HEALTH COLUMN.

Otago Witness, Issue 2861, 13 January 1909, Page 76

HEALTH COLUMN.

THE GREM 1 SCOURGE. (By Woods Hutchixsox, A.M., M.D., ir. the Washington Evening Post.) Not only have most di-eases a livir>£ j ! cause, and a consequent natural history and course, but they .have a special method i of attack, wjiich loots i-lmost like a prr>- j ferencj. It seems little wonder that the | terror-stricken imagination of our Stone j Age ancestors should ha^e personified them |as demons, "attacking" or leaping upon their \ietiais and "seizing" them with malevolent delight. The concrete comparison ■was ready to their hand in the attack of ' fierce beas's of prey; and as the tiger leaps ! for the head to break the neck viith one j stroke of his paw, the wildcat flies at the | face, the wolf springs for the slack of the flank or the hamstring, so these different j disease demons appear each to have its i favourite point of attack : smallpox, the ' skin ; cholera, the 'jowels ; the Black Death, I the armpits and the groin, and pneumonia. ' ' the lung. ; There are probably few diseases which are so clear!} recognised by e\eryone and about ivhie!i populai impressions are in the nwiii so clear-cuL and &o coriect as pneumonia. Ihe «tabbing pam in the ohesS the (oug : ). the rusty* or bloodstained expectoration, the rapid breathing, all stamp <t upiTi staka ! 4y an a dkea c c of the lung. Its furious onset -with a teeth-chattering chill, ' followed by a high fever, flushed face, and its rapid course toward recovery or death, [mark it off sharply from all other lung* : infections. j I»s popular names of "lung fever," "lung plague,'" "congestion of the lungs " are us ' 1 graphic- and distinctive as anything that , medical science has invented. In fact, ; our most univcrsilly-accepted term for >t. pneumonia is merely the Greek equivaI lent of the first of the?e. I It is remarkable how many of out disease enemies appear to have a preference | for the lung a* a point of attack In the j language of Old Man Mean* m ''The j Hoosier Schoolmaster," the lung i»- "the : r ! fav'rit hok." Oar d^adhes-t dsea'2s arc i lung- diseases, headed by con-^inpuon, ) seconded b> pneumonia, and followed by , bronchitis, asthma, etc ; together, they | n.^nage to account foi one-fourth to onej third of all the deaths that occur in a j community, young or old. No other great , organ or bysiem of the body is responsible i for more than half such a mortality. New. this bad eminence has long been a puzzle, since foul ac is the air or lmta-ting as is the gas or dust that we may breathe into our lungs, they cannot compare for a moment with the awful conccctioiib in the shape of food which ar-s loaded into our etomachs. Even from the point of %iew of infections, focd is at lecist as likely to be contaminated with di-c-a'-e garm« as. air is. Yet there is no di-ea^e or combination of diseases of the whol^ food canal which has j half the mortality of consumption alone in ci\ili«cd conuni nitw;, wh-le in the Oiient the pncuino'iic form of the plague j is a greater &courg- > than cholera. — An Inheritance From the Mud fi-^h.— It has even been si'gje^ted that there j J may possibly be a historic or ancestral j reason for thi~ weakness to attack and I one dating clear back to the day* of the mud-fieh. It if, pointed out that "the lung! |is = he last of our c?reot organs lo develop, inasmuch as o%er half of our family tree it "jrwjcr vrat^r. Whtn our mud-loving . ancestor, the lung-fi-h. began to ci.au 1 out on tlie tide-fiats he had every organ that he needed for land life in excellent worki ma condition and a fair degi"-> of comI plesity : bra.in. ptoinacb lioart, !ner, kitl-nes-s — but he had to manufacture a lung which he proceeded to do out of an old

hwim-bladder. Thi*. of course, was several ' years ago. But the lung has not quite , caught up yet. The two or three million ' year lead of the other organs was too much to be overcome all at once. So carelessly and hastily was this impromptu lung rigged up that it was allowed to open from I the front of the gullet or oesophagus, in- , ' stead of the back, while the upper part i of the mouth was cut off for its intake tube, as we have already seen in considering adenoids, thus making every mouthful , ' swallowed cut right across tho air passag-*-, j | which had to be provided with a special I valve trap (the epiglottis) to prevent c ood from falling into the lungs. So whenever you choke at table >ou ' have a. right to call down a benediction y 1 upon the soul of your long-departed aueostor. the lung-fish. However applicable or remote we may regard "the bearin's of ■ this observation," the practical and most , undesirable fact confronts us to-day that , this crossing and mutual interference of , the air and tho food passages is a fertik cause of pneumonia, inasmuch as the germs of this disease have their habitat in the mouth, and are from that lurking place probably inhaled' into the lung, as is also \ the case with the germs of several milder bronchitic and catarrhal affections. — The Aquatic Life of Human Beings. — j It may be also pointed out that, history apart, our lung cells at the present day are at another disadvantage as compared with all the other cells of the body, except those of the skin; and that is, that they are in • constant contact with air, instead of being \ submerged' in water. Ninety-five per cent. | of our body cells are still aquatic in their , habits, and marine at that, and can only ■ live saturated with, and bathed in, warm ' saline soli*tion. Dry them, or even rvH- j dry them, and they die. Even the pave- | j ment cells coating our skin surfaces are I practically dead before they reach the air, and are shed off daily in showers. We speak of ourselves as "land animals," but it is only our lungs that, are really i so. All the rest of the body is still made j up of sea creatures. It ie little wo icier ! that our lungs should pay the heaviest | penalty of our change from the warm and ' equable sea water to the gusty and changeable air. Even if we have set down the lung as a po : nt of the least resistance in the body, we have by no means thereby explained its diseases. Our point of view ha« Jis- J tinctly shifted in this respect within ro | cent years. Twenty years ago pathologist*; | were practically content with tracing a case j of illness or death to an inflammation or . disease of some particular organ, like the ' heart, the kidney, the lung, or the stomach. ' Now, however, we are coming to see that ; not only may the causation of thi.3 heart disease. "kidney disease, lung disease, have lain somewhere entirulv outside of the i heait, kidney, or lung, but that, a<* a rule, the entire body is affected by the diesaec, ) which simply expresses its-elf more v iolently — focuses, a-s it wero — in this particular organ. ' In other words, diseases of definite organs j are most commonly the local expressions j of general diseases or infections: and "this ' local aggravation of the disease, would I never have occurred if the general resisting j power and vigour of the entire body had i not been depressed below par. So that j even in guarding against or curing a ] disease of a particular organ it is necessary i to consider and to treat tho whole body. | Nowhere i* thi3 new altitude better ilhis- , tratcd than in pneumonia. Fiank and unquestioned infection as it is, wreaking twothirdfc of its viiible damage in the lung itself, the liability to it-< occurrence ant! | the outlook for its cure depend almost wholly upon the general vigour and rally- | | ing power of the entire body. It is per- i fectly idle to endeavour to avoid it by J measures directs! toward the protection of j the lung or of the air passage*, and equally futile to attempt to arrest its course by treatment directed to the lung, or e\en the chest. The best place to wear a chestprotector is on the soles of the feet. And j poulticing the cheet for pneumonia is about . as effective as shampooing the scalp for j brain-fag. j This clears the ground of a good many ancient misconceptions. For instance, the ! chief fcauso of pneumonia is direct exposure , to cold or a wetting, or the inhalation of raw, cold air. Few beliefs are more firmly j fixed in the popular mmd — and, for the I matter of that, m the medical, up to 15 | or 20 y«.-aps a<*o. It has found its way in'o literature: and the hero of the shipwreck' in an icy gale or of weeks of wandering I in the Frozen North, who must be offered ' up for armtic reasons as a soenfice to the , plot, invariably dies a victim of pneumonia, j from his "frightful exposure,"' just as the ] ■\ ictim of disappointed love dies of "a, broken heart," or the man who sees the j ambition* of years conic crashing about hi? | ears or the woman who has lost all that > m«kes hfc worth living invariably develops "brain fever." There is a physical basis for all of these standard catastrophes, but it is much slenderer than is usually supposed. For in- i stance, almost everyone can tell you how < friends of theirs have "brought on conges- j tion of the lungs" or pneumonia by going J without an overcoat on a- winter day, or j breaking through the ice when ekating, or!

even by getting their feet wet and not " changing their stockings, and this single dramatic instance has firmly convinced them that the chief cause of "lung fever" is a chill or a wetting. Yefc when we come to tabulate long series of causes, rising into thousands, we find that the percentage in which even the patients themselves attribute the •disease to exposure or a chill .links to a surprisingly small amount. For instance, in the largest series collected with this point in mmd — that of Musser and Norris — out of 4200 eases only 17 per cpnt. gave a history of exposure and "catching cold"; and the smaller series ran are from 10 to 15 per cent. So that even in the face of the returns, not more than one-fifth of all cases of pneumonia can reasonably be attributed to chill. And when we fun her remember that under thisheading of expocuie and "catching cold" are included many mere coincidences and the chilly sensatu r.s attending the beginning of those milder infections which we term "common colds," it is probable that even this finali pexcentage could be reduced one-half. Indeed, most cauiious investigators of the question have expressed themselves to this effect. This harmonises with a number of obstinate facts which have long proved stumbling-blocks in jhe way of the theory of exposure as a cause of pneumonia. One of the classic ones was that during Napoleon's frightful retreat from Moscow in the dead of winter, while his wretched soldiers died by thousands of fro-t-bito and s*"irvation, exceedingly little pneumonia developed among them. Another was that, as we ha\e already seen with colds, instead of being commoner and more frequent in the extreme Northern climate and on the borders of the Arctic Zone, pneumonia is almost unknown there. Of course, given the presence of the germ, prolonged exposure to cold may depress the vital powers sufficiently to permit an attack to develop. j — Pneumonia a Disease of Cities. — \ Again, the ages at which pneumonia is both most common and most deadly — namely, under fhe and over 65 — are precisely those at which this feature of exposure to the weather plays the most insignificant part. Last and most conclusive of all, since definite statistics have begun to be kept upon a large scalo pneumopia has been found to be emphatically a disease of cities, instsad of country districts. Even under the favourable conditions existing in the ¥nited States, for instance, the death rate per 100,000 living, according to the last census, was in the cities 233 and for the country districts 135 per 100,000 living. In other words, nearly 70 per cent, greater in city populations. How, then, did the impression become so widely spread and so firmly rooted that pneumonia is"' chiefly due to exposure? Two things, I think, will explain most of this. One ie, that the disease is most common in the winter time, and, like all febrile diseases, it most frequently begins with sensations of chilliness-, varying all the way j from a light shiver to a violent chill, or rigor. The savage, bone-freezing, teethrattling chill which ushers in an attack of pneumonia is one of the most strikingcharacteristics of the disease and occurs in 25 to 50 per cent, of all cases. j Its chief occurrence in the winter time is an equally well-known and undisputed fact, and it has been for centuries set down in medical works as one of the diseases chiefly due to changes in temperature, humidity, and directions of the wind. Years of research have been expended in order to trace the relations between the different factors in the weather and the occurrence of pneumonia, and volumes — yes, whole libraries — published pointing out how each one of these factors, the temperature, humidity, direction of wind, barometric pressure, and electric tension, is in succession the principal cause of the spread of this plague. Many interesting coincidences were shown. But one thing always puzzled us. And that was that the heaviest mortality usually occurred not just at the beginning of winter, wlien the shock of the cold would be severest, nor even in the months of lowest temperature, like December or January, but in the late winter and the early spring. — Hothouse- for Pneumonia. — Throughout the greater part of the temperate zone the death rate for pneumonia begins to rise in December, increases in January, goes higher still in February, reaching its climax in that month or in March. April is almost as bad, and the decline often doesn't fairly 6et in until May. No better illustration could probably be given of The danger of drawing conclusions when you arc not in possession of all the facts. One thing was entirely overlooked in all this speculation until about 20 years ago — that pneumonia was due not simply to the depressing effects of cold, but to a, specific germ, tho Pneumocoocus of Fraenkel. This threw an entirely new light upon our elaborate weather-causation theories. And while thei=e still hold the field by weight of authority and that mental inertia which yve term conservatism, yet the more thoughtful physicians and patho-logi-sts are now coming to regard these factors as chiefly important according to the extent to which they crowd us together in often badly-lijrhted and ill-ventilated houses and rooms, with the windows and doors shut to save fuel, and thus afford a magnificent hothouse hatching ground for each g«rnw as may be present, and ideal facilities for their communication from one victim to another. At, the same time, by this crowding and the cutting off of life and exercise in the open air which accompanies it, the resisting power of our bodies 'a lowered. And when these two processes have had an opportunity of progressing side by side for from two to three months— i when, in other words, the Foil has been carefully prepared, the seed sown, and the moist heat applied as in a forcing-house— '• then we suddenly reap the harvest. In j other word*, the heavy crop of pneumonia in January. February, and March is the logical result of the "seed-sowing and forcing of the preceding two or three months. The warm tli of summer is even more depressing in its immediate effects than the cold o' winter, but the heat carries with it one blessing, in that it drive* us willy-nilly into the open air. day and nighfc. And on looking At statistics we find precisely" what might have been expected on this theory — j that the death-rate is lowest for pneumonia in July and August. It might be said" in passjng that in epite of our vivid dread of sunstroke, of cholera, and of pestilence in hot ■weather, the h,gfc months of the year in temperate c)lmatea are invariably the months of fewest diseased } and fewest deaths. Our extraordinary { dread of the summer heat has but alendat;

rational physical basis. It may be but a sub-ccnscious after-vibration in our braincells from the simooms, the choleras, and the pestilences of our tropical origin as a race. Open air. whether hot, cold, vrel, dry, windy, or stiil, is our best friend, and house an- our deadliest enemy. if this \ic\v be well founded, then the advance of modern civilisation v.-culd tend' to furnish a more and more fa\oural>le soil for the spread of this disease. This, unfortunately, is abotit the conclusion to which we are being most unwillingly driven. Almost every other known infectious disease is diminishing, both in frequency and in. fatality, under civilisation. Pneumonia alone 'defies our onslaughts. In fact, if statistics are to be talcen at their surface value Mve are facing the appalling situation of an apparently marked increase both in its prevalence and mortality. Fcr a number of years past — tver since, in fact, accurate statistics bagan to bo kept, pneumonia, has been listed as the second heaviest cause of d-eath, its only surpasser being- tuberculosis. About 10 years ago it began to bo noticed that the second competitor in the race of death was overtaking its leader, and; this ghastly rivalry continued • until about three years ago pneumonia forged ahead. In some great Amsriean cities- it now occupies, the bad eminence of the most fatal single disease on the death lists. The situation is, however, far from being; as serious and alarming as it might appear, simply from this baUi statement of statistics. First of all, because the forging ahead of pneumonia has been due in greater degree to the falling behind of tuberculosis than to any aotual advance on ihs part. The death rate of tuberculosis within the last 30 years has diminished! between 30 and 40 per cent. And pneumonia at its worst has never yet equalled the old fatality of tuberculosis. Furthermore*, all who have carefully studied the subject are convinced that much of this apparent increase is due to more accurate and careful diagnosis. Up to 10 years or so ago it was generally believed that pneumonia was rare in young children. Now, however, that we make the diagnosis with a. microscope, we discover that a la-rge percentage of the cases of capillary bronchitis, broncho-pneumonia and acute congestion of the lung in children are due to the presence of the Pncumoccccus. Similarly, at the other end of the line deaths that were put down to bronchitis, aiFhma, heart failure — yes. even to old age, — have now been shown on bacteriological examination to be duo to this übiquitous iirlp of malevolence. So that, on the whole, all that we are probably justified »in saying is that pneumonia is not decreasing under civilisation. This is not to be wondered at, inasmuch as the inevitable crowding and congestion which accompany civilisation, especially in its derivative sense of " cibification," tend to foster it in every way, both by multiplying 1 the opportunities for infection and lowering" the resisting power of tho crowded' masses. (To be continued.)