HEALTH COLUMN.

Otago Witness, Issue 2862, 20 January 1909, Page 84

HEALTH COLUMN.

THE GREAT SCOURGE. (By Woods, Hct< m.vsox, AM., M.D., in the Washington livening Po*t ) — The Habits of the Pneiirnococcus. — It was only in the last 10 years — yes, within the last five yean,,— that v\o fairly grasped the real method and nature of the spread of the disease, and recogmocd the means that must be adopted against it. And as all of these factoid arc matter* which are not only <tb&olutel\ within our own control, bui are included m that programme of general bet lei merit of human comfort and vigour to vhich the truest intelligence and philanthropy of the nation is now being dneitod, the outlook for the future, instead of being gloomy, is distinctly encouraging. Our chief difficulty in discovering the cau-ie of pneumonia lay in the warm of applicants for the honour. Almott every celt-respecting bacteriologist seemed to think it his duty to discover at least one, and the abundance and variety of germs constantly or accidentally present in the human sa.li\a made it so difficult positively to isolate the real criminal that, although it was identified and described as long ago as 1884 by Fraenkel, the validity of its claim was" not generally recognised and established antil nearly 10 years later. It is a tinj, inonensive-looking little organism, of an oval or lance-head shape, which, after masquerading under os many aliases as a confidence man, Lac finally

come to i>e called the pneumococcus, for ] short, or "lung germ"— -though by those who are more precise it is still known as the "Diplococcus pneumoniae" or "Diplooocous lanceolatus," from its faculty of usually appearing in pairs, and from its lancelike shape. Its conduct abounds in "ways that are dark and tricks that are. vain," whose elucidation throws a flood of ; light upon a number of interesting- problems in the spread of disease. ■ i First of all it literally fulfils the prognostic of Scripture, that "A man's foes shall be they of his own household," for its- chosen abiding place and normal habitat I is no less intimate a place than the human mouth. Outside of this warm and sheltering fold it perishes quickly, as coldj sunlight, and dryness are alike fatal to it. — A Bad Disease for Weaklings. — "We could hardly believe the evidence of our senses when studies of the saliva of j perfectly healthy individuals showed this j deadly little bacillus to be present in considerable numbers in from 15 to 45 per cent, of the cases examined. "Why, then, does not everyone develop pneumonia? The answer to this strikes the keynote of our modern knowledge of infectious diseasenamely, that while an invading germ is necessary a certain breaking down of the body defences and a lowering of the vital ] resistance are equally necessary. ■• These in- j vaders lie in wait at the very gates of the | citadel, below the muzzles of our guns, as. i it were, waiting for some slackening of discipline or of watchfulness to rush in and put the fortress to 6ack. Nowhere is this more strikingly true than in pneumonia. It is emphatically a disease where, in the language of the brilliant pathologistphilosopher Moxon : I "While it is most important to know J what kind of a disease the patient has got, it is even more important to know what kind of a patient the disease has got." The death rate in pneumonia is an almost mathematically accurate deduction from the age, vigour, and nutrition of the patient | attacked. No other disease has such a. brutal and inveterate habit of killing the •weaklings. The half -stifled baby in the tenement, the underfed, overworked labour- J ing man, th© old man with ri<rid arteries j and stiffening muscles or waning life vigour, the chronic sufferer from malnutrition, alcoholism, Bright's disease, heart disease — these are its chosen victims. Another interesting feature about the pneumococcus is ite vitality, outside of the body. If the saliva in which it is contained be kept moist, and not exposed tc the direct sunlight and in a fairly warn place, it may survive as long as two weeks. If dried but kept in the dark, it will survive four hours. If exposed to sunlight, or even diffuse daylight, it dies within an hour. In other werds, under the condi- , tions of dampness and darkness which often | prevail in crowded tenements it may remain alive and malignant for weeks ; in decently-lighted and ventiiated rooms less than two hours. This explains why in j private practice and under civilised condi- | tions epidemics of this admittedly infectious disease are rare; while in jails, overcrowded barracks, prison ships and winter camps of armies in the field they are bf no means uncommon. This is vividly supported by the fact brought out in our later investigations of the sputum of slumdwellers, carried out by city boards of health, that the percentage of individuals harbouring the pneumococcus steadily increases all through the winter months, from 10 per cent, in December Lo 45, 50, and even 60 per cent, in February and March. The old proverb, "When want comes in at the door Love flies out at the window," might be revised to read: "When sunlight comes .in at the window the pneumococcus flies 'up che flue.' " Authorities are still divided as to the meaning and even the precise frequency ! of the occurrence of the pneumococcus in the healthy human mouth. Some hold that its presence is due to recent infection, which has either been unable to gain entrance to the system or is preparing its attack; others that it is a survival from some previous mild attack of the disease, and the body tissues having acquired immunity against it.it lemains in them as a harmless parasite, as is now well known to be the ease with the germs of several of our infectious disease* — for instance, vyphoid — for months and even years afterward. Others hold the highly suggestive view that it is a normal inhabitant of the healthy mouth, wh'ch can become injurious to the body, or pathogenic, only under certain depressed or disturbed conditions of the latter. In defence of this last it may be pointed out that dental bacteriologists have now already isolated and described some 30 different forms of organisms which inhabit the mouth and teeth ; and the pneumococeu* may well be one of these. Further, that a number of our most dangerous disease germs, like the typhoid bacillus, the bacillus of tuberculosis, and the bacillus of diphtheria, ha\e almost perfect "doubles," law abiding relatives, so to speak, among the germs that normally inhabit our throats, our intcotinos, or oiir immediate surroundings. The ultimate foundation question of the science of bacteriology is: How did the 'ii-e-ase germs become disease gernia? But the question is still unanswered. However, fortunately, nere as in other human affairs, imperfect as our knowledge is, it ia feulßcient to serve as a guide for practical conduct. Widely piesent as the pneumococcus is, we know well that it is powerless for harm except in unhealthful surroundings. There is another interesting feature of its life history which i<* of practical importance, and that is, like many other bacilli, it is increased in virulence and infect-iousne^-s by passing through ihe body of a patient. Flushed with \ ictory over a weakened subject it acquires courage I lo attack a stronger. This is the reason why, in thot>e comparatively infrequent instance.-, m which penumonid, runti through a family. it it> the btrongest and moot v igouroui members of the family who are the la^t (o he attacked. It also explains one of the paradoxes of this disease, that whileemphatically a disease of overcrowding and foul air, and attacking chiefly weakened i individuals, it 16 a veritable scourge of camps, whether mining or military. When once three or four cases of pneumonia have occurred m a mining camp, even though this consist almost exclusively of vigorous men, most of them in the prime of life, it acquires a virulence like- that of a pestilence, so that, while ordinarily not more than 15 to 20 per cent, of those attacked die, death-rates of 40, 50, and even 70 per cent, are by no means uncommon in raining camps. The fury and swiftness of this "miner'o pneumonia" is equally incredible. Strong, vigorous meir are taken

with a chill while working in their eluieingi ditches, are delirious before night, and die within 48 hours. ' So widely known, are. these facts and so drea-ded is the disease throughout the Far West and in mountain regions generally that there is a widespread belief iha-i: pneumonia at high altitudes is particularly deadly. I had occasion to interest myeelf in this question some years ago, and by" writing to co'leagucs practising at high elevations and collecting reports from the literature, especially of the surgeons of army posts in -mountain regions, was somewhat surprised^ to find that the mortality of all oases occurring above 5000 ft elevation was almost; identical with that of a similar class of the population at sea-level. It is only whe» a sufficient number of cases occur in succession to raise the virulence of the pneiK moooccus in this curious manner that an epidemic vrith high fatality develops. That this increase in,' virulence in that organism does occur' Was clearly demon-.." strated by a bacteriologist friend 1 of mine," who succeeded in securing some of the' sputum from a fatal case in the famous Tonopah epidemic of some years ago, art epidemic so fatal that it was locally known as the "Black I>eakh." Upon injecting 1 cultures from this, sputum into guinea-pig» the latter died in one-quarter oi the time that it usually took them to succimib to 9> similar dose of an ordinary culture, of ths pneumococcus. It is therefore evident that just as "no chain is stronger thaD its weakest link," co in the broad sense no community i* stronger thar its weakest group of individuals, and pneumonia, like other epidemics, may be well described as the vengeance which the "submerged tenth" may wreak from time +o time upon their more fortunate brethren. Now that we know that under decent and civilised conditions of light and ventila* tion the pneumococcus will live but an hour to an hour and a-half, thia reduces the risk of direct infection under these conditions to a minimum. It is obvious that the principal factors in the- control of the diaease are those which tend to build up the vigour and resieting power of sill possible victims. The more broadly we study the disease the more clearly do tha data point in this direction. (To be continued.)