[Dr. Prudden is Professor of Pathology in the College of Physicians
and Surgeons, New York. He has bestowed especial attention upon
the means of preventing disease: in that important field he has
written three capital manuals, all published by G. P. Putnam's
Sons, New York:--"Story of the Bacteria," "Dust and Its Dangers,"
"Water and Ice Supplies." His other works, intended for the
professional reader, are of the highest authority. The article
here given appeared in _Harper's Magazine_, March, 1894; copyright
by Harper & Brothers, who have granted permission to reprint.
In May, 1902, these pages were revised by Dr. Prudden.]
It is commonly neither wise nor necessary for people not professionally
concerned to think much about disease, or weigh anxiously the chance or
mode of its acquirement. But now and then conditions arise which demand
general attention and instruction regarding certain diseases in order
that a great, threatening calamity may be averted. Such a condition
faces the people in all lands to-day in the appalling prevalence of
tuberculosis. A disease which in mild or severe form affects at least
one-half of the whole human race, and which causes the death of full
one-seventh of all who pass away, killing about one-third of those who
perish between the ages of fifteen and forty-five--a disease which is
most insidious in its onset, and often relentless in its course, and
which may be largely prevented--is one about which we cannot be
indifferent, and should not be longer inactive.
There has long been reason for believing that tuberculosis is a
communicable disease. Its prevalence in certain families and
communities, its frequent occurrence in those who have personally
attended upon its victims, its onset in those who have occupied
apartments vacated by consumptives--such facts observed over and over
again abundantly justify the belief in its communicability. Up to the
commencement of the last decade the cause of the disease was altogether
unknown, and no definite data were at hand which could enable us to fix
upon a feasible plan for limiting its ravages. But in these later years
a great light has been thrown upon this and other kindred diseases.
Most intelligent people are aware that within the past decade a new
field in the domain of life has been revealed and widely explored. It
has been learned that in earth and air and water there exist countless
myriads of living things so minute as to lie far beyond the limits of
the unaided vision, and yet in the aggregate so potent in the
maintenance of the cycle of life upon earth that without their activity
all life would soon cease to be, and the elements which for a short span
fall under the sway of the life forces in all higher animals and plants
would lapse finally and irrevocably into their primal state. These tiny
organisms are called germs, microbes, or micro-organisms. One great and
important group of them belongs among the microscopic plants called
bacteria. These bacteria as a class are important in their economy of
nature, because they live for the most part on dead organic
material--that is, such material as has once formed a portion of some
living thing.
The world's store of available oxygen, hydrogen, carbon and nitrogen,
out of which all living beings are largely formed, is limited, and if
after these have served their temporary uses, as the medium through
which that mysterious potency called life alone can find expression,
they were not speedily released, new generations of living beings could
neither assume nor maintain their place in the great cycle of life. And
so these tiny plants, year in, year out, by day and by night, unseen and
mostly unheeded, are busy always in making possible the return of each
year's visible vegetation and the maintenance of an unbroken succession
of generations in man and beast.
Different groups and races among the bacteria have different
habitations, and vary widely in their special powers. Complex and
powerful as is the aggregate result which they accomplish in the world,
the performances of the individual are comparatively simple. They are
most liberally endowed with the capacity for multiplication, and each
germ acts as a tiny chemical laboratory, taking into itself the organic
matter on which it feeds, and resolving it into new compounds. Some of
the latter are used in building up and maintaining its own body, while
others are given off into the surrounding media.
We are but just beginning to peer at the mysterious processes which go
on under the influence of the bacteria in this underworld of life, and
to realize that all the lore which unwearied toilers in the past have
gathered in their studies of the visible forms of animals and plants,
makes but one of the many chapters in nature's story-book of life.
But this new and stimulating point of view, toward which the studies of
the past decade have led us, does not look so largely into the domain of
the practical that it would greatly attract the majority of business and
pleasure and _ennui_ ridden mankind were it not for one very practical
fact which these recent studies have revealed. This is, that among the
myriads of altogether beneficent bacteria which people the earth, and
air, and water, there are a few forms which have chosen out of all the
world as their most congenial residence the bodies of men. But even this
would be of only passing interest to most people were it not still
further unfortunately true that in the performance of their simple
life-processes these man-loving bacteria, feeding on the tissues of
their host, and setting free certain subtle poisons in his blood, each
after its kind, can induce those disturbances of the body's functions
and those changes in its structure which we call disease.
The diseases caused by the growth of germs in the body are called
infectious. The germs causing some of the infectious diseases are given
off from the bodies of their victims in such form as to be readily
transmitted through the air to others, in whom they may incite similar
disease. Such diseases are spoken of as readily communicable, though it
is not actually the disease itself, but only the germ causing it, which
is transmitted. In other infectious diseases transmission but rarely
occurs. Many infectious diseases are very easily communicated from the
sick to the well under unsanitary and uncleanly conditions, which with
proper care are very little liable to spread.
I need not here put on parade the whole uncanny list of germ diseases,
in which tuberculosis stands foremost, followed by pneumonia,
diphtheria, typhoid fever, scarlatina, cholera, small-pox, and the rest.
Nor need I call to mind the means by which our growing knowledge in this
domain has been day by day laid under tribute for suggestions of hope
and safety for the stricken. It is a record of brilliant conquest in
nature, and already of far-reaching beneficence to man.
But the great fundamental advance which signalizes the past decade is
the lifting of this whole class of fateful germ diseases out of the
region of the intangible and mysterious, and their establishment, on the
basis of positive experimental research, in the domain of the
comprehensible and definite. The things which cause them are no longer
for us mysterious emanations from the sick, or incorporate expressions
of malign forces against which conjurations or prayers could alone
promise protection, but they are particulate beings, never
self-engendered, never evolved in the body, always entering from
without--things which we can see and handle and kill.
Let us now glance at the germ called the tubercle bacillus, the germ
which induces and which alone can induce tuberculosis. It does not exist
and thrive in the body of men or animals in health. Without the entrance
of this particular germ into the human body from without, tuberculosis
cannot develop in it. Without the transmission of this germ in some way
or other in a living condition from the sick to the well, tuberculosis
cannot spread. In the life-story of this tiny germ lie both the potency
for mischief which we deplore and the secret of our release from its
bondage.
The tubercle bacillus is a little colourless, rod-like plant, so small
that even many thousands of them piled together would make a heap far
too small to be visible to the naked eye. It cannot move about, nor can
it grow without moisture, nor at a temperature much above or much below
that of the human body. The material on which it feeds must be very
nicely adapted to its requirements, and it has no lurking and growing
places in nature outside of the bodies of men and a few warm-blooded
animals. It can be cultivated artificially in the laboratory, and we
know more about its life and peculiarities than about almost any other
germ. While it can remain alive in a dried state for many weeks, it is
readily killed by heat, by sunlight, and by many of those chemical
substances which we call disinfectants. It does not flourish equally
well in the bodies of all human beings.
When once it gains lodgment in a body suited to its growth it multiplies
slowly, each germ dividing and subdividing, taking from the tissues
material for its growth, and returning to them certain subtle poisons
which it sets free. The action of the tubercle bacillus is peculiar in
that it stimulates the cells of the body, wherever it may lodge and
grow, to the formation of little masses of new tissue, which we call
tubercles. These tubercles are as a rule short-lived, and, if the
disease progresses, tend to disintegrate. If the tubercles have grown in
such situations as to make this possible, as in the intestinal canal or
the lungs, the disintegrated and broken-down material, often containing
myriads of the living germs, may be cast off from the body. In
tuberculosis of the lungs, or consumption, this waste material is thrown
off with the sputum [spittle]. While almost any part of the body may be
affected, tuberculosis of the lungs is by far the most common form of
the disease.
It follows from what has been said that the only way in which we can
acquire tuberculosis is by getting into our bodies tubercle bacilli from
tuberculous men or animals. The only animals liable to convey the
disease to man are tuberculous cattle, and these through the use of
either meat or milk. The danger from the use of uncooked meat or the
unboiled milk from tuberculous cattle is real and serious, but it will
not be considered here at length, because the great and prevailing
danger of infection comes from another source.
Almost as soon as the significance of the tubercle bacillus was
established, a series of studies was undertaken on the possibility of
the spread of the disease by the breath or exhalations of the persons of
consumptives. These studies at once showed that the tubercle bacillus
cannot be given off into the air of the breath from the moist surfaces
of the mouth and air passages, nor from any material which may come from
them while this material remains moist, nor from healthy unsoiled
surfaces of the body. The establishment of this fact is of far-reaching
consequence, because it shows that neither the person nor the breath of
the consumptive is a direct source of danger, even to the most constant
and intimate attendants.
While the discharges from the bowels in persons suffering from
tuberculosis of the intestinal tract may contain many living bacilli,
the usual mode of disposal of these discharges protects us from any
considerable danger from this source.
It is the sputum after its discharge from the body on which our
attention must be fixed. While the sputum is moist it can, as a rule, do
no harm, unless it should be directly transmitted to those who are well
by violent coughing, sneezing, etc., by the use of uncleansed cooking or
eating utensils, by soiled hands, or by such intimate personal contact
as kissing or fondling. But if in any way the sputum becomes dried, on
floors or walls or bedding, on handkerchiefs or towels, or on the person
of the patient, it may soon become disseminated in the air as dust, and
can thus be breathed into the lungs of exposed persons.
The wide distribution of tubercle bacilli in the air of living-rooms,
and in other dusty places where people go, is due partly to the
frequency of the disease and the large numbers of living bacilli which
are cast off in the sputum (sometimes millions in a day), and partly to
the fact that many of the victims of consumption go about among their
fellows for purposes of business or pleasure for months or years. So
each consumptive, if not intelligently careful, may year after year be
to his fellow-men a source of active and serious and continual
infection.
This, then, the dried, uncared-for sputum of those suffering from
pulmonary tuberculosis, is the great source of danger; this the means so
long concealed by which a large part of the human race prematurely
perishes. Let but this discharged material be rendered harmless or
destroyed before it dries in all cases, and the ravages of this scourge
would largely cease. This is not a theoretic matter only, for again and
again have the living and virulent germs been found clinging to the
walls and furniture and bedding and handkerchiefs of consumptive
persons, and in the dust of the rooms in which they dwell. A malady
whose victims far outnumber those of all other infectious diseases put
together, sparing neither rich nor poor, seizing upon life while it is
as yet only a promise, but most inexorable in the fulness of its
tide--this malady can be largely prevented by the universal and
persistent practice of intelligent cleanliness.
We have learned in the past few years one fact about tuberculosis which
is of incalculable comfort to many, and that is that the disease is not
hereditary. It is very important that we should understand this, because
it seems to contradict a long-prevalent tradition, and a belief still
widely and sorrowfully entertained. Bacteria, and especially most
disease-producing bacteria, are very sensitive in the matter of growth
and reproduction to the conditions under which they are placed, and
especially to the material on which they feed. So that a germ which can
induce serious disease in one species of animal is harmless in the body
of a different though closely allied form. More than this, different
individuals of the same species, or the same individual at different
times, may have the most marked differences in susceptibility in the
presence of disease-producing germs. What this subtle difference is we
do not know. Whether the body at one time affords a congenial soil to
the invading germs and at another does not, whether its marvelous and
complex powers of resisting the virulent tendencies of disease-producing
bacteria at one period or in one individual are more vigorous than in
another, and vary at different times, we do not certainly know. This,
however, we do know, that certain individuals are more likely than
others to yield to the incursions of the tubercle bacillus. This
vulnerability in the presence of invading germs we call susceptibility,
and susceptibility to the action of the tubercle bacillus is hereditary.
It is not the disease, tuberculosis, which comes into the world with
certain individuals or with successive children of the same family, but
the aptitude to contract it should external conditions favour. What
subtle impress on the cells which are to develop into the new individual
renders him more than another an easy prey to the tubercle bacillus
should it later find lodgment in his body we do not know, and we may
not hope soon to be enlightened, since all the intricate mysteries of
heredity seem involved in the problem. But this we do know, that how
ever much the child of tuberculous parents or a member of a tuberculous
family may be predisposed to the disease, he cannot acquire tuberculosis
unless by some mischance the fateful germ enters his body from without.
What has been all through these years regarded as the strongest proof of
the hereditary transmission of tuberculosis--namely, the occurrence of
the disease in several members of the same household--is, in the new
light, simply the result of household infection--the breathing of air
especially liable to contain the noxious germs, or their entrance in
some other way into the bodies of persons especially sensitive to their
presence. I do not mean to imply that under no conditions can the
tubercle bacillus be transmitted from the mother to the child before its
birth. In a few instances this is believed to have happened. But its
occurrence is so extremely infrequent that it may be regarded as
accidental, and of no serious importance from our present point of view.
But it will perhaps be said, "If the tubercle bacilli are so widely
diffused, why do we not all acquire tuberculosis, and why was the world
not long since depopulated?" In order to explain this matter I must ask
the reader to look with me for a moment at some of the body's natural
safeguards against bacterial and other invaders from the air. It has
been found that a person breathing in germ and dust-laden air through
the nose breathes out again air which is both dust and germ free. The
air passages of the nose are tortuous, and lined with a moist membrane,
against which the air impinges in its passage. On these moist surfaces
most of the solid suspended particles, the germs among them, are caught
and held fast, and may be thrown off again by secretion. In breathing
through the mouth this safeguard is not utilized. Again, the upper
passages leading to the lungs are lined with a delicate membrane of
cells, whose free surfaces are thickly beset with tiny hairlike
projections. These projections are constantly moving back and forth with
a quick sweep, in such a way that they carry small particles which may
have escaped the barriers above up into the mouth, from which they may
be readily discharged. In this way much of the evil of breathing dust
and germ-laden air is averted. But in spite of these natural safeguards
a great deal of foreign material does, under the ordinary conditions of
life indoors or in dusty places, find lodgment in the delicate recesses
of the lungs. The body tolerates a good deal of the deleterious
material, but its overtasked toleration fails at last, when serious
disease may ensue.
When ordinary forms of living bacteria get into the tissues of the body,
a very complex cellular mechanism, not fully understood, usually
results in their destruction and ultimate removal. In the presence of
the tubercle bacillus the body cells are often able to build a dense
enclosing wall around the affected region, shutting it off from the rest
of the body. This is one of the modes of natural cure. The body cells
are sometimes able, if sustained by nourishing food and an abundance of
fresh air, to carry on, year after year, a successful struggle with the
invading germs, so that the usefulness and enjoyment of life are but
little interfered with. Finally, a certain proportion of human beings
seem to be endowed at birth with some as yet unknown quality in the
cells or fluids of the body which naturally unfits them for the life
uses of the tubercle bacillus, and so renders the individual for longer
or shorter periods practically immune.
Others, on the contrary, are, as we have seen, from birth unusually
susceptible. This inherited susceptibility to the incursions of the
tubercle bacillus, should this find lodgment in the body from without,
by no means always reveals itself in any apparent lack of vigour or
robustness of the body. Still, any habit or mode of life which
diminishes the bodily vigour, whether in those predisposed to this
malady or in the apparently immune, and gives it a leaning toward
disease, diminishes, as a rule, the chances of a successful contest with
the bacillus. And so it is that in spite of the wide distribution of
these fateful germs in frequented places, and the tendency of certain
vulnerable persons to succumb to their ravages, so many people are not
affected by them, and so many, although not altogether escaping their
malign influence, are yet able to wrest at least a moiety of life from
the hand of the great destroyer.
The degree of success which may attend our crusade against tuberculosis
will largely depend upon the wide diffusion of the knowledge of its
communicability by means of the sputum dried and powdered and floating
in the air as dust, and the intelligent persistence with which the
morbid material may be safely cared for at its sources. The resolute
avoidance by consumptives of the not only filthy but dangerous practice
of spitting upon floors or streets, or anywhere else except into proper
receptacles; the use of receptacles which may be and are frequently and
thoroughly cleansed, and, best of all, of water-proof paper cups, which
with their contents may be burned; or, when circumstances require, the
receiving of the dangerous material on cloths or Japanese paper napkins,
which may be destroyed by fire, and not on more valuable handkerchiefs
on which the sputum is allowed to dry while in use or before
disinfection and washing; scrupulous care by others of the sputum of
those too ill to care for it themselves--these are the comparatively
simple means from which we may most confidently expect relief. The
details of these precautions and their adaptation to the special
circumstances of those suffering from the disease can be most wisely
left to the physician, and though of paramount importance, need not
further engage our attention here.
To the consumptive himself these measures are not without a vital
significance. For his chances of recovery may be in no small degree
diminished if he be more or less constantly liable to a fresh infection
from material which he has once got rid of, and which should have been
destroyed.
The great volumes of fresh, moving air which we encounter out-of-doors
in properly cleansed streets usually so greatly dilutes the dust, of
whatever kind, that little apprehension need be felt from its presence.
When, however, in crowded cities, the streets are, as is nearly always
the case, save for a few favored localities, filthy, and but fitfully
cared for; when choking dust clouds must be encountered by the citizen
during the haphazard and slatternly essays at cleaning made by untrained
and irresponsible sweepers; we cannot ignore a danger from street dust
which may well incite grave apprehension. The citizen can, if he must,
run from the presence of cloud-enwrapped machines furiously whirled
along half-sprinkled pavements; he may avoid a block on which the
hand-sweepers, in the absence or in disregard of rules, ply their
nefarious brooms over unwet surfaces, because too indolent or
indifferent to sprinkle them--these things he can do if he be not
willing or ready to apply the citizen's remedy for municipal misrule.
But it is in rooms either of dwelling or assembling places that the ill
effects of infectious dust are most potent, because the air is here not
so constantly renewed as it is out-of-doors, and is liable to be
breathed over and over again. Dust which gets into houses does not
readily leave them, unless special and intelligent means be directed to
its removal. We do not usually realize that, though the air itself in
inhabited rooms is constantly changing more or less rapidly by
diffusion, by draughts, or by purposed ventilation, fine dust particles
are not removed under the same influences in proportionate degree. They
cling more or less tenaciously to all surfaces on which they have
settled, and especially to fabrics, so that currents of abundant force
and sufficient distribution to change the air may and usually do leave
the lodged dust particles almost entirely undisturbed.
One of the most threatening tendencies of modern times in matters of
health is that of overcrowding in cities, and the great element of
danger from this overcrowding is not only and not chiefly the
insufficiency of air in living-rooms and the lack of ready means for its
renewal, but the accumulation in this air of infectious germs floating
with the dust. Abundant water supply and good sewerage have rendered
possible and measurably safe, so far as the ordinary waste of life is
concerned, the building of vast tenements which swarm with people. But
the means of getting pure air, and especially of disposing of infectious
material often floating in it when it is confined, have not at all kept
pace with the demands of health and cleanliness.
But when we return to larger and more liberally furnished dwellings of
the well-to-do classes, we are not reassured, for in some respects the
rich are sadly handicapped by the "tyranny of things." Of course, long
and thick piled carpets afford persistent lurking-places for infectious
as well as other dust. Certainly heavy hangings in a measure hinder the
detergent action of the sunlight, shut the used air in and the fresh air
out, and shelter floating matter which might otherwise escape. Without
doubt, complex upholstery with roughened fabrics increases the
difficulties in the maintenance of cleanliness. But the usage of the
householder in these matters will, after all, depend upon whether his
practical devotion be most at Fashion's or Hygeia's shrine. We may hope
for the coming of a time when clean, clear, airy, simply furnished
living-rooms shall replace the stuffy, fabric strewn apartments in which
the fashionable citizen so much delights to-day.
In one particular, however, the devotion to cleanliness may be
unreservedly insistent, and that is that in the cleaning of
living-rooms, whether occupied by the sick or the well, the distinct and
recognized purpose of the operation shall be to remove, and not simply
to stir up, the ever-gathering dust. The past few years, so beneficently
signalized by the exploitation of the new germ lore, have seen marked
departures from the traditional sweepings and dustings of a past era;
and the emancipation of the housekeeper, and incidentally of the
household, from the thrall of the pestiferous feather duster seems
fairly under way. Still, some of the old barbarous travesties upon
cleaning widely persist. The dry broom still seeks out in the deep
recesses of the carpets not the coarser particles of dirt alone, but the
hordes of living germs which were for the time safely ensconced, and
among these such malignant forms as the chances of the day have
gathered. These all are set awhirl in the air; some collect upon salient
points of the fittings and furnishings; many stay with the operator, to
vex for hours the delicate breathing passages or the deeper recesses of
the lungs. Then in the lull which follows, gravity reasserts its sway,
and the myriad particles, both the living and the dead, slowly settle to
the horizontal surfaces, especially to the carpets. Then the feather
duster comes upon the scene, and another cyclone befalls. The result of
it all is that the dust has finally been forced to more or less
completely abandon the smooth and shining surfaces where it would be
visible, and is largely caught in the surface roughness of the carpets
or upholstery or hangings, ready at the lightest footfall or the
chariest touch to dance into the air again, and be taken into the lungs
of the victims of the prevailing delusion--the delusion that the way to
care for always obnoxious and offensive and often dangerous dust is not
to get it out of the house, but to keep it stirring in the air until at
last it has settled where it does not vex the eye.
By the use of moist tea leaves in the sweeping of carpets, by the use of
soft-textured fabrics, frequently shaken out-of-doors, or by moist
cloths or chamois in dusting, much useless dust-scattering may be
avoided. But no matter what the means employed, the final purpose of
every household cleaning should be to get the dust, not afloat, but
away.
Probably the most serious source of infection which one is liable to
encounter in the usual ways of life is the occupancy at hotels of
bed-rooms vacated by consumptives without subsequent efficient
cleansing, and travel in sleeping cars. I need not enter here into the
harrowing details of desperate uncleanness which the ordinary railway
travel brings to light. It is to be hoped that popular demand for reform
in the routine of hotel-keepers and railroad managers in the matter of
ordinary sweeping and dusting, and in the precautions against the spread
of tuberculosis, may soon usher in among them a day of reasonable
sanitary intelligence.
A belief in the communicability of tuberculosis is becoming widely
diffused, and it would seem to be desirable, on the ground of policy
alone, for the managers of summer, and especially of winter resorts
frequented by consumptives, to let it be known in no uncertain way that
their precautions against the spread of infectious diseases are
effectually in line with the demands of modern sanitary science.
The members of families bearing a hereditary susceptibility to the
acquirement of this disease should strive to foster those conditions
which favour a healthy, vigorous life in occupation, food, exercise and
amusement and remember that for them more than for others it is
important to avoid such occupations and places as favour the
distribution, in the air or otherwise, of the tubercle bacillus.
But when the individual has done what he can in making his surroundings
clean, and in thus limiting the spread of the tubercle bacillus, there
still remains work for municipal and State and national authorities in
diffusing the necessary knowledge of the disease and its modes of
prevention; in directly caring for those unable to care for themselves;
in securing for all such freedom from contact with sources of the
disease as the dictates of science and humanity may require.
To health boards, either national or local, must be largely entrusted
the primary protection of the people against the danger from tuberculous
cattle.
A national bureau of health might be of incalculable service in
stimulating and harmonizing measures for the suppression of tuberculosis
in various parts of the land, and in fostering research in lines which
promise large practical return in the saving of life.
Tuberculosis has in this country been officially almost entirely ignored
in those practical measures which health boards universally recognize as
efficient in the suppression of this class of maladies. Physicians are
not now generally required to report it to the local health boards.
Systematic official measures of disinfection are not widely practised.
But such official measures have been found extremely useful in the
limitation of other communicable diseases. While consumption must
logically be classed with diphtheria and scarlatina and small-pox as a
communicable germ disease, it is, in fact, in the light of our present
knowledge, when intelligently cared for, so little liable to spread that
it is properly exempt from some of those summary measures which health
authorities are justified in adopting with the more readily and less
avoidably communicable maladies. Moreover, consumption is apt to involve
such prolonged illness, and so often permits affected persons for months
and years to go about their usual avocations, that general isolation
would be both impracticable and inhumane. Moreover, for reasons which
it is hoped are evident to the reader, isolation among those capable of
caring for themselves is at present entirely unnecessary.
But while extreme measures are not called for, local health boards must
soon act in the prevention of tuberculosis. For the present the wisest
and most humane course would seem to be to attempt to secure the desired
ends rather by instruction and counsel and help than by direct and
summary procedures. There is no more pitiable spectacle in this land
to-day than that of hundreds of victims of advanced tuberculosis in
every large town who cannot be comfortably or safely cared for in the
dwellings of the poor, and yet who are always unwelcome applicants at
most of our hospitals and at many are denied admission altogether. They
are victims of ignorance and of vicious social and hygienic conditions
for which they are not largely responsible, and States and
municipalities, which are most to blame, owe them at least a shelter and
a place to die. Unquestionably one of the urgent duties immediately
before us in all parts of the land where tuberculosis prevails is the
establishment of special hospitals in which this disease can be treated
and its victims safely cared for.
And now at last remains to be spoken what word of cheer and hope our new
outlooks may have given us for those who are already under the shadow
of this sorrowful affliction. The dreams and aspirations and strenuous
labours of the students of this disease have looked steadily toward the
discovery of some definite and positive means of cure, but as yet full
success lingers beyond their grasp. The methods for the early detection
of tuberculosis which science has pointed out make it possible for
affected persons to plan such modes of life and early seek such
salubrious climates as promise a hope of recovery. We have studied
closely the ways in which the cells of the body often successfully
resist the incursions of the already seated germs, and learned how in
many ways the natural forces of cure may be sustained and strengthened.
We have learned much about certain complicating occurrences which often
form the most serious features in the progress of tuberculosis of the
lungs, and how they may be best avoided. And so to-day the outlook for
those in the earlier stages of this disease is in a considerable
proportion of cases extremely encouraging. It is no longer for us the
hopeless malady which it was earlier believed to be. It is not
necessarily a bitter losing fight upon which one enters who becomes
aware that the finger of this disease is upon him. A long and happy and
useful life may still be his if the conditions which favour his cure be
early and intelligently fixed upon, and patiently and faithfully
persisted in. The wise physician is here the best adviser in climate
and regimen, as well as in the proper selection of remedial measures,
and the earlier his counsel is sought and acted on, the brighter will
usually be the outlook for recovery.
Research in tuberculosis and the ministration of the physician should,
and generally do, go hand in hand, and no time should be lost in
bringing to the aid of the stricken what light and promise the studies
of the laboratory day by day may yield. The great and beneficent work
which has been accomplished by Trudeau in the Adirondack woods, in at
once widening the bounds of knowledge of tuberculosis and in carrying to
a successful issue in so many the varied and delicate processes of cure,
is a cheering example of what may be accomplished with persistent
devotion, by the light of our new knowledge, in mastering a malady so
long considered hopeless.