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The mean relative humidity as per United States signal service

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The above reports show that Fort Davis has the most favorable climate for persons suffering from lung diseases. It has the smallest range of temperature, most porous soil, fewest cloudy days, dryest air, requisite altitude, and pure drinking water. I can not learn of a single case of tuberculosis ever having originated in the vicinity of Fort Davis.

Now, as to the cases of tuberculosis and other diseases most benefited by the climate. It is a well known fact that the earlier in its development tuberculosis is recognized, sent to a suitable climate, under proper restraints and appropriate treatment, the better the chances are for recovery. I am fully convinced that a large per cent of tuberculosis patients, if sent to West Texas when the disease is in its incipiency, would recover, provided they were placed under proper care and treatment, and remain a sufficient length of time. Unfortunately a number of such patients become discouraged and homesick because they do not recover in a few

weeks' time, or improve as rapidly as they wish. There are cases in which several months will sometimes elapse before there is any perceptible improvement. There is at present a young lady in Fort Davis who came from southern Texas nearly two years ago with a well defined case of incipient tuberculosis of lungs, having high evening temperature, night sweats, distressing coughs and rapidly losing flesh. Examination of sputum showed abundant tubercle bacilli. These symptoms persisted, with intervals of slight improvement, for eight or ten months before there was any decided change for the better. She has had no elevation of temperature for nearly one year, coughs but little, very few bacilli in sputum, and now weighs 162 pounds-more than she ever weighed. My own experience is not in conformity to the generally accepted opinion in the profession that high altitudes are not suitable to hemorrhagic cases of tuberculosis. I have seen several cases that were having frequent hemorrhages before coming to this climate, which at once became less and finally ceased altogether. Dr. D. M. Appel, surgeon in charge of the United States hospital for tuberculosis soldiers at Fort Bayard, N. M., says upon the subject:

"Further experience confirms my statement of two years ago, that hemoptysis occurs much less frequently than at lower altitudes. Nearly fifty per cent of our cases have a previous history of hemorrhages, and in many it has occurred very recently before admission. In a very few has there been a recurrence, and when recurring it has been readily controlled, excepting in those with large excavations."

Fort Bayard is 6040 feet above the sea level-840 feet higher than Fort Davis. I believe that even advanced cases of tuberculosis would be materially benefited and life prolonged in this climate, if they could be placed under proper restraints and care, otherwise they had better remain at home among friends and relatives, who will comfort and soothe them to the inevitable end.

A very grave error, committed by some physicians when sending their tuberculosis patients to this or any high altitude, is the advice

to rough it, and take all the exercise possible. I have been told by some that their physicians had instructed them to go to the mountains of West Texas, camp out, drink whisky and rough it. I will admit that a few survive the ill effects of such pernicious advice, but the great majority succumb sooner or later to the rapid progress of the disease, superinduced by exposure, over exertion and excessive indulgence in whisky-most likely the latter. Absolute rest is essential to the successful treatment of tuberculosis of lungs in high altitudes until the patient becomes acclimated, and ceases to have elevated temperature, then gentle exercise should be encouraged. Out door life should be insisted upon, and the climate of Fort Davis will permit a patient to spend at least 300 days of the year in the open. The sun is very pleasant in coldest weather when one is protected from winds, and is not disagreeably warm in sum

mer.

The altitude of Fort Davis is too high for those suffering from organic heart diseases, but I don't think a better climate is known for the cure of asthma, hay fever, rheumatism contracted in the lower altitudes, and all malarial troubles.

In writing of the climate of Fort Davis, it is not my purpose to disparage the claims of any place in West Texas for preferment as a health resort, as I believe all that region west of the Pecos river from its mouth on the Rio Grande, extending into New Mexico and Southern Arizona, to be the ideal climate for tuberculosis patients, yet there are certain local conditions favoring Fort Davis, viz. Its pure water, porous soil and sheltered location from the northers and west winds prevalent at certain seasons. These favorable conditions are not found in all this vast arid region, especially pure, palatable water.

Could our law makers and wealthy philanthropists be aroused to the urgent necessity, and be induced to build and maintain consumptive sanatoriums in this healthful region, especially for the indigent sufferers, many human lives would be saved, the lives of many more materially prolonged, and the spread of "the terrible white plague," which is the scourge of our country, would greatly diminish.

THE PUBLIC CONTROL OF TUBERCULOSIS.

WM. S. CARTER, M. D.,

Professor of Physiology and Hygiene, University of Texas.

One feels considerable hesitation in discussing a subject which has been threshed over so many times, but the failure of public authorities to realize the importance of the matter and to take the precautions necessary for the prevention of a disease which can be controlled to a very large extent is sufficient excuse for once more agitating this question.

At the present day there are many physicians who still hold to antiquated ideas or prejudices concerning the infectivity of tuberculosis; there are others who think the communicability of this disease and the necessity for public control of it are greatly exaggerated; still others hold the fatalistic view that the prevention of tuberculosis is a matter of personal resistance. Those who hold this opinion contend that prophylactic measures by public health authorities are impracticable and useless.

As long as such diverse views are held by medical men we can not hope for any advance in the prevention of this "great white plague." The importance of the subject is sufficient reason for reconsidering it, even though it has been worn almost threadbare.

IS THERE ANY NECESSITY FOR THE PUBLIC CONTROL OF
TUBERCULOSIS?

The fact that progressive and up-to-date boards of health all over the country are taking active steps to limit the spread of this disease indicates that such necessity exists.

Some legislative bodies are passing laws providing for disinfection, which will really accomplish nothing in the way of preventing tuberculosis. It is unfortunate that efforts are misguided in this direction, for they give a false sense of security.

It is stated that at least one State (California) has attempted to

establish quarantine against the admission of tuberculous patients. When we stop to consider that bubonic plague has existed in California for two years and has gained a foothold that endangers the entire country, through negligence and misrepresentation which is nothing less than criminal, such hysterical and spasmodic efforts on the part of those in authority to control tuberculosis would indicate that it is not only desirable, but necessary.

The necessity for the public control of tuberculosis would depend upon (1) the prevalence of the disease, and (2) upon the cause, manner in which it spreads, and the feasibility of stopping its dissemination.

Although figures are often quoted, the prevalence of tuberculosis is seldom appreciated. In 1890, according to the death rate in the registration districts of the United States Census Bureau, there were 153,000 deaths from tuberculosis in a population of 63,000,000. In 1900 there were 145,000 deaths from the same disease among a population of 76,000,000. The mortality statistics for cities show that from one-tenth to one-seventh of all deaths in cities are due to tuberculosis.

With the exception of pneumonia, tuberculosis causes more deaths than all the common acute infections combined. According to the last census report, tuberculosis caused more deaths in 1900 than scarlet fever, diphtheria, typhoid fever, malaria, smallpox, dysentery and cholera infantum all together. If some of these are deemed of sufficient importance to be placed under public control, then, surely, tuberculosis should be dealt with in the same way. Merely because tuberculosis is a disease of long duration is not sufficient excuse for shirking responsibility in regard to it.

It is not pleasant to contemplate that of the three millions of people living in Texas at the time of the last Federal census enumeration, between 300,000 and 400,000 are certain to die of tuberculosis unless radical measures are taken to prevent its spread. This is not the prediction of an alarmist, but is as certain as is the entire system of life insurance. Life insurance is not a lottery, but a certainty, based upon the experience gained from large numbers and expressed in statistics.

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