SHALL THE STATE TAKE CHARGE OF PHTHISICAL PATIENTS AND TREAT THEM

AS CONTAGIOUS?

BY F. N. SAUER, M. D., OF RACINE.

Knowing at the outset of this paper that it will meet with fixed opposition in the minds of many, as it attacks certain principles laid down by the medical profession, nevertheless, we will endeavor to show a few reasons why the treatment of phthisical patients should be a State charge.

Every one will admit the danger of phthisical persons going around in our midst. We come daily in contact with them either socially or in business. If we were all above the age of forty the danger of infection would be diminished, but we are not, and the children are the most cruelly exposed, as their powers of resistance are not very great; we find, therefore, thousands of young patients dying of phthisis in which there is no hereditary taint, physical or anatomical deformity.

We ask ourselves why is it thus? The answer invariably will be, because they have been infected. We find the disease more amongst the poorer and middle classes than amongst the wealthy, the chief reason being the unsanitary surroundings; frequently large families occupying the same rooms day and night. Such hothouses of propagation we find in every city, town, village and hamlet. Into these houses come people of all classes, either in business, social or religious intercourse, and become infected and carry it into their respective stations of life.

Under these circumstances, poverty becomes the nutrition of the tubercular bacillus. Many of these people keep also pet animals which become infected and spread the disease. The eminent Dr. Aronson in the Berlin Medezinsche Gesel

schaft exhibited a goat that had been with a phthisical family and had become diseased. In the course of time this goat became the property of another family and infected them with tuberculosis, several members dying of that disease.

Another source of infection are the second-hand clothing shops from which go forth germs of disease in the discarded garments of phthisical people. The report of a noted bacteriologist regarding the longevity of the bacillus, he having examined, microscopically, tapestries that for generations adorned the walls of a country mansion, found them teeming with bacteria of consumption. It is well known that irritating substances produce disease of lungs and air passages, and so predispose to phthisis. It becomes an easy matter for one infected person to infect others, as observation shows us the result of workingmen being compelled to work in unsanitary shops and becoming infected from association with their fellow workmen. It is here that we quote the discussion in the Academy of Medicine of France, January 27, 1896, upon the contagiousness of tuberculosis. The majority of the members considered it more dangerous than diphtheria, measles or smallpox, and say it should be isolated with the greatest care. Terrier asserted that the mortality among the interne nurses and servants of the hospital that he is connected with, is something frightful and directly traceable to infection, ast he has watched the development year after year. All agree that the present method of treating persons affected with tuberculosis is criminally lax in regard to the general health of the community, and a radical reformation is imperatively necessary. The doctrine of proper selection in matrimony is one that may be properly considered by the State.

It is a rather striking commentary upon our civilization that a phthisically degenerated individual can obtain a marriage license, and so propagate his miserable species, and this degenerated kind will fill our clinic hospitals and all charitable.

institutions, and so so entail an enormous expense which could be avoided if the State only recognized their actual condition and sent them to the proper resorts.

It becomes a serious question when we understand that this unfortunate class of dependants is yearly growing in number out of all proportion to the natural increase of population.

Now when we sum up all the dangers of propagation and infection of this fatal disease, to what conclusion do we come? Simply to the self-evident fact that, with our present knowledge, medicinal treatment without climatological treatment is an utter failure. The treatment of tuberculosis has only two points which need seriously to be considered. These are climate and nutrition; and as the poor dependent patient is not financially able to take advantage of the suitable climate and nutrition, and the condition of society demands protection, it behooves us that we should use all efforts to induce the State government to pass laws to place these people where they may have proper surroundings, and prevent the propagation of the diseases.

SHALL THE STATE TREAT TUBERCULOSIS AS "CONTAGIOUS?"

BY F. T. NYE, M. D., OF BELOIT,

PROFESSOR OF RHINOLOGY AND LARYNGOLOGY, WISCONSIN COLLEGE OF PHYSICIANS AND SURGEONS, MILWAUKEE.

Delafield and Prudden tell us, that persons are said to have tuberculosis when there are going on in the body inflammatory and necrotic processes, accompanying and dependent upon the presence and growth of the tubercle bacillus. Also that the lesions we regularly find, are,

Ist. Miliary tubercles.

2nd. Diffuse inflammation of various kinds, with cheesy degeneration of the inflammatory products.

3rd. The ordinary products of inflammation-pus, fibrin, serum, epithelium, granulation tissues and connective tissue. Associated with all these lesions we find the tubercle bacilli.

This brief description of this disease gives also an accurate description of the causes. Actual observation, careful study, clinically and otherwise, based upon several years experience, satisfy me as to the tubercle bacillus being the direct cause of tuberculosis.

Admitting this to be a fact, then the vital question arises, how can we obviate or control these microbes or stay the spread of this dread disease? Is it necessary for me to state that there is always danger from infection by these bacilli lodging in any part of the body, or, as has been recently shown, that transmission does occur from mother to child? (Lahman reports a case of congenital tuberculosis, where the mother died of tuberculous meningitis; the child lived but twenty-four hours. In its spleen, lungs and liver were found nodules resembling tubercles, and containing tubercle bacilli in large numbers.) Or that it is not always absolutely nec

essary for their development that they are located in any definite part of the body or in just such media as any and all are liable?

Admitting these facts to be incontrovertible, is there one physician present who would not prefer some definite method for their control? How can this result be reached otherwise than through State control, or perhaps better still, national, and then referred to each State and carried out by the State Health Boards?

In a recent letter from Dr. Prudden of New York, some very wise and efficient suggestions are offered:

"It is unfortunate to speak of tuberculosis as contagious because upon the whole most people associate with the word 'contagious' a degree of communicability which is far higher than properly belongs to tuberculosis. If we were to speak of tuberculosis as a communicable disease, keeping the word 'contagious' for such diseases as smallpox, scarlet fever and other like infectious diseases, we should avoid in such public measures as as we have in mind, the danger of unduly frightening people and setting up a more or less justifiable opposition. It is certainly communicable and largely through the sputum, but it certainly is not so readily communicable as are the exanthemata, and more than this, under a proper sanitary regime its degree of communicability can be reduced practically to nothing.

If Boards of Health would straighten out their nomenclature a little, dividing the infectious diseases into the communicable and non-communicable; and then divide up the communicable diseases, which include nearly all of the infectious ones, into those which are readily communicable and which are not readily communicable, reserving the term 'contagious' for those which have been indicated, then there would be a proper basis for work without risk of doing harm. This is a line along which the New York Health Board has been working, as well as many others."