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one that is caused by the invasion and reproduction within the body of pathogenic micro-organisms, not necessarily an invasion by bacteria, because in one case at least malaria, the chief cause, or the invading pathogenic micro-organism, is not a bacterium, but belongs to an entirely different class. According to the same author the contagium in any infectious process is the particular pathogenic micro-organism itself, the advent of which in the body ushers in those reactions of the body cells, which we call disease. An infectious disease is contagious when its contagium, that is, the micro-organism which causes it, under the ordinary conditions of life can be freed from the body of the diseased person and, by whatever means, conveyed to the body of another in a condition capable of lighting up the disease anew.
The particular contagia of contagious diseases may be given out from the mucous membranes, from the skin, or from the various discharges of the body. The prevention of contagious diseases can only be secured by attacking the virus at its source before it has had time to disseminate itself by means of the atmosphere, or water, or in the earth. Infectious diseases may thus prove slightly contagious, or widely contagious, according to the active means taken to destroy the virus as nearly as possible at its source. Hence the degrees of contagiousness or communicability can be influenced by the physician's art, and it is his duty to exert all the means known to science in such a direction. The subject of the prevention of the spread of contagious disease divides itself into (1) what may be accomplished by the attending physician, and (2) what may be attempted by the State or municipality. To the physician himself the subject is beset with difficulties, as ideal home conditions are not often found. In a private house it is well to place the patient on the top floor, where complete isolation from the rest of the family may be comparatively easy. Having isolated the case, the virus must be destroyed at its source, according to the nature of the disease, and not be allowed to disseminate itself. All superfluous articles should be removed from the room. It is better to have the patient on a cheap cot, which can afterward be thoroughly cleansed or destroyed, rather than upon a bed or sofa which would be difficult to free from germs. Any discharges from the mouth, nose, ears or skin should be collected upon rags, which should at once be burned. This valuable precaution can easily be taken in the most restricted apartments, and yet is often neglected. The nurse should not mingle with the members of the family, and, when she leaves the house for fresh air,
should change her clothing before leaving the room. The details to be observed in each case vary according to the nature of the disease. The room should be kept warm enough to allow a constant supply of fresh air to be procured by dropping one of the windows a little from the top. This will not only have a favorable effect on the patient by diminishing the chances of his own reinfection, but it will lessen the risks to the attendant. Although bacilli have not been demonstrated in many contagious diseases, their virus will probably respond to disinfectants in the same way. It seems best, in the present state of our knowledge, to constantly apply some antiseptic or so-called disinfecting agent as nearly as possible to the source of the poison, and thus prevent a multiplication of the virus, ending with boiling or burning as many of the objects as possible that have been in contact with the patient during the progress of the disease. The germs of many diseases, notably scarlatina, diphtheria, and phthisis pulmonalis, remain long dormant in apartments; hence the necessity for thorough cleansing and disinfection. All the clothing, bed-linen, etc., that has been in contact with the patient suffering from any of the contagious diseases should be soaked in the following solution : R Zinci sulphatis,
ziv; Sodii chloridi,
· Zij; Aquæ puræ,
· cong. j. M. This solution is cheap, and easily procured, and may be kept constantly standing in the room. Quilts, comforts, pillows, etc., may be thoroughly shaken on the roof, and then exposed for hours to the fresh air and sunlight. The two latter factors form the most harmless but complete disinfections that are known. Spoons, cups, and all feeding utensils should be soaked in the above solution, and all articles after being taken out should be subjected to thorough boiling. The furniture, floors, walls, and ceiling may be washed with carbolic acid, 1-20, or corrosive sublimate, 1-1,000. These two disinfectants frequently fail to be effective because of too weak solution. If the walls are papered they may be rubbed down with stale bread crumbs, which bacteriologists have taught us collect the germs. This may also be done to the ceiling
A few words in regard to preventing the spread of tuberculosis may not be amiss here.
In this age, which may be properly called the "germ age,” the knowledge of the infectious nature of tuberculosis, and its dependence
upon a germ, has led to the sterilization of almost every thing that enters the stomach of the tuberculous patient, sometimes greatly to the detriment of his digestion and nutrition. The evidence heretofore adduced seems conclusive that tubercular infection is very rarely produced by alimentary ingesta, and that many of our precautions, so far as tuberculosis is concerned, have been unnecessary, while the real problem of prevention remains unsolved. As it is a fact admitted by all progressive physicians, that "it is by breathing an atmosphere containing tubercle bacilli that most persons get the disease,” we are painfully apprised of the fact that we have hardly made a beginning toward the prevention of tuberculosis. Optimists as we may be, hardly a ray of hope is afforded by any pian except a strict quarantine of the tuberculous, including a destruction by fire of all secretions or other vehicles of infection.
If a poor, inoffensive leper is known to be at large the people of a whole community or city shudder with fright and horror, and clamor for his confinement, compared to which death would be preferable; but, toward a disease much more infectious than leprosy, and of which “countless thousands” die annually in the United States, the laity are totally indifferent, and the medical profession as a body still apathetic. Yet, none are so indifferent to life as to die without a regret, so well expressed by the poet:
"For who, to dumb forgetfulness a prey,
Nor cast one longing, ling'ring look behind?” Radical measures along the line of the prevention of diseases are impracticable and unwise; results are more likely to be attained by work on educational lines than by legislation. A persistent and diplomatic campaign of education can do a great deal in the way of prevention, but tuberculosis is on the increase where it has always existed, and has appeared where formerly it was unknown.
It has only recently transpired that regions like Colorado and Southern California, where formerly tuberculosis was unknown, and whose climatic conditions have in recent years attracted hordes of tuberculous people, have become infected and now offer no immunity even to natives. This transformation, in the light of our present knowledge, is due to a contamination of that previously pure air by imported infectious material.
If whole regions can be thus infected, how much easier can public conveyances, public thoroughfares, places of entertainment and worship, work-shop and sales-room, hostelry and private house, become the scene of abiding infection. Much would be accomplished if the laity could be brought to a realizing sense of the infectiousness of the sputum; but that is only the first step, and, sooner or later, it will transpire that only by a rigid quarantine can the disease be checked. It is doubtful if, by any known human means, it can be entirely stamped out.
A great deal may be done along the line of prevention of diseases by paying strict attention to the proper disposal of all refuse matter, garbage, etc., that is wont to accumulate about cities, towns, and even private dwellings in the rural districts.
Great advance has been made recently by a number of our American cities in the methods of disposing of garbage, but few, if any, have as yet attained that success in its disposal as has been accomplished by the transmarine cities. As a rule the easiest and apparently most economic method as yet adopted has resulted in the contamination of our beautiful streams and waterways to such an extent that they have become a menace to the health of the communities along their banks, which erstwhile were the servitors of heightened health and increased longevity. The only rational way to deal with this question seems to be the one adopted by some of the European cities, known as the system of “ sewage farms.” By this system is utilized to the best advantage the vast wealth of fertilizing material contained in the refuse of urban life, returning it, as it were, "to the earth from whence it came," and preventing it from being ultimately consigned to “Old Ocean's gray and melancholy waste." This seems to be the most practical and scientific method of disposing of garbage. You will, I trust, pardon me for the following slight digression, as I deem it germane at this juncture to make an allusion to some axioms, facts, or laws of nature, viz., changes of matter. Chemical changes are constantly taking place. All nature is a torrent of ceaselesss change.
We ourselves are but parts of a grand system, and the elements we use are not our own. The water we drink and the food we eat to-day may have been used a thousand times before, and that by the vilest mendicant or the lowliest worm of the dust. Hamlet was more of a philosopher or chemist than a madman, when he gravely assured Claudius, the king, that "man may fish with the worm that hath eat of a king, and eat of the fish that hath fed of the worm.” The com
ponent parts of our bodies a short time ago have waved in the meadow as grass, and in the field as corn. From us they pass on their ceaseless cycle to develop new forms of vegetation and life; and the same atom may freeze on arctic snows or bleach on torrid sands. Shakespeare expresses this identical thought when he says in Hamlet:
"Imperious Cæsar, dead and turned to clay,
Should patch a wall to expel the winter's flaw!” That matter passes from the animal back to the vegetable, and from the vegetable to the animal kingdom again, is a theorem that is daily demonstrated. In nature all is common, and no use is base.
As additional testimony along this line, the “ Prince of Denmark” says, again, “To what base uses we may return, Horatio! Why may not imagination trace the noble dust of Alexander till he find it stopping a bung-hole?" And he reasons thus: “Alexander died, Alexander was buried, Alexander returneth into dust; the dust is earth; of earth we make loam; and why of that loam, whereto he was converted, might they not stop a beer barrel?” This is not the language of fancy, it is the veritable philosophy—the demonstrated facts of science. Life and death are thus throughout nature commensurate with and companions of each other. Oxygen is the relentless destroyer, and sunlight the great builder. Oxygen tears down every living structure, and unmolested would bring every thing to dust; but the sunshine reinvigorates, rebuilds, and rescues matter from decay. Thus death alone makes life possible.
Theoretically many objections no doubt might be raised against the system of sewage farms which would be sufficient to condemn it, were it not for the fact that it has been tried and has proved unobjectionable and is now in use in a large number of transatlantic cities. The most salient objections raised to the system are, that the sewage farms will cause an intolerable stench; that the earth will become saturated after a short time, and necessitate the employment of constantly widening areas for this purpose; and that sewage farms are likely to be an excellent culture ground for the germs of infectious diseases.
Dr. Weyl discusses these various objections, and answers them in a most convincing manner. Practically the odors emitted are of no consequence. Dr. Carpenter, an English expert, reports that the sewage farm of Norwood, in the vicinity of London, is so free from objections of this nature that a favorite promenade leads directly across its fields.