Spread of Phthisis.

The disease which causes the heaviest mortality in New Zealand is undoubtedly phthisis. Very great interest is now being taken in all parts of the civilised world in the subject of the prevention and cure of this too common disease, and it is important to note that His Majesty the King is taking an active interest in the research which has for its object "the prevention and curative treatment of consumption." It seems to me that, in the lesson on the elementary laws of health which I have suggested should be impressed upon the children of the Seventh Standard before leaving school, one of the things to be explained would be the cause of this disease. They would be informed that a chronic cough is a source of danger, that the frequent catching of colds is very often a predisposing cause of consumption by rendering respiratory tracts less able to resist the disease, and that the germs of the disease are in the breath and phlegm of persons suffering from pulmonary phthisis.

I would suggest also, in addition to imparting such knowledge as I have above stated, that there should be a periodical examination of the weakly children in our public schools. By such an examination the family predisposition to any disease might be discovered, and, at any rate, the signs of early phthisis might be detected and arrested. I would recommend that at the commencement of each year the height and weight of each child and its age should be taken. By this means of periodical examination the Government would obtain a valuable report upon the health and physical condition of the young in the country.

I would like here for the benefit of the public to assess the infectivity of pulmonary phthisis, because it is possible, in the eagerness which we may display to arrest the disease, to become unduly harsh in our treatment of those who are unfortunate enough to suffer from the complaint.

Dr. H. Trimbell Bulstrode, in delivering the Milroy Lectures of the Royal College of Physicians, London, has pointed out that at the present time there may be said to be two schools of thought with regard to the channels of infection between man and man: the one school maintaining that the greatest danger is to be attributed to the tubercle bacillus contained in the dry sputum, whilst the other considers that there is more potency for harm in the droplets thrown off by a tuberculous patient during coughing. He admits that pulmonary tuberculosis is infectious, but holds that the communicability of the disease can only be contrasted, but not compared, with that of such diseases as smallpox, whooping-cough, typhus, &c. I will quote also from another authority, Dr. Newsholme, who believes that we must accept Dr. Bulstrode's statement cum grano salis. Dr. Newsholme states that "Phthisis is caused by phthisis, and does not occur, so far as we know, apart from the existence of a previous patient suffering from the disease. The tubercle bacillus is not ubiquitous. It haunts the vicinity of the consumptive. An extensive experience amongst notified cases compels me to the conclusions that defective nutrition, insufficient sunlight and ventilation, domestic uncleanliness, are mere adjuvants to the spread of the disease, and that this spread may occur in their absence. Unless cleanliness involves also the prompt destruction of infective material, infection may spread almost regardless of environment." He illustrates a case of infection which I will now read: "Mrs. X. lived in a large house open to the sea and in an excellent sanitary condition. After several years' illness she died from phthisis in May, 1902. The disease was acquired before coining to the town. As shown in the following scheme, her only child died seven months earlier from tuberculous meningitis, and her sister, who nursed her for some months before she died, had a 'very bad cough' when she left the town some months page 13 after Mrs. X.'s death. Y. Z., aged eighteen years, entered Mrs. X.'s service as general servant in November, 1901. One of her daily duties was to wash Mrs. X.'s handkerchiefs and to clean out her spittoon. No precautionary instructions were ever given to her. She left her place in the following April, when she was admitted to hospital suffering from 'bronchitis and pleurisy.' Before entering Mrs. X.'s service she had been in good health. She subsequently returned to her mother's home, and died there from acute phthisis on the 18th July, 1902. Her brother V. Z., living at the same address, who up to the onset of his illness had a healthy outdoor occupation (driving a cart for a news-agent), was notified on the 6th January, 1903, to be suffering from phthisis. He was then stated to have been ill for only nine weeks, though he looked ill for a few weeks previously. The early diagnosis was made in consequence of the detection of tubercle bacilli in his sputum. He died from acute phthisis on the 30th April, 1903. Meanwhile a sister, W. Z., entered Mrs. X.'s service just before her sister Y.Z. left it, and took on the latter's duties, except that she declined to wash the handkerchiefs of the patient. (These were sent to wash without any preliminary treatment. What about the poor 'sorter' at the laundry?) Mrs. X.'s sister now washed out the spittoons. W. Z. swept out the sick-room. She remained in Mrs. X.'s service until January, 1903, and as she frequently visited her sister Y. Z. during this time she bad double opportunities of infection, assuming carelessness on the part of either patient. On the 29th January, 1903, W. Z. was notified to be suffering from phthisis. She was admitted to the borough sanatorium on the 19th February, and discharged on the 21st March greatly improved. On the 4th June she was readmitted owing to a return of cough and expectoration. She left on the 2nd July, and since then has kept well and is in domestic service." He points out also that phthisis is rarely acquired by nurses in public institutions, and also that it is frequently acquired by nurses or relatives in private houses. Which means that in hospitals every care is taken to see that the expectoration is received into spittoons containing perchloride of mercury or some other germicide; the wards are kept page 14 scrupulously clean and well ventilated, and every precaution taken. In private houses it is often not possible to take all the same precautions as you would in a hospital. However, I consider that when a person knows he has phthisis he ought to find out all the precautions it is necessary for him to take to prevent his communicating the disease to his neighbour. The sources of infection being limited, it is certain that if all proper precautions are taken the risk of infection is not so very great.

With regard to the cure of this disease, it is to be observed that Dr. Marmorec, late of the Pasteur Institute, states that he has been able to isolate the true toxin from cultures of the tubercle bacillus. He has tried the toxin on patients, but the cases are at present too few to allow of a definite opinion to be formed as to the therapeutic value of the serum.