The Cleveland Medical Journal VOL II JANUARY, 1903 The Prevention of Consumption BY FRANK WARNER, M. D., COLUMBUS No I As Chairman of the Committee on Public Health, I have pre- I offer no apology for selecting this subject for discussion. For 2,000 years tuberculosis has been looked upon by many as He, of course, at once contended for the existence of a specific, Read before the Columbus Academy of Medicine, October 6, 1902 148681 covery. Koch's work was painstaking and conclusive. It was conclusive in that the tubercle bacilli were proven to be not only present in every case of tuberculosis, but that these germs were capable of infecting guinea-pigs and rabbits after a definite time of incubation. If these germs could be depended upon to uniformly produce the disease in these animals after infection by inoculation, and as the germs were always present in tuberculosis, the fair inference was, of course, that they were the cause of consumption. If these germs were the cause of consumption and you could successfully infect animals, why would not these germs infect man by being breathed into the air-passages? It is the belief of the vast majority of the medical profession of the civilized world today, that under certain conditions of the general system and careless or ignorant disposition of the sputum of a patient, coupled often with bad hygenic surroundings, that this disease is conveyed from one patient to the other, that it is a specific, infectious disease; that this infection rests in the sputum in the form of the bacilli of tuberculosis; that these bacilli as a rule only find their way into the system through the air-passages, only after the sputum has become dried; that this infection does not pass from body to body, but only in the way indicated. Many would classify pulmonary tuberculosis as a contagious disease, but the term infectious disease, or a disease communicable by infection, seems to me to be more in accord with the facts. A considerable misunderstanding by the public results by naming the disease a contagious one. Indeed, I think there is often a great laxity of the use of the terms in the medical profession which designate just what we do mean in reference to this very question of infection, contagion, etc. Many use these terms synonymously. Consult some medical dictionary and you find the same thing. This is unfortunate and is capable of working indefinite and widespread misunderstanding among the laity. It is to the laity that we physicians and the State must look in our efforts to lessen, or even blot out from the civilized world, tuberculosis. In some dictionaries, as just stated, little or no distinction is made between contagious and infectious diseases. Tetanus is an infectious disease, but everybody knows it is not contagious. People have come to know that typhoid fever is alone infectious, but not contagious. One may become infected with malarial fever, but who would say contagious and infectious can be synonymously used here. Septicemia and pyemia result from an infection, and the disease established is a specific, infectious one; but it is not contagious. Tetanus, glanders, gonorrhea, syphilis, actinomycosis, hydrophobia, anthrax, malarial fever, dysentery, bubonic plague, beriberi, septicemia and pyemia, erysipelas, diphtheria, lobular pneumonia, cerebrospinal meningitis, dengue, influenza, whoopingcough, epidemic parotitis, rubella, rubeola, scarlet fever, varicella, variola, relapsing fever, typhoid fever, leprosy and tuberculosis, are all specific infectious diseases, but they are not all contagious by any means, and we see at once by looking over the list of infectious diseases just mentioned the inaccuracy of using so frequently the word contagious interchangeably with infectious. Simply because a disease is not contagious does not imply that it is not highly infectious. Septicemia is not contagious, but it is highly infectious. Where there are but few of the specific germs, as in a pure country air, the likelihood of infecting a recently-made peritoneal wound is not what it would be in a room where there was a suppurating wound, and the air was filled with these germs. That is so selfapparent and so consistent with the facts that no argument is required to convince anyone of that. This disease, however, is a highly infectious one. It is only natural that it should infect with sufficient uniformity to give results that no one questions. It is different with a disease which infects with much less uniformity; a disease to which thousands may be exposed and yet all escape if the conditions are favorable for their escape. However, infecting a patient here and a patient there, after having permitted so many to escape infection after repeated and prolonged exposures, it is only natural that such a mode of infection should be sometimes doubted as to whether that specific disease is transmitted from one patient to another, either directly or indirectly. Tuberculosis is a specific infectious disease. How does it infect? Is it contagious? Is it communicable from one patient to another? Dr Hermann M. Biggs, in an address on "Preventive Medicine in the City of New York," delivered before the British Medical Association at Montreal, says that: "It is now universally admitted that tuberculosis is infectious and is communicable, and the most fatal disease. to which the human race is subject. Yet, as a rule, no effective measures, or no measures at all, have been adopted by sanitary authorities with relation to it. We believe, nevertheless, that it may be more easily controled than any other of the principal infectious diseases with which we have to deal, and that it is of as great importance-judged by the deaths it causes-as all the other together." In 1893, the Health Department of New York passed a rule |