The Tupelo journal., 1904-06-10
The Duty Of the
State in Restricting
tuberculosis
BY HAROLD N. MOYER. M. b.
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infectious nature of tuberculosis has
come a tendency to urge legislation that
should restrict the spread of the disease
by quarantining the consumptive. The
| educational effect of this propaganda is
apparent in certain legislative enact
ments which have tended to impose bur-
densome restrictions upon the consump-
tive and his friends. In certain COM
munities to which consumptives COM
monty resort something like a panic has
developed due to the fear OF contaelon.
Teaching of this kind is pernicious in the
extreme and will ultimately fail OF its
aim. A shotgun quarantine and a most
rigid segregation would not materially
restrict the spread of tuberculosis. SUCH
a view of tuberculosis does not express
the underlying factors by which it is
propagated. 1t does not recognize that
tuberculosis is a house and factory bred
disease, and while the element OF per-
sonal contagion is present, it is by no
means the dominating factor. The most
important lesson that recent years have
taught in the study of tuberculosis is
that individual resistance is the impor-
tant factor in preventing it's spread.
Large numbers of %autopsies show that
a very large percentage of those who die
have at one time in their lives been in
fected with tuberculosis and have re-
covered. This shows that the element
of exposure is almost universal, and that
no matter what care an individual may
take to avoid personal contact with con-
sumptives, he will almost inevitably &C
quire the disease. 1t also shows that the
element of vital resistance is the most
important factor IN it's treatment and
care, as more than two-thirds of those
who get tuberculosis recover spOntane-
ously and never know that they have
the disease.
The reported cases of personal con-
tagion show it plays only an insig-
nificant role in the spread of tubercu-
losis, particularly if we eliminate those
cases in which the environment is the
same and make proper allowances for
lowered family resistance, which is the
main factor in what is understood by
heredity as applied to tuberculosis. A
full recognition of these facts would pre-
vent unnecessary laws restricting the
movements of the tuberculous. Such
laws are essentially cruel and they Gre
ate in a community an unnecessary
dread of the individual afflicted with the
disease and consequently lead to great
hardship with no corresponding advan-
tage. 1t is doubtful if any system of
compulsory notification would be of
value, particularly if it were coupled
with a system of notification by which
it would become known that a particu-
lar individual was suffering from tuber-
culosis. A further and very good reason
why laws of this kind should not be
passed is the doubt which still remains
as to exactly how tuberculosis is spread.
When the bacillus was first discovered
it was a natural conclusion that the
expectoration of consumptives dried and
pulverized and inhaled by healthy indi-
| viduals was the means by which the dis
ease was conveyed. No one has definite
ly proven that this is the chief method
of transmitting the disease, but it was
so ~fascinatingly simple that it at once
gained general acceptance. 1t is still
the favorite theory, though some very
good observers, such as Behring, be-
lieve that almost the sole means Of
spreading tuberculosis is by ingesting
the bacilli with the food. In view OF
these uncertainties and of the folly of
attempting to limit by segregation or
other means the movements of the
chronic tuberculous, restrictive and
compulsory statutes should not be en-
acted. The work of the state should
be limited to the education of the o N
sumptive and his family with the active
cooperation of the family physician.
One of the most important problems
in the restriction of tuberculosis is the
early recognition of the individual case.
The significance of the early loss of ap-
petite, sleeplessness, slight cough and
the general failure of health is not ap-
preciated until abnormal sounds develop
in the chest or there is abundant sputum
together with fever and night sweats,
the unQuestioned signs of tuberculosis.
When this stage is reached the oppor-
tunities for treatment are lessened and
the possibility of arresting the disease
is limited. Such an individual for a
number of months after this stage is
reached becomes an active culture
ground for the breeding of the bacilli.
Hence from the standpoint of restric-
ton the recognition and cure of the in
dividual case early in the disease is most
;mportant In this way the production
of the contagion is limited and the liza
bility of spreading the infection to 9th
ers is lessened. One of the most impor-
tant of the early d%iagnostic signs is the
recognition of the presence of the tuber-
Gle bacillus in the sputum. 1t may be
safely asserted that a large proportion
of the cases of consumption in this
state do not have their sputum exam
ined from the beginning of the disease
to it's end. While it is easy to make a
diagnosis of consumption in the late
stages without examination, 1t is most
important that infected cases should be
recognized in their incipiency. The
state through the board of health
should undertake the examination of
sputum. This could be readily done
with a trilng expense and would place
the state authorities in touch with a
large number of cases of tuberculosis.
Many physicians are not equipped for
examining sputum, and even where
they are it is a considerable burden to
put upon the profession in cases of poor
patients who cannot afford to pay a