THE WHITE PLAGUE

Waikato Times, Volume 87, Issue 13308, 11 October 1916, Page 7

THE WHITE PLAGUE

TREATMENT OF CONSUMPTION. GRAVE SOCIAL PROBLEM. ALMOST EVERY FAMILY AFFECTED "So insidious and so universal i: this dread scourge that there is scar cely a family, particularly among th< poorer classes, in which traces of i t are not to be found." This remark able and startling statement was madt by Dr. Bernstein (Medical Superintendent of the Te Waikato Sanatorium) in an address on the causes and treatment of consumption to members of th< Waikato Hospital Board, who paid £ visit to the Sanatorium a few days ago Dr. Bernstein is a comparatively youn* man, unmarried, who for several years was engaged in fighting the white plague in the slums of London, where between 20,000 and 30,000 consumptive cases passed through his hands, He has studied every branch of medicine, but has now decided to devote himself fo tubercular research work, and to members of the Hospital Board he explained the reasons for the reform in the iqethods of treatment which he had caused to be adopted at Te Waikato since he assumed control. Consumption, he said, was caused by a special germ, and was not confined to the lungs, but could affect any part of the system from the scalp to the soles of the feet. The disease was incurable, but it could be so treated that its presence would not be felt by the patient, and it could, if taken in time, be so arrested that the infected person could do ordinary hard work for 20 or 30 years, and then perhaps die of some quite different complaint. The disease, as he had previously stated, was caused by germs, and could not arise without the presence of these in the system. It was not caused by cold or draught. The germs occurred in millions In the sputum of consumptive patients, and they could live for a time outside the body, especially in dirt, dust and dark places. They were blown about in the air and breathed into the lungs, setting up the disease. There was, however, little fear of the infection of ordinary healthy, good-living people and where they had a free and plentiful supply of air under ordinary healthful conditions. An Insidious Poison. The germ entered the system and generally lodged in the lungs, and it was chiefly lung affections that were treated at Te Waikato. It was an established fact that flies bred at the rate of millions a day, but tubercular germs bred at the rate of millions and millions in a single hour. The bacilli were so small that 7000 of them would fit into a line a thirty-thousandth of !an inch thick and one inch long. On entering the system they set up a virulent poison, so that really the disease could be and was regarded as a general blood poisoning. It was so insidious that it crept on to the patient slowly for years before he really became aware that anything was wrong with him, by which time it probably had a firm hold. The symptoms were numerous, but the most common were a general feeling of lassitude, a slight oough, constant headaches, an "out of sorts" feeling, pains in different parts of the body, but really nothing to indicate to the ordinary lay mind that the lungs were affected. If by any chance an infected person should spit blood (for this sometimes happened in the early stages of the disease) the patient was really fortunate in receiving indications so early as to enable him to take the necessary precautions and treatment before it became too late. The poison in the system slowly but steadily increased without the patient's knowledge, until one day, perhaps, he would find that he could not keep his food on his stomach or that he became more than usually tired before his customary day's work was done. There was, however, in the human system the power to generate an antidote for the tubercular poison, and the treatment adopted at Te Waikato was to impose such restrictions on the habits and mode of living as to induce this antidote to accumulate in the system and so overcome the poison germs. The power of resistance to the disease and to produce the antidote differed considerably in the persons affected. The first thing the patient was compelled to do on entering the sanatorium was to go to bed in a well-ventilated shelter, perhaps for many weeks (according to his condition), and that was where the "cruelty" arose. The effects of lying still in bed for a lengthy period caused a general settling down of the poison factory, as the germs became less active, while at the same time the resistant antidote increased. Effects of Treatment. By lying quietly in bed the antidote generated until the balance was practically even, and it was at this stage that one of the most difficult problems arose. The patient was then allowed to rise for a few hours daily and was gradually permitted to take short walks and eventually to do a little vvork. By getting up and walking about, however, it was often found that the exertion lighted up the poison germs and a further period of rest had to be ordered. In the meanitime the patient had been educated as to how to conduct himself. When c<oughing he was taught to cover his mou th with a handkerchief to prevent til e spray, which contained the germs, being scattered into the air. Each patient also carried a pocket bask, audi was not allowed to expectorate, except into this. He was taught n.©t to swallow the sputum lest the bowels should become affected. Each patienlt had his own eating utensils—knife, fork, spoon and cup—and his own towe 1. When meals were finished b& wash ed his utensils and wiped the.m on his c >wn towel. The Board would therefore understand the necessity for the impos ition of restrictions in a sanatorium, and would be able to understand the nature of the crime wI ien they heard of the horrible tragedy of a patient being compelled

J to lay in bed for several weeks. II ' was necessary to keep the patients under close observation in order to see that the restrictions were enforced, and consequently every phase of the day's work was regulated by a gong. At that moment the gong sounded, which, Dr. Bernstein explained, was the signal , for all "up" patients to take an hour's rest on their beds. All this time, said the doctor, the condition of the pati- • ents was being carefully watched (for many of thern might by this time be . feeling perfectly well) to prevent overexertion and the stimulation of the poison germ to a greater extent than the resistant antidote could cope with. Therefore the chief essential in a consumptive sanatorium was discipline, which was absolutely necessary to save ttie patients from themselves. If the patient could not be taught to control himself and his manner of living, then the benefits of the treatment were to a large extent wasted. At the Sanatorium there were three classes of patients; those who were in an advanced stage, those who were in the intermediate stage, and others who were feeling perfectly well, yet had

nothing much to do. The latter class of patient usually wanted to break from all restrictions, and sometimes did so, even against the strong advice of the superintendent and matron. It was gratifying to know, however, that the patients had now been sufficiently educated to the system of living that the rules were seldom broken, and the doctor doubted if a free tubercular germ could be found at the Sanatorium, for every patient used iiis own sputum flask wherever he went, and everything, including the bag in which it was carried, was boiled for 15 minutes and disinfected each day.

Disease not Hereditary. The importance of the campaign, Dr. Bernstein pointed out, was to educate public opinion on the subject and to get hold of the patients in the incipient stages. The problem was not so much a medical one as a social one. The disease was so stealthy that it could hardly be perceived, and there was scarcely a family of any size that did not show signs of it, especially among the poorer classes. In New Zealand there were very few people who were insufficiently clad or fed, and he considered that there should be no great difficulty in stamping out the disease, with a rigorous campaign, in the course of two or three generations. Even now it was less virulent than several generations ago. The doctor made one point clear (upon which there is a great misconception in the public mind), that "consumption is not hereditary, but is only caused by infection." Consumptive parents had been known to have healthy children, with no signs of the dread disease upon them. Touching on the question of milk as a source of infection, Dr. Bernstein said that the risk of infection by drinking unsterilised milk was not so great with adults, but with infants the danger was a very grave one, as many children were undoubtedly infected simply because of drinking unscalded milk. It was almost impossible to stamp out tuberculosis amongst cows, while pigs were infected as a result of being fed on skim-milk from tubercular cows.

Dr. Roberts, a former superintendent of the Sanatorium, supplemented the remarks of Dr. Bernstein, and also expressed the opinion that while consumption was not hereditary, the power of resistance was inherited. He was not surprised to hear Dr. Bernstein say that the disease was incurable, for that was the opinion he (the speaker) had held always. He agreed with the Superintendent that it could be so arrested, however, as to place the patient in a condition to carry on his usual occupation and live a normal life, with necessary care, for 20 or 30 years if treated in time. i No Cure, but Arrest. The power of producing the antidote, if carefully humoured, may after a period have the effect of imprisoning the tubercular baccili in a fibrous tissue and so long as the person remained and lived a good life, and did not contract some' other complaint, he was likely to be free from the effects of it for a very lengthy period. As an old superintendent of the institution, Dr. Roberts said he desired to express his extreme gratification at the success of the system adopted by Dr. Bernstein. His administration of the institution had born infinitely better than it had ever been before, and the speakfer had never seen it in a better state of organisation than it was at the present time. Discipline was essential to its conduct, and it behoved outsiders, before passing judgment on the control of an institution qf this kind (which was totally different to an ordinary hospital) to first make themselves acquainted with both sides of the question. The speaker freely admitted that he would never have been able to run the institution as efficiently and economically as Dr. Bernstein had done. In view of these circumstances he felt it his duty to express his true and distinct opinion of l!ie work done by Dr. Bernstein. l>i\ Douglas also complimented Dr.. Bernstein on his success, and declared tli;;t consumption must be treated methodically. Dr. Bernstein had a farharder task than he (Dr. Douglas) had,, because the patients were with Dr.. Bernstein for a long period, and frequently felt lit and well the whole time. He felt sure that all who had heard what Dr. Bernstein and Dr. Roberts had said would do their best toback him up in his organisation and methodical treatment. Dr. Bernstein, in reply, stated that the bulk of the patients were contented, but occasional ones would break, the disciplinary bonds. His task at Te Waikato had been an uphill one, and. he must admit that his first six monthswas a period of "Hell," but the path of any reformer was hard and the only real recompense was the ultimate good achieved. It was a game of hope, for' research work of the nature he had taken up was extremely fascinating, while there was constant pleasure in watching the advancement of patients towards the healthy state. The prob-

t lorn was to get hold of cases in the 5 early stages, and towards that end he ; was making fortnighty visits to AuckI land to examine suspected cases and ? to get into infected houses. In Engt land thousands upon thousands of , cases of infection were discovered in I houses where perhaps one or more of ; the family had died of consumption. I Frequently when people were con- • stantly complaining of a cold, it was • not a cold at all, but an incipient form ! of consumption. In America a great campaign had been started against the white scourge, and people were being induced to see their medical advisers and be thoroughly overhauled every 12 months whether they were feeling well or not. The doctor mentioned that he had already treated over 200 patients at Te Waikato, and the results had been very satisfactory. There were at present 70 patients of both sexes at the institution. The sexes never mixed, and never even saw each other. In their walks about the hills, the men and women took different directions over special areas mapped out for them. This was absolutely necessary. Dr. Bernstein has issued a useful little booklet on "Hints to Consumptives," which no doubt he will be pleased to mail free on receipt of a stamped addressed envelope to all desiring to secure one.