Dearborn independent. [volume], January 17, 1920, Page 10, Image 10

About Dearborn independent. [volume] (Dearborn, Mich.) 1901-1927

Image provided by: Central Michigan University, Clark Historical Library

                
10
THIS page was written after an
1 inanity indorsed and promoted by a
phxsician who has given his life not only
to the study of tuberculosis, but his even1
effort to an attempt to check and beat
down the plague that annually exacts a toll
of one hundred and fifty thousand lives. $
It's purely an economic problem,
he said. "Present methods are a failure,
and they will continue to be9
It IS an economic problem, and
according to the many authorities con
sulted by the writer in the working out of
the article, it is a situation that demands
most serious thought by the public at
large and by the people who have directly
interested themselves in the saving of lives.
It is planned from time to time to take up
for discussion other angles of the problem,
that light may be thrown on it, and per
haps an intelligent handling brought about.
The Enemy Within the Lines
a, HAROLD W. ROLAND
....... i. -v I N. 1 1 1- I' I- I M " ' " '
suggest
1 1
win
remain ai-
of
1I1COI11-
THE first steps to wage effective war against
tuberculosis in this country WW taken somewhat
less than thirty vears ago. Since that time many
millions of dollars have been spent in educational cam
paigns and it has been proclaimed that the disease
which annuallv exacts a toll ol more than one hundred
and fifty thousand lives, can he eradicated through
the continuation of such methods.
Men who are devoting their lives to the study of
the disease disagree. While it is true that tuberculosis
mortality has decreased, it is likewise true that it has
been on the decline for one hundred years, which period
of time obviously includes the seventy years prior to
the beginning of an organized campaign against the
scourge. Again while tuberculosis claims fewer lives
per hundred thousand of population each succeeding
year, the decline in the tables of the mortality from
tuberculosis if markedly less than the decline noted in
the mortality tables covering all deaths, proving that
tuberculosis " has not responded to the efforts made,
which, say some, are quite futile and barren of results
that are likely to prove of permanent benefit.
At any rate this and succeeding articles are intended
to take up the various anglei that go to make up the
situation, in the belief of the writer that discussion can
not fail to prove helpful in that it will stimulate
thought, and that it will cause those who are devoting
their efforts to pause and ask whether they are getting
the results that should be expected from the expendi
ture of energy.
The whole problem today is fundamentally an
economic one, say students, men who are spending
their lives in the study of the disease and the means
with which successfully to combat it. and the methods
now employed cannot help but will continue to fail,
as they have jailed and are failing, because they do not
meet that situation. Until economic conditions are
changed the tight against tuberculosis, in the larger
sense at least, is foredoomed to lose its battle against
the insidious workings of the plague.
Other elements naturally have their place but the
whole tragedy is bound up in the cold, hard fact that
impossible economic condition! are responsible first, for
tuberculosis; second, for its spread; third, for its
terrific and appalling wastage of human lives.
In the past it hai been estimated that the number
of cases of tuberculosis in the country approximates
thrice the number of deaths annually ; that, for the
150.000 deaths in the United States in round numbers,
there are a half million cases of active tuberculosis. It
is known now of course that these figures are ridiculous
ly small. In fact, it is accepted that there are at least
three times that number which require treatment, and
it is further estimated and believed that careful di
agnosis, of which more will be said later, would bring
to light ten times the number first mentioned. In
deed, one authority states that it hai resolved itself
purely into a question of whether at least ninety per
cent, rather than seventy-five per cent, of the popula
tion are not in some measure tuberculous. As pointed
out by one writer. "As a matter of fact very few escape
infection with tubercle bacilli, especially those living
in large industrial cities." but as this same authority
later says, '"Tuberculous disease is always preceded by
infection, but infection with tubercle bacilli is not
invariably followed by disease."
Urbanization and industrialization of the country are
factors greatly responsible of course for tuberculosis.
Inadequate housing conditions which exist always
among the poorer people, their whole environment, at
home and in their places of employment, make for
the success of tuberculosis. Of that there can he no
doubt. And that nothing, or very little, at least, of a
reformatory character having been done to bring ade
quate and healthful housing conditions in the renters
of industry, little can he expected of the campaigns
against tuberculosis as they are now conducted. nd
with the foregoing goes hand in hand the economic
serfdom of those who labor.
ON THE ha-i- of statistics concerning the death-rate
from tuberculosis, one authority with whom the
writer discussed the problem urged that some radical
change is necessary in our anti-tuberculosis program if we
would achieve any further reduction of the death-rate.
In the past j ,,r seven ars. despite a vast amount of
effort, little real proures hai been made. In 1(12 the
death-rate from pulmonary tuberculosis in the United
ates was 129.9 for 100,000 population; in l(lx h was
WM. The rate has remained practically stationary,
A similar condition has been observed in Great Britain
to
.mi in uermanv. ami t,uiw- ..
rictors as possibly responsible, dietary resincuou.
eclhv'thc war" conditions, and the
h, proportion of woinen m mdustry. I'1 u
tuberculosis mortality in the United States was quite
stationarv in 1912, 1913, and 1914 it was VS
,lus professional man. these two factori just mentioned
tail to explain conditions in this countn.
On the other hand the .speaker recalled a conversa
tion NVlth the discoverer of the tubercle to"1;?
Koch, who. ten years ago, gave warning of just .such
a situation as at present 'A our tuberculosis mortality
curve.- said ProfcSSOT Koch, "is last taking on the
a f a nmhnl Mid unless voii introduce some
u.,n with which to combat the disease, you
1 1 v. irvavH ...... .. -
.....i oih.M-iMdosis death rate will
MMU lllHl JVHI wtm -
most stationary."
The fault, however, cannot be laid entirely to un-
.nhcfnrtnrv .ronomic conditions. Tart Oi it rests witn
MVivwi j . . -
mmlii"! I nro tVxsion. according to this mcmner
I IIV 1WV.VUVU1 l ' ' i -v
.i r.,!..;,.!! md is- dnr to inaccurate am
plete diagnosis by careless physicians, with ins views
many others high in the medical world agree. I MS IS
particularly a difficult subject to touch upon for there
is nothing else probably that will so arouse a physician
as a statement questioning the care exercised by the
profession in the performance of its duties. And vet
the writer 'is in a position to vouch for the fact that
such a condition does exist if the word of men high
in the practice of medicine is to be believed. Coupled
with this carelessness and inadequacy in diagnosis is
the deplorable fact that as yet no reliable statistics
are available concerning the actual number o tuber
culosis cases in tht country. In many chief oi course
it is true that most of the cases diagnosed a tubercu
losis are reported to the health authorities, but that
there are hundreds of thousands of persons who are
victims of the tubercle bacillus and either are living
in ignorance of that fact, or knowing it, go without
medical assistance, can not be gainsaid.
special effort should be made throughout the coun
try to discover the large number of cases of tuber
culosis now passing undiagnosed, believes this physician
with whom the writer talked. Even in a city like
New York, where an intensive anti-tuberculosis cam
paign has been carried on for more than twenty-live
years, fewer than one-half of the cases of tuberculosis
believed, by competent authorities, to exist in the city,
are actually recognized and reported to the health au
thorities. These unrecognized cases are especially dan
gerous as sources of infection, for as a rule they rep
rint an entire absence of precautions to prevent the
spread of the disease to others.
In this undertaking health officers, physicians, .so
cial workers and the general public should co-operate.
Some physicians still allow cases of well-developed
tuberculosis to pass unrecognized, making only the most
hurried and incomplete physical examinations, method
ically carried out. and with all clothing Stripped from
the chest, and should learn to .shun as incompetent or
careless a physician who attempts to diagnose the pa
tient's condition without such an examination.
In connection with the foregoing statement it may
be of interest to quote from the most recent work of
authority on tuberculosis which, in dealing with the
general management of tuberculosis, insists that a pa
tient found to have tuberculosis sh,,uld not be kept in
ignorance of that fait. It is stated: '"Many physicians
are inclined to keep him (the patient) in ignorance
as to the true state of affairs, and t tell him that h
is merely affected with a 'mild bronchial catarrh,'
'pleurisy.' 'a protracted cold.' etc. Wry often a patient
is brought to the office by relatives and friends who beg
the physician that in case tuberculosis is diagnosticated,
the patient should under no circumstances be told the
truth.
"There are many valid reasons against such a
procedure. From the standpoint of the physician's pet
tonal interest, it is bad practice. It is always t- be
borne in mind that the patient will, sooner or later,
find out the truth and blame his doctor for deception
or, more often, accuse him of ignorance and claim, with
Considerable justice, that had he been informed in time
he might hive taken better care of himself."
It is pointed out too that many of the older physi
cians probably have not had the opportunity of keeping
up with newer diagnostic methods and as one of the
first and most important steps to hi- taken if a successful
battle against the disease is to be fought, the writer's
informant urged that measures be devised whereby in
struction in modern methods of examining patients
tOr pulmonary tuberculosis would be given to such
physicians all over the United States. As one means
of performing this it is suggested that the use ol a
motion picture film (successfully used to train sur
geons in the army) would be an important step in
the right direction.
Of the decline in the mortality from tuberculosis,
which has been noted for more than one hundred
years. Dr. Maurice Fishberg, an eminent authority on
the disease, and clinical professor of medicine, New
York University and Belfevue Hospital Medical Col
lege, says, in the second (1919) edition of his work.
"Pulmonary Tuberculosis," the authoritative work n
the disease
"What are the CttttCI of this decline in the tubercu
losis mortality? 11 authorities agree that it is mainly
due to the causes which have been operative in re
ducing the general mortality; in banishing, or abat
ing, the malignancy of most other infectious disca s
Among these factors are largelv to be considered
the improvements in the sanitary and hygienic condi
ttOHI under which the bulk of the people live at present.
f also to be Considered that modern factory legi ,-
tion the improvements in the economic conditions .f
the people, the shorter hours of work, etc., which c
h n wtrnstic id' the present, as compared with
. .- 1 1 C I. - ,1.
ditions during the tirst nan oi inc niueieemn cei
have been instrumental in reducing the general mor
tality and of phthisis as well. Wages have been m
creasing, and the ii( consumed D) the working p, pic
of today i much superior to that which they
afford fifty or one hundred years ago. Tin- disti
tion of food, as well as its preservation, preel
famines at present An increase in the tubercu! -
rates is often observed during and after famines
"Most authors, when speaking of the reduction in
the tuberculosis mortality, point at once at the sp
measures which have been taken to combat this dis
ease as the sole factor in this direction. In fact, the
figures (figures on mortality from tuberculosis I are
always brought forward in proof of the effect n sS
of the anti-tuberculosis campaign which has Ik.
aggressively waged.
"Hut careful studies of the available statistical ifa
have not sustained this contention. In England, where
the decline has been more pronounced than in any i
country, it has been shown by Competent statisticians
that siich is not the tact. Karl Pearson points out .,
examining available data, it appears that the d ith
rates from phthisis aie steadily increasing as w
backward to 1838; according to Arthur Kans, .ni.
.is tar hack as 1743. Now, this could not go on in
definitely, because if it did. every individual five hun
dred years ago must have dud in England
phthisis. There was assuredly a tune in England
the phthisis rates were rising, jusl as they have re
cently been falling. 'We have to stretch.' says i
son, 'our ideas of time a little and we should r
the possibility of a typical epidemic curve in the fre
quency of phthisis. Indeed, the mortality from phtl
in England has been declining since 1838, i. e., long be
fore any special measures had been taken for tin con
trol of the disease, or segregation of the sour if
infection tuberculous human beings and animals ad
been attempted.'
ki I V i j irom other countries, especially wnere
L disease has become a menace during recent j irs,
confirm these views. 1 hiring the first half of tin
teenth century there were isolated areas in I
where tuberculosis was tare, hut with the jc.. W
of the population in cities during recent years, and the
introduction of modern industrial conditions, the .lis
i ase has made its appearance, and rages there with
greater vigor than in countries where the dtseas hai
appeared before. Thus, the tuberculous mortalit) hai
been rising in Ireland. Norway, Serbia, Bulgaria, Hun
gary, Japan, etc., during the very period that it hai
been declining in England, Germany, etc. There is nt.
doubt that the measures taken for the control of tin
disease in Norway are as aggresswa and advanced at
those taken in neighboring Denmark, yet in the forma
the mortality-rates have been rising, while in the (at
ter they have steadily dec lined. The same is true oi
France when compared with Belgium, and stmilai an
alogies can be made between other countries, or .
regions of any single country."
The following sentence is italicized by Dr. Fij
himself as his conclusion, whereas those phras .i!
ready italicized were marked by this writer:
"It appears that the mortality-rates from tubcrculosu
have been declining to the same extent as the g ft
Mortality from all causes, as has been shown clca 6j
Many competent statist icians."
To ouote from another authority:
Professor Walter F, Wilcox, in the monthly bi ' ;
of the New York State Board of Health, says tl "!'
show that the campaign against tuberculosis is havitt
its effects, it should be found that the death-rate Ofl
that disas are decreasing faster than the average fo:
all other causes." The test, a comparison of the sta
tistics for the mortality in New York State, show ! tha
the result is a negative one
But read the testimony of William Charles Whiti
who in 1913, as treasurer of the National Ass
ur the Study and Prevention of Tuberculosis. IS
"We Cannot noisihlv avniH thm frf that in -1it'
of all our labor our results are not what W(
have expected On a right premise; f,r our reduct
morbidity and mortality from tuberculosis has not
pace with the reduction in the general death-rat
further, our reduction in mortalit ri about as
before we started our present methods, and in pr VttH
how great the inthience of our efforts has been w
usually neglect all the influences that Operated hffor
we began, and new factors, such as the Mills-Kcin-ck
phenomenon, and ascribe all mod to our own work "
In this connection it should be stated that for I0SJ
time the Mills Reinecke phenomenon was scoffed at
many who were engaged in anti-tuberculosis work. Tc
day it is admitted that the facts put forth in thi
phenomenon have h, , ,, fullv verified It has to do jl
Showing that the filtration ".f drinking water indirect!
has brought about a decrease in number -of cases o
tuberculosis, in that other diseases from which tubei
culosis most easily springs have been minimi
through nitration.
As a concluding quotation of authorities let us r(
tnrn to I)r. Fishberg, who writes:
I areful study of the economic and social cottd
tions in the various t,,untries where statistical dat
are available shows clearly that there is a pronounce
correlation bet urbanization, i. c., concentration c
large masses ol population in cities, and the cleat
rates from phth.s,s Wherever the process of urbal
tfimchukd em pat 15)
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