain facts about the disease gradually came to light.

When men began to make autopsies on people who had died of consumption, they were surprised to find in those parts of the lungs which had not been completely destroyed Httle lumps, ranging in size from a millet seed to a hickory nut. These little lumps were found in larger numbers in

What Tuberculosis is 23

some cases than in others, but they always were present. It was noticed, too, that the little lumps were sometimes hard and sometimes soft. The thought at once suggested itself that the hard lumps, the soft lumps, and the holes or cavities which also were found were all stages of the same process and that the beginning of every case of consumption was the formation of these little lumps.

In the scientific language of that day, which was Latin, the lumps were called tubercles, and the process which took place in the tissues was called tuberculosis. As consumption was looked upon as an outward manifestation of the process which was going on inside it came to be known among scientific men as tuberculosis. Gradually the laity likewise took up the name, and tuberculosis and consumption came to be known as the same thing.

Tuberculosis, in a popular sense, is not a disease. Disease means want of ease or comfort, and in common parlance is only used to describe a condition of health in which the affected person knows that he is sick. From a physician's point of view tuberculosis is a disease.

No difference how small the implantation of tubercle bacilli may be in a person, it sets up symptoms which can be recognized by an expert. These symptoms are deviations of functions from the normal, but often they are so slight and have come on so insidiously that the transition from the normal to the abnormal is overlooked by the patient and his friends. This oversight takes place the more easily because many of the symptoms of tuberculosis occur in everyone's life as the result of occupation, use of improper or badly prepared food, and residence under unhealthy environment.

Inaptitude for occupation and fatigue upon slight exertion, dyspepsia, malnutrition, sensitiveness to cold, want of appetite,

What Tuberculosis is 25

dislike of certain kinds of food, irritability, peevishness, and mental depression all are symptoms which may manifest themselves in tuberculosis, but they also are the common inheritance of mankind in the vicissitudes of life and by most people are looked upon as natural results of conditions of life over which they have no control.

When any or all of these symptoms occur in tuberculosis they are only part of a picture which, like the puzzle picture in the newspapers, must be filled in by careful search for other symptoms which exist, but do not show themselves. Some of these hidden symptoms can be discovered by a layman, others only reveal themselves to an expert. The symptoms discoverable to a layman which arouse the strongest suspicion of tuberculosis are loss of weight, slight increase in pulse-rate, and slight depression or rise of temperature.

CHAPTER III The Relationship between

Consumption and

Tuberculosis

POPULARLY speaking, consumption and tuberculosis are one and the same thing. Scientifically, they differ quite materially. In the interest of the crusade against tuberculosis it is important that the relationship between the two be well understood by the people.

With the knowledge which is now in the world, among the people, tuberculosis nearly always terminates in consumption. The transition is so gradual as to be imperceptible, and usually it is only when consumption has set in that the existence of tuberculosis is revealed. Practically, therefore, there is but one disease, the

Consumption and Tuber cidosis 27

beginning of which goes unrecognized, and in the minds of most people is a mere fiction.

Tuberculosis is caused by the implantation and growth of the tubercle bacillus. By itself this micro-organism does little harm and rarely causes death. Could the streptococcus and the staphylococcus be kept out it would run slowly through the lifetime of an individual without serious consequences.

Its growth in the tissues, however, invites the streptococcus and staphylococcus to those tissues by the injury which it does to them. Sooner or later these micro-organisms run the gauntlet of the sentinels which nature has set up to keep them out, and get into the system. They at once associate themselves with the tubercle bacillus and form a partnership for mutual advantage and the destruction of the individual on whom they prey. The partnership is consumption.

28 Crusade against Ttiberculosis

The streptococcus and the staphylococcus are essential co -efficients to the tubercle bacillus for the completion of its cycle of life. Without them the tubercle bacillus probably would soon become extinct. They do for the tubercle bacillus what frost does for the chestnut, enable it to escape from imprisonment so that it may again start on a new cycle of life. They also make a cache for it so as to protect it against its many enemies, especially air and sunlight, and thus preserve its life until it can by some chance be carried into new soil.

The little tumors or lumps which are formed in the tissues by the growth of the tubercle bacillus consist of cells, tubercle bacilli, and debris. The inside of the little tumor may soften, but the little lump remains more or less firm, and the tubercle bacilli are imprisoned.

When the streptococcus and staphylococcus gain admission into the little tumor, they at once begin a work of destruction

Consumption and Tuberculosis 29

of the cells and produce the broken-down tissue which serves as the covering for the tubercle bacillus. An ulcerative process also is begun by these associates, and an opening is gradually made by which the tubercle bacillus again gets into the outside world.

It is during the time when the tubercle bacillus is set free from its imprisonment that the symptoms prevail which give us the picture of human suffering known as consumption. Thus the enfranchisement, the marriage feast, so to speak, of this invisible bit of bioplasm becomes the sorrow and sore affliction of the highest representative of organic life on earth. How interdependent is all organic life !

The first implantation of the tubercle bacillus, even when followed by an implantation of the streptococcus and staphylococcus, rarely gives rise to a full-fledged consumption. It may give rise to a process so slight as not to attract attention during any part of the course through which it passes.

When the first tubercle matures and the bacilH are set free and come away, there is a sHght cough, a few night-sweats, perchance, indisposition for a week or two, — a miniature consumption, so to speak, but so trifling and brief as to pass for a cold.

During this process, however, a new seed-scattering takes place, a new implantation follows, a larger growth ensues, and with the second harvest more pronounced symptoms occur. The interval between the two processes is so long as to obliterate the first from memory before the second comes on. A third seed -scattering takes place with the same sequences as the preceding two, and again with a larger area of implantation than the one immediately going before.

Attack after attack comes on at intervals of longer or shorter duration, varying from three months to a year, each severer

Consumption aiid Tuberculosis. 31

than the one before, each a miniature consumption and approaching nearer to the real thing than its predecessor, until finally, as with the orange tree, harvest and seedtime meet and there is one continuous consumption which everybody can recognize. Usually, this is the time when the poor deluded victim seeks aid. He knocks at the doctor's door, and the undertaker answers.

CHAPTER IV What Colds, Influenza, and

Pneumonia have to do

with Consumption

COLDS, influenza, and pneumonia have been looked upon as causes of consumption and by many still are regarded as such. A neglected cold, repeated attacks of influenza, an unhealed pneumonia, to the lay mind, are highways to consumption, which like the roads to Rome can lead nowhere else. A half truth lies hidden back of these popular notions which looks so like the whole truth as to be misleading.

Colds, influenza, and pneumonia all are caused by micro-organisms, each of which is an independent entity. The micro-organism or micro-organisms which produce colds have not been identified as yet, but

Colds, Influenza, and Pneumonia 33

we have every reason to believe that they exist. It is possible that a number of micro-organisms have to do with the condition which is termed a cold. The micro-organisms which cause influenza and pneumonia are known. One is a bacillus, and is called the influenza bacillus ; the other is a coccus, and is known as the pneumococcus. These diseases, being caused by micro-organisms, are communicable from one person to another.

Inasmuch as the micro-organisms which produce colds, influenza, and pneumonia are independent entities, endowed with life and the essential qualities of living things, they cannot be transformed into other living things. A micro-organism can only reproduce a micro-organism of its own kind, and therefore a disease caused by one kind of micro-organism cannot give rise to a disease caused by another kind of micro-organism. It is no more possible for a cold micro-organism, an influenza bacillus, or a pneumococcus to give rise to tuberculosis than it is for a grain of oats to grow into a stalk of wheat.

Nevertheless, the cold micro-organism, the influenza bacillus, and the pneumococcus do play a role in the production of consumption which usually is so dramatic as to be readily mistaken for the cause.

A person may have tuberculosis for a long time without knowing it because there are no marked symptoms. Quite suddenly a cold, an influenza, or a pneumonia sets in with a chill, fever, and the most acute indisposition. The person at once knows that he is ill and from the moment of seizure his attention is riveted upon his condition.

Because of the pre-existing tuberculosis, the cold, influenza, or pneumonia does not run a normal course, but shows a strong tendency to chronicity. Finally, as it disappears it leaves in its wake well-developed symptoms of comsumption, which perhaps for the first time bring to light the

Colds, Influenza, and Pneicmo7iia 35

pre-existing tuberculosis. How natural for the patient to ascribe his consumption to the most apparent cause.

The part which the cold micro-organism, the influenza bacillus, or the pneumococcus plays in such cases is twofold, that of a fertilizer for the tubercle bacillus, and that of a roadmaker for the streptococcus and staphylococcus.

Colds, influenza, and pneumonia reduce the vital force of the body, and thus make the tissues a better soil for the tubercle bacillus. They also disarm the sentinels which, stand guard against the admission of the streptococcus and staphylococcus and often bring these marauders in.

A cold, an influenza, or a pneumonia always is a serious matter to a tubercular subject. These three diseases, figuratively speaking, are the hunting dogs for tuberculosis, because they bring the disease to light when its existence is not suspected. They also are drummers for the streptococcus and staphylococcus and constantly bring trade to them which otherwise they would not get. They are in business for themselves, but they don't mind doing a little commission business on the side. This they can do the better because their own business paves the way for the partnership business of the tubercle bacillus and the micro-organisms for whom they act as agents,

CHAPTER V What Consumption Means to the World

IT IS beyond the grasp of the human mind to fully realize what consumption means to the world. The disease exists in every part of the habitable globe, upon the surface of the earth, underneath the waters, and in the heavens above. It probably is the direct cause of death of one-seventh of the human species, and a fair percentage of the animal species. It affects the fishes of the sea and the birds of the air.

True knowledge can come only from personal experience. Knowledge of consumption is restricted by the experience of the individual, and the sum total of individual knowledge upon one given subject constitutes pubhc consciousness upon that subject.

Consumption has been a plague upon the earth at all times and in all places, but man never has been conscious of it. This is because the disease is devoid of drama and tragedy.

The individual sees but little of it because his social horizon necessarily is circumscribed. Within the family the disease is a family affliction. It gives no idea of what is going on beyond.

Consumption is a disease of the poor. It lurks in dark corners. No one sees it in the aggregate. Even the clergyman and the doctor see but one case at a time and see relatively few cases in a lifetime.

Could the consumptives of any given community be seen at one time or pass in panorama before the people, public consciousness of the magnitude of the affliction might be aroused. A physical disaster shocks the world and lets loose the sympathy of millions. A few thousand deaths are nothing as compared with the deaths from consumption.

What Co7isumption memis 39

In the United States upward of one hundred thousand people die annually from consumption. In Germany the number of deaths every year is nearly the same; and in France the figures stand very little below. In Austria there are about eighty thousand deaths a year from the disease ; in England about sixty thousand; in Italy about fifty thousand. Throughout the world there probably are a millon deaths a year from the disease.

Ever}^ community has its litttle army of victims of the disease, but they are seen only in ones and twos and make no impression. Could they be massed and all the armies brought into one composite picture, what a harrowing sight they would present !

The death-rate from consumption does not give a true picture of the ravages of the disease. It does not even tell the truth about consumption. When tuberculosis ends fatally, it usually does so by

40 Crusade against Tttberctdosis

way of consumption ; but not all deaths caused by consumption are so recorded.

Some of the names under which consumption parades, even with propriety, because of long usage, are quite misleading to a layman. Marasmus, for instance, would hardly be taken for the same disease as consumption, and yet it is. The only difference is in the place of beginning of the micro-organisms. Exactly the same micro-organisms are at work. In marasmus they make their headquarters in the lymphatic glands of the belly ; in consumption they make them in the lungs.

When the tubercle bacillus in union with the streptococcus and staphylococcus causes death, by' operating in some other part of the body than the lungs and lymphatic glands of the belly, the death usually is recorded under a name which gives no clue to the real cause of death.

Usage has established the practice of recording deaths by a name which indicates

What Consumption means 41 an inflammation of the organ affected by the death-dealing disease. Pneumonia means an inflammation of the lungs ; nephritis, an inflammation of the kidneys; meningitis, an inflammation of the Hning membrane of the brain ; pericarditis, an inflammation of the membrane around the heart ; peritonitis, an inflammation of the peritoneum ; and pleurisy, an inflammation of the pleura. Nothing is told us by these names about the cause of the inflammation.

The tubercle bacillus, in union with the streptococcus and staphylococcus, frequently is the cause of inflammation of these organs and tissues and, when it is, often leads to death. The death certificate, however, fails to tell about the work of the tubercle bacillus and its associates in such cases.

What consumption means to the world in deprivation, anguish, grief, and degeneration cannot be imagined even. We can take one family which has been afflicted by the disease, study the course of the disease from beginning to end, contemplate the havoc made and even tr^^ to analyze the damage done financially, physically, socially, and mentally, but we cannot read the hearts of those who looked on while the disease was torturing and killing inch by inch a loved one ; we cannot measure the longing hope nor fathom the deep despair alternant in the minds of the stricken members; we cannot measure the heroism of those who stood at the post of duty year in and year out, realizing their danger but unable to flee from it ; and we cannot know of the misanthropy, envy, and hatred engendered, and perhaps virtuously withstood, whilst helplessly the stricken family stood in the shadow of affluence and wealth.

Who can understand the mental anguish created by a fancied remedy for a fatal disease, withheld by poverty in the midst of plenty, except he who has drunk the dregs of such poverty ?

CHAPTER VI The Prevalency of Tuberculosis

THE denizens of the microscopic world, although beyond the reach of the naked eye, usually can be seen through their work. What they accomplish manifests itself in material form or sets up changes in material things which can be recognize 1. As yet, however, man is not well enough informed about the micro-organic world to be quick in detecting all the phenomena which emanate from any given member of that world.

Tuberculosis as a manifestation of micro-organic life is not well understood as yet. To the minds of most men the word tuberculosis merely conveys the idea of consumption. Men know consumption but do not know tuberculosis, and as consumption grows out of tuberculosis its manifestations are unconsciously ascribed to tuberculosis. The tuberculosis is overlooked because it is sought for in the dress of consumption, just as a larva would be overlooked when sought for in the form of a butterfly.

Tuberculosis exists in the world to a much greater degree than the manifestations of consumption would indicate. Many cases end in recovery without attracting attention. Many others end in death from some other disease without the existence of tuberculosis ever being suspected.

Autopsies upon the dead bodies of poor people who have died in charity hospitals from some other disease than tuberculosis reveal the existence of tubercular implantation in vastly the majority. This would seem to indicate that among people in the lower walks of life nearly everybody gets an implantation of tubercle bacilli at one time or another.

The Prevalency of Tuberculosis 45

Tuberculosis can develop in any part of the body. The tubercle bacillus apparently finds a more congenial culture medium in some tissues than in others, but can grow in any tissue.