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TUBERCULOSIS, SOCIALLY AND FINAN plagues and pestilences were expressions of a CIALLY.*
merciful provision on the part of Providence
to lessen the burthen of the poor man's famC. A. BOICE, M. D.
ily, and that it was impious and profane to
wrest from the hands of the Almighty these WASHINGTON, IA.
divine dispensations." There are some be. We are told the story of a gentleman who
lievers in that old superstition living yet. while traveling in Turkey, made inquiries of
Lord · Beaconsfield said that "the public his guide concerning the population and in
health is the foundation upon which reposes dustries of the various cities through which
the happiness of the people and the power of they passed. The guide informed him that the state, and that the first duty of the states. it was difficult to answer bis questions, and man is the care of the public health.” We that the knowledge was useless any way. Are only sorry that our present day statesmen
The proper study of the ravages of the do not see their first duty in the proper light. great white plague necessitates very much. Ten per cent of our total death-rate is due work in the collection of statistics. The to tubercular diseases. work is difficult, but it is by no means use
"Consumption is the most feared, the most less. It is invaluable.
prevalent, the most fatal of diseases. Other During the past summer we have wit.
diseases have caused more dismay, more panic nessed the general excitement wbich always and occasionally, for short periods, even prevails when a virulent epidemic visits our more destruction, but consumption has been country. A few hundred cases of yellow
the most constant and the most pestilential fever occurred in a Southern state, with a few of all, the worst scourge of mankind.” score deaths. The whole country was intense. Every community has many cases, rare is ly interested, some men in official position
the family which is not directly interested. lost much valuable time in jealous wrangling No age, nor race, no condition in life or lo. when they should bave stood sboulder to
cation of home is exempt. shoulder against the "yellow peril.”
"The continued activity of the prevalence Yellow fever is but an occasional visitor to of this disease is a reflection on the civilizaour country, and its ravages extend over but tion in which we live.” a limited area; while consumption is present
Men sbow a greater mortality rate than do at all times and in all places.
women, 10.7% of all deaths in men are due to Consumption is carrying away to an un.
tuberculosis, 10.3% in women. The greatest timely grave in this country every year
mortality among men occurs between the ages 110,000 victims, 3,000 every twenty-four
of twenty-five and thirty-four. Thirty-three hours, two every pinute, and no very great
per cent of all deaths in men between the excitement prevails. Why?
ages of twenty and thirty are from preventable diseases. Women show the greatest mor
tality rate between the ages of fifteen and No loud alarms, no fierce assaults are shown,
twenty-four, She starves the fortress first, then takes the town.”
Tuberculosis of bones and joints and of That we may know how and when to act, the glandular system occurs with greatest we must learn the social and financial impor. frequency in childhood — during the milk tance of the captain of the men of death. period of life. The great prevalence of these
The struggle with tuberculosis is intensely forms of tuberculosis at this time of life calls bound up with the solutions of the most for a more careful and thorough study of the complex economic problems, and no plans disease as it occurs in the source of our meat will be complete which do not bave for their and milk supply basis the material and moral improvement of Tuberculosis is widespread among all the the people. The struggle with tuberculosis lower animals—cattle, hogs, horses, chicken, demands the mobilization of the social forces and all wild animals in captivity are affected. -public and private, oscial and voluntary; Of the domesticated animals, those which are and the man behind the gun is the general the basis of our food supply show the greatpractitioner who sball, lead and guide and est predisposition. In some countries (Dendireot in the universal campaign,
mark, Belgium, Germany, England) 2 or 3 Osler says that it is not necessary to awak. per cent of the hogs, 25 to 33 per cent of the en the public. The public is already awake beef cattle and 50% of the milch cattle and, sitting on the edge of the bed, awaiting are tubercular. In the United States further orders.
as a whole, the per cent of milch cows An old heatben superstition, “That affeoted is about five (Minnesota 7%), but
when left to itself, the disease inoreases so * Read before the Henry County (Iowa) Medical So
rapidly that it is not an unusual thing to
“Whilst meagre phthisis gives a silent blow,
Her strokes are sure, but her advances slow,
ciety, August 10, 1905.
find milch herds where from 50 to 90 per are scavengers. Very rarely is the musoular cent are tubercular.
tissue the seat of this disease. In the interval between 1895 and 1901, the Cattle usually show the infection in the Bureau of Animal Industry examined the lungs, glandular system and udder; hence, carcasses of 30,000,000 beef cattle and of the spreading of the disease through the 120,000,000 hogs. In 1895 the condemnation meat and milk is inevitable. of cattle carcasses for tuberculosis was 407,4 It is a question wbich deserves far greater per million; in 1901 this bad increased to attention than it is receiving. 1285.6 per million, a gain of over 300%. In
In 1900 the average age of all dying (ex. 1896 tbe condemnation of hog carcasses was cept those under fifteen) was 52.8 years; of 29.5 per million; in 1901 the number bad those dying froin consumption the average arisen to 352.8 per million, an increase of over age at death was 37.4 years. At this age 1200%. Some portion of this increase is un. the normal after-life time is thirty-two years, doubtedly due to a more careful inspection, so that the real loss of life covered-measbut the fact remains that tuberculosis among ured in time—is represented by 3,520,000 our domestic animals is on the increase, and years annually. at a very rapid rate.
Death is most common in young men and In 1901, at the Chicago stock yards, 4,000
women at ages when they are just beginning hog carcasses were condemned; in 1904 the to repay the commonwealth the expenses of number was 14,000. Ninety per cent of these education. Again, tuberculosis is more fatal diseased hogs came from the dairy districts among married people than single, seeming of Iowa, Minnesota and Wisconsin. These to bear out the statement of Robert Louis bogs were fattened on the buttermilk from Stevenson. "that marriage is a field of battle
ies. lowa bas 600 creameries.. and not a bed of roses.” In Massachusetts, from 1856 to 1895, the The mortality from tuberculosis is, there. deaths from tuberculosis (other than pulmon. fore, a problem compared with which all ary) bave increased 36%, wbile the general other social problems of a medical cbaracter mortality from consumption has decreased sink into insignificance; and it is safe to 45%. This means that the disease is on the say that the possible prevention of a large increase in those animals which serve as the portion of the mortality of this disease is basis of our food supply, and that unless more justly deserving of the solicitude, the active care is exercised in the selection and care of
personal interest and liberal pecuniary supour dairy berds our boasted sanitary measures port of all who have the real welfare of the will come to naught.
people at heart. That it is possible to contract tuberculosis from the milk and meat of diseased animals, Race. The influence of race on any social there can be no doubt. Clinical evidence is phenomenon is hopelessly obscured by the overw belming in support of the contention. historioal accidents of conquest and migra
In Michigan, where vital statistics are re. tion. We almost feel the truth of the say. liable, in children under five years of age ing, "we need not deny that blood tells, but there averaged from 1885 to 1897, 104.3 deaths we must not be prematurely certain that we from tuberculosis not affecting the lungs to can hear what it tells, or that we can distin. every 100 deaths from the pulmonary form. guish the voice of the particular blood that In the period from 1898 to 1900 the ratio had speaks.” increased to 263.3 to 100. Why this tremend. The registration area of the United States ous increase in the mortality from other includes 38% of the population, and the reforms of tuberculosis as compared with con. ports collected therefrom are a fair repre. sumption at wbat has well been called the sentation for the whole country. milk-drinking age of life?
Statistics show that the colored races (Afri. A recent epidemic of sickness among the cans, Indians, Chinese and Japanese) bave a students of the U. S. Naval Academy caused general mortality rate of 70% in excess of an investigation of the milk supply to be that for the white race; while the tubercular made, with the result that thirty-six out of mortality exceeds that of the whites by over the herd of sixty-two milch cows were found 300%. These colored races show great ten. to be tubercular. One tubercular animal in dencies to crowd together in dirty tenements. a herd is like a rotten apple in a barrel of The ignorance and carelessness of such peogoorl ones—it is not long until the entire ples provides an ever ready field for the inberd is diseased, then if some of the animals fecting organisms. The death rate among be sold, the infection is carried to other white children (under fifteen years of age) is berds.
31.8 per 100,000; among colored children the Tuberculosis affects hogs almost exclu. rate is 246 per 100,000. Total colored mor. sively through the intestinal tract- hogs tality rate (ages öfteen to forty-four) is 587.4
per 100,000. Next come the Irish with a The following facts must be told again and rate of 428 per 100,000. Their well known again: habits of overcrowding, carelessness of living, 1. Tuberculosis is infectious. intemperance and poverty.render them very 2 Tuberculosis is preventable. liable to disease. In city tenements the death 3. Tuberculosis is curable in from 80 to rate is lowest among that class of population 90% of the cases when diagnosed early and which is least addicted to drunkenness. In treated correctly. tem perance more than trebles the liability The treatment of tuberculosis has for its to tuberculosis.
basic principle, rest, food and fresh air, all
other lines of treatment are but supplemenOccupation.-A list has been compiled of
tary to these. fifty-three different occupations. Marble and " stone-cutters head the list with a rate of Financial Importance.—Maryland statis510.5 per 100,000 engaged in that work. ticians estimate the average individual loss for Tobacco workers hold second place, physi. every wage earning male dying with tuberou. cians and surgeons rank fortieth, with a losis at $741.64; and the potential loss to rate of 168.8; clergymen rank fiftieth and the community for such death at $8512.52. bankers fifty-third-the healthiest of all, Dr. Homer Thomas, of Chicago, has esti. 42.8 per 100,000.
mated as follows for Illinois: Money loss in Condition in Iowa.-Iowa is essentially
education of those who die before the age of an agricultural or rural community. We
twenty, $1,187,800; loss from inability to have only one city with a population in ex.
perform manual labor on the part of those cess of 50,000. Only 16.8% of our people
sick, $30,000,000; loss in savings of those live in cities of over 8,000 inhabitants. Men
wbo die before the end of the producing age, constitute 51.8% of the city population. We
$5,139,000; and cost of sickness, $225,000, a have no crowded tenements; no filthy breed.
total for the state of $36,551,000 a year. Illi. ing places of epidemios. Our population is
nois has about 7,000 deaths in a population 2,231,853, and we have tuberculosis-lots of
of almost 5,000,000.
Iowa's death rate of 2,000 is two-sevenths it. The Board of Control, from fairly reliable
liable that of Illinois. At the same ratio, our
annual loss for this leader of the preventable, statistics, credits the state with 10,000 cases of tuberculosis and a yearly mortality of
and therefore unnecessary, diseases is about 2,000. Iowa's mortality rate from this
$10,443, 142. one disease is 7.05% of all deaths. Forty
For the United States in the same propor. three of the states exceed us, and we exceed
tion, the arerage yearly contribution to ignor. five-Idaho, Wyoming, Indian Territory,
ance and slothfulness totals the enormous New Mexico and Utab. California leads the
sum of $574,385,420; nearly $8.00 for every Union with a rate of 15.46%.
man, woman and child; more than one-half The average length of life after the onset
the value of the entire corn crop, $952,868,of the disease is two and one-half years. .
000. We certainly have cause for congratulating Signs of Progress.- Massachusetts, New ourselves, not for anything which we have York, Pennsylvania, Indiana, Illinois, New done, but for our natural advantanges, but we Hampshire and Iowa have State Societies for have room for improvement.
the Study and Prevention of Tuberculosis. Pasteur said that "It is in the power of These societies will accomplish great good man to cause all parasitic diseases to disap. in the systematic study of the disease as it is, pear from the world.”
and in the scientifio presentation of the In New York City very reliable statistics learned facts. have been kept since 1885. At that time The working rule of the average statesman the annual tuberculosis mortality was would seem to have been, “millions for tri. 8,000. The mortality remains the same while bute, but not one cent for defense," but with the population has doubled in the past the information gathered by these societies twenty years. Preventive measures are sav. we have no doubt but that Daniel Webster's ing for that city 8,000 lives yearly, still the famous remark will find a more widespread city is losing $23,000,000 annually on ac. application, count of the plague. Mortality from con- Masaschusetts and Pennsylvania now have sumption decreased 46% from 1800 to 1900. State sanatoria, and without doubt Iowu and
“We must care for the consumptive in the Illinois will soon be in line. right place, in the right way, and at the right These states have found that the money extime until he is cured; instead of as now, in pended for sanatoria has been returned many the wrong place, in the wrong way, and at the fold, in increased health and happiness of the wrong time until he is dead."
*The new shall do
Its hand shall shape the course;
To win the richest prize that man can win-
The expenditure of $50,000 or $100,000 by in that restricted sphere have made his name Iowa for a sanatorium will within a few known all over the land; and in his line he short years greatly reduce our annual loss of has few superiors. But we have searched in over $10,000,000.
vain through the records of medicine to find Under the present systematic enforcement any indication of his having practised medi. of isolation and disinfection, tuberculosis cine in his days of maturity, or contributed will be extinct in Prussia in 1927, in Eng. anything of value to non-surgical medicine, land in 1917.
much less to therapeutics; or that indicates Are not our citizens of as much value as that he has paid any attention to the develop. are those of any foreign country? Does not ments in the latter during the last twenty the medical profession owe to humanity the years. In fact, we must give his startling truths which it knows, and knows abso. assertion about the credit that our own would lutely?
receive, were we to state that there was no
surgical treatment for appendicitis. The unknown things, the wondrous deeds
But the influence exerted by such stateEarth's future needs demands;
ments does not stop with the medical profesIts brain devise the plan
sion. They form part of that enormous system of detraction and pessiwism by which the profession has been undermined in the estimation of the publio, and the way opened
for the operations of quackery. The intelliTHE PRESENT STATUS OF THE ALKA gent layman says: “According to the leaders LOIDAL MOVEMENT.
of your own profession you have nothing to
offer me except the sharp point of the knife. W. C. ABBOTT, M. D.
I don't want it.” The quack says: “Regu
lar medicine acknowledges she has no remeCHICAGO, ILL.
dies but surgery. I bave." And he bas. WHEN Boswell first met Samuel Johnson Nowadays the quack is a graduate of regular the latter was giving his views as to some medical colleges, and as well qualified as the other man with considerable vigor. Boswell average practician-perbaps a little better, endeavored to moderate the storm by remark. while relieved of the trammels of ethics and ing that he hardly thought the man as bad possessed of an infinitely greater knowledge as Johnson said; when the latter turned on of human nature and of business methods. him witb-'Sir, I do not see what right you He is devoid of prejudices and quick to pick have to an opinion on the matter !".
up and utilize any improvements in medicines Very often we have the opportunity to ask and methods that arise-far quicker than the this question, when people advance their views plodding general practician. The latter may with an ex cathedra air, as if that settled the have in his office a microscope he never uses, matter in dispute.
and an electric outfit that is out of order, When a distinguished surgeon, professor of but he continues to prescribes squills and surgery in Rush Medical College, says flatly, paregoric for every cough, opium for every "there is no medical treatment for pneu. pain, whisky for everything else. monia” we feel warranted in respectfully ask. Let me state as my profound belief, after ing-what right have you to an opinion on studying quackery in all its aspects for years, this subject? and, for whom do you speak that its existence has a tangible, easily comthus ? For yourself, for your colleagues, or prehended reason. That reason is little credfor the medical profession in general? If for itable to ourselves. If the profession is poor, yourself, we submit that you should have said if the doctor finds it yearly more difficult to that you knew of no such treatment; and make both ends meet, to provide himself with with that statement we should have no quar- the needs of an up-to-date practice, if quacks rel. If you spoke for your colleagues, we ask multiply and the public accepts and enriches if they authorize this assertion, and if tbis is every new one, however absurd may be bis the present teaching of Rush? If so, the claims, whose fault is it? It is our belief that physician who has medical students may well the whole mutter may be summed up, by say. consider whether they will get from Rush the ing that the therapeutics of the regular med. teaching he deems best. If Dr. Bevan speaks ical profession is not good enough to meet in bebalf of the medical profession, we ask the requirements of the present day. It is by what authority does he assume the right this miserable, outworn therapy, I and my to do so ? And as a member of that profession colleagues are endeavoring to reform. we repudiate bis assumption to speak for us. Well, what's the matter with our therapeu. and deny the truth of his assertion.
tics? It is uncertain, inefficient, wrongly Dr. Bevan is a surgeon, whose attainment directed, unpalatable and crude, antiquated,
and in a word unscientifio. Let us take up Wrongly Directed. Here we come to the each count of this indictment:
crux of the matter. We have been directing
our attacks against diseases as entities, when Uncertain. - It is scarcely necessary to ex
there are no such things. Leaving out the patiate on this point. The writer has seen a
influence of quinine over malaria, mercury man with dilated heart die within an hour
over syphilis, and where bave wo a third inof taking a dose of Anid extract of digi.
stance of a specific for any disease? We are talis, that bappened to be weak in the
in truth not called on to treat diseases, but cardiac tensors and rich in the cardiao
conditions. No matter what may be the disdepressant, digitonin. He has given jab
ease, we recognize the presence of autotoxe. orandi to increase a mother's milk and
mia, and remedy it; of hyperpyrexia, and had the drug dry up the secretion entirely,
quell it; and if we are qualified, of disturbbecause it was weak in pilocarpine and rich
ances of the vasomotor equilibrium, and corin jaborine. Even with cincbona, whose al.
rect them. Well were it if we did away with kaloids are pbenomenally synergistic, we
these things — the prescription books, the have practically dropped the cruder prepara
ready-made remedies for single diseases, and tions for quinine. How much more neo
the belief that a name-diagnosis is an essenessary this is with plants tbat contain an.
tial preliminary to drug treatment. tagonistio principles. I will only allude to
Here is how we get wrongly started in our hyoscine, which is completely smothered
work; we see a patient; wait some days till by the accompanying atropine except in some
able to make a name.diagnosis-eight days rare specimens of hyoscyamus; arbutin, which
for a Widal-and then turn to our formula is accompanied by thirty-five times its weight
collection-select the one that has the biggest of tannin, so that effective dosage was un
name behind it, or contains the most ingredi. known until the arbutin was separated and
ents, and give it throughout the attack. If administered alone.
we construct our own prescription we select But I must speak of the ulkaloids of hy.
the remedy we prefer-not knowing just what drastis: Berberine contracts relaxed connec. it will do we throw in a few others, any one tire tissue, while hydraştine contracts the
of wbich may hit the case, and let her go at smaller blood vessels, especially of the uterus. The former is a much needed remedy for di.
The difficulty is that the dependence on latation of the stomach, for uterine, gastrio
formulas leaves us at the mercy of the manu. and intestinal ptosis, for all relaxed states of
facturers who promote specific remedies for ligamentous tissues. Hydrastine is a useful
specific diseases; and abdicating our funo. remedy for menorrhagia and especially me.
tions as prescribers we follow the lead of pat. trorrbagia. The man who administers prep.
ent medicine makers. arations containing both when but one is
Instead of this, our attack should be di. indicated, loses much of the satisfaction that
rected against just what we see to attack-the comes from an intelligent practice of med.
symptoms present. We have fever-modericine. In a word, there is in the crude prep.
ate it; we treat what there is to treat, and arations uncertainty as to the nature and
study our cases instead of our books. We do the degree of effect we are going to get,
not wait for a name-diagnosis, but make a whereas with the active principles we have
condition-diagnosis on which we base our certainty as to both.
therapeutics. We can not stop to ascertain Inefficient.—When we have to wait for what is the cause of hyperpyrexia, because beour medicinal principles to be dissolved fore we can do this our patient will be dead from an encumbering mass of inert sub. — we just apply ice and cool him off-then stances, when we are uncertain as to the we hold an ante.mortem instead of a post. kind and quantity of effect that will follow, mortem to complete the diagnosis. This we we are paralyzed as to tbe prompt and effec- term condition-therapy. tive intervention at the beginning of an at. tack that is indicated, and that alone would
Unpalatable and Crude. Because we ad. prove capable of breaking up the malady be
minister uselessly a lot of inert woody fiber, fore it had become firmly seated in the tis.
gum, sugar, pectin, albumen and other ingresues.
dients of the plant, which add no useful ele. Consequently our attitude toward the pa
ment to the dose but make it larger, more untient tends to become that of a benevolent
pleasant, slower to act, less likely to be respectator, insteud of powerfully and intelli
tained by the stomach, and materially intergently intervening, and becoming the con
fere with the absorption of the active prin. trolling element in the situation. Sureness
ciples presented. we must have, to act with power. Sureness Antiquated.- Here is our final point. The as to our drugs gives us the first firm footing. basis of scientific therapeutics is the known