, THE SUNDAY 0EEGONIAN, PORTLAND", 'AUGUST 18, 1901. 11" IsMtPilK, r avag'es of Consumption, " How Present Great Mortality Rate May Be Lessened Under Proper Management. Through the kindness of Dr. August C. . wanting:. To send a phthisical patient 3Cinney. of Astoria, the following: paper is submitted. It is by Llewellyn P. Bar bour, M. D., Tullahoma, Tenn., profes sor of materia medlca and therapeutics. University of the South; lecturer on tuber culosis, University of Tennessee: According to the- statistics of the last census, 130,000 people die from consump tion in the United States alone each year. If the effects of this disease were con centrated in Memphis your city would be (depopulated in nine months. By the same authority there are 2500 deaths from consumption in Tennessee each year. This concentrated in a town like Tullahoma would wipe it from, the earth in a year's time. Again, these figures mean that in the United States 15 people die from this cause every hour. Three hundred and sixty every day. Ten in Tennessee ev ery day. Recently in a gathering- of about 100 men and women I asked if there were any present who had not felt the dread fulness of consumption by the loss of some one dear to them; there was not one. In the same gathering Ave had mourned death from yellow fever, seven from diphtheria, four from scarlet fever, one from smallpox, and one from cholera. Surely this is the David among diseases. Our duty as guardians of the public health is plain. Our leaders nave dem onstrated the truths of the contagiousness of consumption, of its preventablencss, and of Its curableness in early stages under proper management. We must arouse ourselves and be making life-saving application of these truths. Every line of attack and defense must be guard ed, every resource used. Individual ef forts and municipal, state and national authority must be enlisted, as is done when tho Sauls of cholera or smallpox threaten to invade our shores or lift their heads within our land. There are two obvious methods by which we may hope to lessen the mortal ity rate of any disease. First, by re storing those already diseased; second, by preventing the occurrence of the mal ady. The first method is the oldest and seems still to be more popular than the second. It is, however, less successful, and considered as a matter of social econ- away from home to some distant resort. there to take his chances In fashionable hotels or unsanitary boarding-houses, and to be his own guide and counselor, is to Invite disaster. Good institutional treat ment In the worst of climates gives far better results than what I will call uncon. trolled treatment in the best climatic re sorts. Indeed, there Is a striking similar ity of results obtained at good institu tions, wherever situated. Meissen, In his sanatorium at Hohennef, Germany, al titude of 774 feet, reports 27 per cent of cures and 40 per cent permanently ar rested. Rompler, at Gorbersdorf, Swit zerland, altitude 1S40 feet, gives the same. Detweller, of Falkensteln, altitude 1378 feet, climate somewhat misty and foggy, reports 23 per cent' of cures. Institu tions at or near the sea level in Russia, Belgium and England give about the same percentage of cures and permanent arrests as do those at higher altitudes. "Von Ruck, at Asheville, altitude 2250 feet, reports from his sanatorium 35 per cent cured or permanently arrested, 46 per cent improved. Trudeau, at Lake Sara nac, altitude 1539 feet, reports out of 91 cases 19 cured and 26 arrested. "While my work at Tullahoma, Tenn., is yet in Its indplency. I have to report out of 16 coses 5 apparent cures, 7 greatly Im proved. Some of these Improved cases are still under treatment, and I shall, appar ently, yet be able to report one or two of them under the . head of cured. Alti tude of Tullahoma", 1150 feet. The lesson of these statistics needs no comment. This segregation of patients in special institutions Is helpful also In preventing the spread of consumption, and will be again referred to under that head. Ob jection is often made to special institu tions that the influence must be depressing upon one surrounded by so many con sumpltves. This objection is born of ig norance. The atmosphere of these places Is usually one of serenity and content. The Improvement of one patient Inspires hope in many others. If the physician in charge has, as he should have, the gift of Inspiring confidence In his patients, they will quietly resign all worry and care about themselves, and willingly sub mit to the minutest details of manage ment, serene In their confidence that the measures taken will restore health. Be sides Inducing obedience to directions, this hope and confidence In itself makes large- ical vigor of young men and women in our better class of colleges. This work must be encouraged and extended to schools of a lower grade and to the public schools. Especially should the children of families predisposed to phthisis receive careful physical training, and be kept In the best of sanitary surroundings. Better Sanitary Conditions. That Insanitary conditions have much to do In the causation of consumption was demonstrated by Drs. Bowdltch, of Massachusetts, and Buchanan, of Eng land, many years ago. They showed conclusively that consumption was much more prevalent in residences situated in low, wet soils than in those situated on hillsides and pervioussoils. They con firmed also the general belief that Ill ventilated, dark, damp dwellings conduced to the occurrence of the disease. And this Is all reasonable In the further light thrown on the etiology of the subject by recent Investigations. While the tuber cular bacillus is the specific cause, it Is only under conditions favorable to Itself that It develops In the human organism and starts the variety of pathological states called consumption. Dark and damp surroundings, with Ill-ventilated rooms, weaken and make susceptible the animal organism, while the microscopic plant is conserved In great vigor to infect and reinfect the hosts. The authorities above cited also give statistics showing a re markable lessening of the amount of phthisis wherever these unwholesome con ditions have been corrected. And here Is a great work for the future. The peo ple must be persistently taught the im portance of proper construction and loca tion of dwellings. Our cities and villages must be thoroughly cleaned and drained. Landlords must be prohibited the erection of apartment and tenement-houses not properly ventilated, sunny and dry. The most worthless of the population must not be allowed to herd In damp and filthy holes. We as physicians must press upon the people as a scipntlfic truth the lesson taught by the Great I'hyslclan that all men are brothers. Germs incubated in hovels may be carried to halls. Dives In his princely palace is not safe so long as Lazarus lives In an unwhole some den. Spread of the Tubercular Bacilli. "There can be no tuberculosis without the tubercular bacillus" is a pathologic axiom. This bacillus, under ordinary cir cumstances, does not propagate Itself, or long exist outside the animal organ Ism. Could we absolutely prevent the spreading of this germ from one animal organism to another, the phthisical death rate would soon be zero. This conveyance of the bacilli occurs through the media of discharges from tuberculous patients, and from milk and flesh of diseased ani mals. The almost complete prevention of infection from these sources certainly seems possible, and It Is in this line that would willingly enter. Many honest work ing men who arc self-supporting when wel! And themselves and families the ob jects of charity when str.cken with a self, with an attempt at enorcemeT:i?r would be educational, and a beginmrs might be made by ordinances forbildlag expectoration on the floors of public ccti- PROFESSOR LLEWELLYN P. BARBOUR, M. ., OF THE UNIVERSITY OF TENNESSEE. 7 X - ,V&&V-' tto li '4 k xlm ijfejjjjjjSjgffllMl ROUND DOME, ROYAL ARCH AND WASHINGTON COLU3IN. omy, Is by far the most wasteful. But the sick, like the poor, we have with us al ways, and for humanity's sake we must be untiring in our efforts to cure. My discussion of the treatment of con sumption there must be brief. An Early Dingmohls. First, permit a sort of Irishism; the greatest advance the general practitioner can make in the treatment of consump tion is in learning to make an earlier diag nosis. It Is a. truism to say of any dis ease -that the earlier It is recognized and put under correct management, the bet ter are the chances of recovery. This is doubly true of phthisis. A distinct dis ease, a pathological entity at first, it be comes in more advanced stages a com plication of various pathological condi tions. Yet alas and alas! cases are dally overlooked, only to be recognized when death has plainly placed his seal upon the face of the patient. The early diagnosis liears also upon the prevention of con sumption; for the atient, knowing his trouble, can thus be early Instructed as to the source of danger he may become to others, and how to avoid that danger. Therapeutic Management. By the judicious use of some of our fa miliar drugs, -we can help to lessen the mortality rate of consumption. Iron, ar senic, the hypophosphltes, strychnine, cod liver oil, digitalis, opium, the digestive ferments these meet Indications which frequently arise, and are aids not to be despised. Yet their excessive and inju dicious use will defeat the ends aimed at. The more recently introduced reme dies for consumption are yet on trial, and are the subjects of much controversy. The ' remedies produced by Professor Klcbs from culture growths of the bacilli are, I am convinced, a distinct advance in the therapeutics of phthisis. These products, antiphthlsin and tuberculocldin, seem to me to be Identical in results. In my hands these remedies have certainly seemed to accomplish all that Klcbs claims for tbem, namely, the destruction of tubercular bacilli in living tissue. This claim Itself shows the limitations of any Specific for tuberculosis. We must keep clearly in mind that advanced phthisis is not a simple disease; that it consists of a multiplicity of pathological conditions. With all the bacilli destroyed, there re main still the septic germ to be overcome, damages to be repaired, and the body, shattered generally, to be restored. This leaves a great work to be done, ana this work can only be done by wise hygienic management. Hycienic Treatment and Special In stitutions. The wise hygienic management of phthi sis Involves the close, careful, untiring, personal supervision of every detail of tho patient's daily life. Nothing avoid able must be allowed to occur that will injure the patient, and nothing left un done that will make for improvement. Because of this need of minute personal supervision of the patient, the general practitioner fails, and must continue to Xall, to attain the success reached In spe cial institutions. The greatest advance we can make toward lessening the mortal ity rate of consumption by bringing about the recovers' of those already diseased, is in placing them In special institutions. This proposition is so well established by statistics as to scarcely admit of discus sion, yet It Is not generally known. Cli matic treatment has been tried and found 3y for recovers'. Peace of mind is almost essential to recovers. Mental treatment is no less Important than physical treat ment. In a well-managed institution the appearance in that of a popular boarding school, so free from care do the inmates seem, rather than that of the usualls con ceived idea of a hospital. Objection on the score of expense is met bsr the estab lishment of state sanltoria for the tuber culous poor. This will be referred to later, as will be also the objection be cause of fear of contagion in such Insti tutions. Prevention of Occurrence of Mnlady. There are two plans by which we may attempt this: First, bj- increasing the re sistance of the race through better phys ical training of jouths and through the introduction of better sanltars' condi tions; second, bs preventing the spread of the specific germs. Much is being done to increase the phjs- we mas' hope for our greatet success in lessening the mortality rate from con umption. A complete plan for dolna this involves first, the education of the general public as to the contagiousness of the disease, and how to avoid the dan ger; second, the registration of every case of tuberculosis as soon as diag nosed; third, the thorough disinfection of all Infected residences, public institutions, halls and conveyances; fourth, the es tablishment of special hospitals for the segregation and treatment of the poor suf fering from the disease: fifth, the enact ment of laws forbidding practices by which others are liable to be infected; sixth, the inspection of dairies and slaughter-houses bj' municipal, state or national authorities. Opinions may differ as to the relative value of these measures, but none will dispute that each has some value. Some of them have been adopted bj' a few S(r. a 'a v '& i -' v,v';3;' o o-V 'y vv r ? ' iE9 YOSE3IITE FALLS, 3000 FEET. cities and states, and wherever any single one has been, enforced to any extent, thero has been a lessening of the death rate. Could all of them be rigidly en forced the world over, it is not extravagant to claim that con sumption would soon be as rare as leprosy. How soon any or all of those measures are undertaken In our own states depends upon the energy and ear nestness with which we set about our task. How to Avoid the Danger. The masses of the American people can best be Instructed upon these points through the magazines and newspapers. We should avail ourselves of these avenues of reaching- the people In a sj-stematic way. To avoid the suspicion of self-advertising which might attach to the phy sician who sought thus to enlighten the public, I suggest that our medical so cieties appoint committees or Individuals who shall prepare a series of short, clear papers, couched In popular phrase, to be printed in all the newspapers within the territory of the society. These papers, signed bs' two or three well-known and responsible phs'slcians, as a committee of whatever soclets' authorizes it, would .have so much more Influence than do the unsigned paragraphs that occaslonalls' appear. Of the details of what should be taught I will not stop for discussion. They are not difficult to settle. Only I would not have such horror of consump tives created as to make them outcasts. It is not necessars'. Sterilization of dis charges Is the keynote. Another mode of reaching the masses is by means of popular lectures. These can be given by responsible resident phj-si-cians in the cities and towns throughout the land. Societies for the prevention of tuberculosis should beprganlzed; litera ture should be distributed land" lectures au thorized by them. Such a society has been in existence in Pennsylvania for five years. It has distributed some 100,000 tracts upon such subjects, as "How to avoid contracting tuberculosis," "How persons suffering from tuberculosis can avoid giving it to others," "How hotel keepers can aid In preventing the spread of tuberculosis," etc. This society is mak ing vigorous efforts for municipal and state institutions for the tuberculous poor, with promise of success In the near fu ture. The results of the work of this so ciety and of educational work In general Is shown in the decided lowering of the death rate from phthisis in Philadelphia. In 1S70. with each 100,000 of population there were 342 deaths from this cause, 317 in 18S0, 264 in 1890, and only 220 In 1S94. Registration of Every Case. To fight a foe successfullj we must know where he is. Not only should there be registration of name and residence at the beginning of the disease, but record should be made of his removal to other residences and distant places. By this means all those immediately concerned can be specially Instructed In the pre- vention, and notice made or inrectea houses, and disinfection enforced. This work can best be done bs' our health offi cers and boards of health. This plan has recently been undertaken bjr one or two cities, and we confidently expect marked results from this one measure alone. Thorough Disinfection. Infected buildings are large factors in the causation of consumption. In an in vestigation of the origin of consumption made by me at Tracy CItj-, Tenn., sev eral years ago, I found about two-thirds of the capes began In houses where It had prevlousls occurred. The cases were in that town comparatively' few, howev er. Dr. Flick, in the much larger field of Philadelphia, sas's that "at least 50 per cent of all cases were contracted in such houses." He has shown that fam ilies in whom no claim of Inherited rhthl sls could be made have been stricken with the disease after moving Into such houses, , and that, after thorough renovation, the families following remained free. Objec tion to disinfection may be made on the. score of expense. We do not hesitate in other diseases because of expense, still less should we do so In this disease. Tha work should be under the supervision of sanitary officers, and among the poor at public expense. The death rate from consumption in pe nal institutions has in the past been something appalling. Part of this has been due to the development of tho dis ease bs the close confinement and often depressed mental condition of the convict, but more of it is due to cases contracted from Infected cells, etc. Yet these insti tutions are under the direct control of the authorities, and preventive measures can easils' be enforced. A case of con sumption originating In a penitentiary ought to be practically unknown. Factors' Infection is a common source of tuberculosis. There should be monthlj' Inspection of factories and workshops not only to compel disinfection whenever ne cessary, but also to exclude all workmen in whom the tuberculosis disease has reached the point of the breaking down of tissues with resulting infectious dis charges. The occupancy of halls, churches, etc., Is of so short duration aa to limit vers' much the danger of infec tion from them. Yet danger lurks in them, and the predisposed mas yield t'o fleeting exposure, Tho proper manage ment and disinfection of these places must be the result of education. Cars Are Hotbeds of Infection. Of our modern cars, street and rallwas", I would speak more In detail. True the occupancs' here is short, but sufficient amount of Infective material makes even short occupancy dangerous. And nowhere is more infective material collected. The floors are used as cuspidors by succeeding passengers. The broom is used at the end of the trip, the germ-laden dust raised and scattered to settle again on seat and woodwork. This Is again stirred up'-wifh j off by the clothes of the passengers, and ' sifted into tho air bs' the jar of travel and the gusts of wind. Sweeping and dusting must give place to washing and scrubbing, t'he washing to be done often with a solution of some germ-destros'ing substance. This reform should bo accom plished easily In the case of street cars; but In railway cars it Involves the over throw of .plush upholstery and reform In the construction of cars. These reforms must come. Of all materials used as up holstery plush is the most! difficult to cleanse and disinfect. Whether it Is used in cars by choice of the' railroads as a matter of economs", or born of popular fanes', I cannot tell. Of the Pullman sleepers I can hardls' speak with patience. Others have called them "centers of pes tilence" and "hotbeds of Infection." Re calling the fact that patients with phthi sis are the most frequent of travelers, that they generalls' occups' sleepers, recalling the curtains, the plush upholstery and tho carpets, we can see that thes are horrible centers from which tuberculosis Infection arises. Pullman sleepers are an abomina tion that must not be suffered. And pop ular opinion Is the lever bs" which we can overthrow them popular opinion and the passage of laws. For If railroad compa nies were compelled to steam their .car pets, boll their curtains and soak their plush frequentls', thes' would rid them selves of this media of contagion. I do not attempt' to suggest a perfect sleeping car, but it must be an apartment car, thus doing away with the hangings; thero must bo no filigree in the woodwork, the upholstery must bo of leather, and there must! be no carpets. Establishment of Public Sanatoria. It is among the poorer that this infec tion spreads most surely and rapidlj' not the wretohedls' poor onls', but also among tho working classes, whoso home are small and often crowded. I have Insisted upon Institutional treatment' of the disease heretofore; I urge the establishment of In stitutions for the poor under the head of prevention, because It is on the ground of protection tb others that we can most ef fectually and most legitlmatels-' advocate the appropriation of mones' by city or state. That this segregation of the af flicted would protect ofhers is beyond doubt. The Progress Medical, in a recent number, makes a statement relative to phthisis In France and England which demonstrates clearly the results accom plished in the prevention of the disease by special hospitals. That! journal states: "There are three times as mans deaths in Parl3 as In Great Britain. In 1S70 the mortality in England and Wales was 2410 for each million of inhabitants, but since consumptive have been treated In special hospitals this number has fallen to 1463 in 1S93." The hospitals In England were built, most of them, bs' philanthropists as a matter of charlts' to the poor. But now that wo know that they afford pro tection to the communits", we should no longer hesitate to urge tfheir establish ment at public expense. Europe Is ahead of us in this matter. Berlin, Cologne, Hanover, Breslau, Dresden, Worms, Wurzburg, Bremen, Vienna, Paris, and several cantons o Switzerland have re cently built, or have in course of erection, such hospitals for their poor. I would not, for the present at least?, risk any violation of the ethical sense of our citizens by compelling entrance at these Institutions. The professional paupers chronic disease. To' compel this class Is i ves'arces, public halls, etc., and requiring to invite resistance, .tsur. oy proper pre sentation most of these could bo Induced to accept this opportunlts" of recovers and thus relieve their families, who could then in mans Instances maintain tfheir inde pendence. The gathering of these inva lids in communities where thes would be under the care of experts, where the sanitary regulations are. as per fect as possible, and where every thing Is made to work for their com fort and recovers, is agreeable to the feel ings when looked at properls. I would, however, comDel all patients, rich or poor, high or low, to choose between fhe alter native of attendance at some such special Institution, private or public, or submis sion to close Inspection and regulation of their homes bs a sanltars officer. The flrst objection made to public sana toria for tttiis purpose is alwas"s on the ground of expenslveness it would in crease our taxes. I answer, first, we can not weign tne suuemng ana loss or me caused bs this disease In the balance with mones; second. It would not Increase the expense of society at large, but is to be urged on the vers ground of economs. Tho tuberculous poor Inevitably become object's of charlts; mans of them are al readsr In hospitals and poorhouses. The expense of their maintenance would be no more In sanatoria, and the'.r chance or. recovery and restoration to usefulness would be immeasurably Improved. Others are supported bs the charlts of their friends and neighbors, to whom thes are a source of danger; and tho expense of all this finally reacts upon the community at large. Another objection made to gathering consumptives in communities Is that the danger of further Infection Is Increased. To this I answer: The posslbllits of com plete enforcement of necessary precau tions makes tne air of all properly-conducted ' sanatoria much freer from bacilli than that of most houses containing a single consumptive. This objection may be urged against the hotels and boarding houses of health resorts, where patients are not controlled, but not against sana toria. The same answer applies to the ob jection that these institutions spread the disease in the communities where they are located. Rompler states tnat not onls has consumption not increased among the In habitants of Gorbersdorf, but on the con trars has diminished since the establish ment of the sanatoria at that place. Tho same is frue of Kalkenstein. This lessen. cuspidors to be placed In all such plae. this is being attempted In New York cow. The iale of clothing or furniture Jst d by consumptives should be prohlbitted by law. unless these articles are flrst thorox.ghy disinfected. The habit of kissing is per haps not a subject for legal prohibition Neither legal prohibition nor risk of infec tion, will stop all torms of kissang; but indiscriminate kissing Is something to bfr deplored and discouraged. I hae felt my blood grow cold at seeing women with ad vanced phthisis and with frequent tot ting of germ-laden sputa, kissing friend3, children and helpless babes square upon the mouth. Inspection of Dairies. The possibility of contracting tuberculo sis from tho flesh and milk of infected cattle Is nov-,a fixed fact. This subject Is receiving much attention from state boards of health, state cattle commiss. n er.J, etc.. but their efforts at preventng tuberculosis among cattle are much ham pered by the Ignorance of the people on the subject and by the want of efficient laws. Tho subject Is of importance, ani wo must continue to agitata until prcer laws are secured; indeed, on the whae subject of tuberculosis we must not ceasa to agitata, agitate, educate, educate. SICK ANIMALS IN CAPT1VITT- Iniuntei of Zoological Gardens Ver Susceptible to Disease. The wild. animals who hold dally recep tions are our zoological gardens are net always as healthy as they look, saya a. writer In the New York World. In fact, ho asserts, the death-rate among the cap tive members of the brute creation is) alarmingly high. Every animal has some particular ali ment to which ho is liable. Lions and tigers, for Instance, are apt to be over come bs nervous debility. As soon aa thes exhibit signs of being run down tho keepers ply them with port and sherry wine. The wine is first mixed with their drinking water, and the dose Is increased; until the patient Is reads to takt its med icine straight from the bottte or keg. In the monkes'-house It Is consumptions that proves most fatal. Verj litte can be done for the sufferers, and many off them die from this cause every year. Birds also have lung troubles, and are dosed; BRIDAL VEIL FALLS, 1000 FEET. Ing of tho death rate Is to be attributed to the educational influence of the sana toria. Preventive Ordinances. The benefits that would result from the enforcement of such ordinances are very paten!. Consumption is not the only dis ease which would be lessened bs stopping the filths and disgusting habit of Indis criminate spitting. The public needs to be educated to the dangers, however, before such laws can be enforced. The law It- WtfSBBssStsMm fSMEL v? "' Jv ., 3V &UtBm!GIBaBxQzyvc&&WA&s!3i HALF DOUE, MERCED RIVER. with tincture of Iron and lime to counter act the disease. Wild hogs of all sorts in captivity are liable to have paralyls. The hard flooring of the cages is sup posed to affect them so thes lose the- usa of their legs. The bear has his off days, but he Is the .easiest animal to ply with medicine. So long as he has any strengths left ho will eat whatever is thrown to him. He Is thus made to gulp down loaves of bread, with castor oil or magnesia, hid den Inside; apples hidden with pills, et?. The most troublesome patient In a zoo is the elephant. His wonderfully keei sense of smell enables him to detect med icine under ans covering, and he must sometimes be starved for several weeks before he will take tho dose that has been prepared for him. Broken legs are most frequent among tho deer. Generally, no attempt Is mad 3 to set tho fractured limb, as tho bores knit of themselves. If left alone. Tho struggles of the Injured animal to escape from the doctor have been found to pro vent tho healing process. Once a year every Hon, tiger and bear Is obliged to have his nails trimmed a, vers dangerous operation for the mani curist who does the work. The animal 13 securels strapped, face forward, to tha front of his cage, while the keepers witu long-handled scissors shear away tha long claws. The healthiest animals in a zoological garden are the frogs and alllators. Snakes also are hards and seldom experience a das of sickness. Yesr He SabeM AH Right. A well-known Pacific Coast attorney; who prides himself upon his handling of Chinese witnesses, was defending a rail way damage case. The lawyer i3 a bt nearsighted, so failed to nota when a Chi naman came upon the stand that the wit ness' clothing was of finer texture than, the ordinary coolie. Instead of following the usual questions as to name, residence. If the nature of an oath were understood, etc, the following , dialogue ensued: "What Is your earner "Kee Lung." ' "Vnii Hva In Rnn TiYnnpIscrt?1' "Yes." r. You sabe God?" 1Ir. Attorney. If you mean Do I un derstand the entity of our Creator?' I will simpls say that Thursday evening next' I shall address the State Ministerial Asso ciation on the subject of 'The Divinity of Christ,' and shall bo pleased to have you attend." When order wa3 restored the examina tion proceeded on ordinary lines, but to the day of hl9 death the lawyer will never cease to be asked If he "sabe God. New York Telegraph. The most Influential newspaper In Scotia-.1 is the Edinburgh. Statesman, and the cMcat Is the Dundee Advertiser. They are edited, ro- spectiveiyv oy air jonn Long- and Charl- Cooper, both of whom are Engllshmer natives of Hull, Yorkshire. A