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the facts above mentioned, we ought opportunity of infecting each other. The rather to ascribe the disease to infection infection, moreover, occurred among tailby the dwelling, not to mention its pos- ors, who are known to be special sufferers sible derivation from other sources.
from phthisis. On January 14th, 1888, Cornet visited The general belief some time ago, a patient who, for three-quarters of a which, to some extent, may hold its year, had suffered from tuberculosis of ground to the present hour, was that this the lung and larynx. The dust of the wasting malady arose froin some pecuroom occupied by this man was proved to liarity in the individual constitution, incontain virulent infective matter. A dependent of infection from without. brother of the patient who, at the time of Enormous mischief has been done through the examination of the dwelling, was al- exaggerated and incorrect notions regardleged to be in perfect health, exhibited ing the influence of predisposition and inphthisis of the larynx four months after- heritance. Members of the same family ward. “We are, surely,” says Cornet, were observed to fall victims to this “ warranted in ascribing this result, not to scourge, but each was regarded as an inheredity, or any other hypothetical cause, dependent source of the disease, to the exbut to the naked fact that the dust of this clusion of the thought that the one had dwelling contained tubercle bacilli which infected the other. Two or three days were capable of infecting the lungs and ago an old man here at Ilind Head told larynx of a man, as they did the perito- me that he had lost three children in sucneum of a guinea-pig."
cession through phthisis ; and he menOn the 31st December, 1887, Cornet tioned another case where five or six robust visited a man who for two years had suf- brothers had fallen, successively, victims fered from phthisis.
He lived in the same to the same disease. “I am sure, room with two brothers who were very the man, with a flash of intelligence across robust, one of whom, however, had be- his usually unintelligent countenance, gun to cough, though without any further must be catching. Cornet describes evidence of serious disorder. The patient some cases which irresistibly suggest famhad been at home for eight days, while ily infection. In 1887 he visited a papreviously he had acted as foreman in a tient, the father of a fainily, who, six tailoring establishment. It was proved, years previously, had lost by consumption to a certainty, that this patient had taken a little girl fourteen years old. A year the place of a colleague who had died from and a half afterward a daughter of the phthisis of the throat, and who had been same man, twenty-one years old, fell a in the habit of expectorating copiously victim to the disease. One or two years upon the floor.
In the work-room, more- later a robust son succumbed, while, a over, the present sufferer had occupied a fortnight before Cornet's visit, a child a place next to the man who died. Cornet year and a half old had been carried away. called upon the proprietor of the estab- Without doing violence to the evidence, lishment, who allowed him every oppor
as Cornet remarks, these cases may be tunity of examining the room, in which justly regarded as due to family infection. eight or ten workmen were engaged. For many years the father had suffered With dust rubbed from about two square from a phthisical cough, and directly or metres of the wall, near the spot where indirectly he, in all probability, infected the patient now works, Cornet infected his children. guinea-pigs and produced tuberculosis. In connection with this subject, I may He ridicules the notion of ascribing this be permitted to relate a sad experience of man's malady to any hereditary endow- my own. It is an easy excursion from ment or predisposition, derived, say, from my cottage in the Alps to the remarkable a phthisical mother, which, after sleeping promontory called “The Nessel,” on for twenty years, woke up to action at which stands a cluster of huts, occupied the precise time when he was surrounded by peasants during the summer months. by infective matter. Our author regards On visiting The Nessel three years ago, I this, and other similar cases which he ad. was requested to look into a hut occupied duces, as of special interest. The tuber- by a man suffering from a racking cough, culous virus was here found in rooms con- accompanied by copious expectoration. taining several workmen, who had thus an I did so. It was easy to see that the poor fellow was the victim of advanced cases, been detected. It behooves those lung disease. In the same hut lived his who have arrived at an opposite result to daughter, who, when I first saw her, pre- repeat their experiments with the most sented the appearance of blooming health scrupulous care, so that no doubt should and vigor. Acquainted as I was with be suffered to rest upon a point of such Koch's discoveries, I remarked to a friend supreme importance. The lungs, air paswho accompanied me, that the girl lived sages, throat, and mouth all present wet in the midst of peril. We had here the surfaces, and it has been proved that even precise conditions notified by Cornet. with sputum rich in bacilli, over which a Spitting on the floor, drying of the spu- current of air of considerable force had tum, and the subsequent treading of the been driven, the air was found perfectly infectious matter into dust. Whenever free from the organism. the hut was swept, this dust mingled freely The immunity as regards infection with the air, and was of course inhaled. which to so great an extent is observed,
I warned the girl against the danger to is ascribed by Cornet in part to the inwhich she was exposed. But it is some. tensely viscous character of the sputum times difficult to make even cultivated when wet. Even after it has been subjectpeople comprehend the magnitude of this ed to a drying process its completo desicdanger, or take the necessary precautions. cation is opposed by its hygroscopic charA year afterward I visited the same hut. acter. Cornet calls other investigators to The father was standing in the midst of bear him witness that the task of reducthe room-a well-built man, nearly six ing well-dried sputum to a fine powder, feet high, and as straight as an arrow. even in a mortar, is by no means an easy He was wheezing heavily, being at inter- one. It is difficult to produce, in this vals bowed down by the violence of his way, a dust fine enough to remain suscough. On a stool in the same room sat pended in the air. It would be an error his daughter, who, a year previously, had to suppose that dry tuberculous phlegm, presented such a picture of Alpine strength when trodden upon in the streets, sends a and beauty. Her appearance shocked cloud of infected dust upward. Its hygrome. The light had gone out of her eyes, scopic qualities in great part prevent this. while the pallor of her face and her pant- When dried sputum is reduced to powder in ing breath showed only too plainly that a humid place, it attracts to itself moisture, she also had been grasped by the destroy- and collects into little balls. The streets
There are thousands at this moment in which phthisical persons expectorate are in England in the position which I then rendered innocuous by rain, or by the artioccupied—standing helpless in the pres- ficial watering common in towns. Cornet cnce of a calamity that might have been regards this watering as an enormous saniavoided. All that could be done was to tary advantage. No doubt when dry eassend the sufferers wine and such little deli- winds prevail for a sufficient time, infect cacies as I could command. Last summer tious dust will iningle with the air. DurI learned that both father and daughter ing easterly winds infectious diseases are were dead, the daughter having been the known to be particularly prevalent. Our first to succumb.
sufferings from influenza during the presIn opposition to those who considerent year have been connected in my mind that they have found bacilli in the breath with the long-continued easterly and of phthisical patients, Cornet adduces a north-easterly winds, which, sweeping number of very definite results. Patients over vast areas of dry land, brought with have been caused to breathe against plates them the contagion that produced the of glass coated with glycerine, which malady. Besides the difficulty encoun. would undoubtedly have held the bacilli tered before the sputum reaches the state fast. Water has been examined, through of very fine powder, other difficulties are which the air expired by phthisical lungs presented by the numberless angles and had been caused to pass.
In this case obstacles of the respiratory tract, and by the bacilli, being moist, would have been the integrity of the ciliary-epithelium, to infallibly intercepted by the water. The the more or less vigorous action of which aqueous vanor exhaled by consumptive is due the fact that amid thousands of oplungs has been carefully condensed by portunities we have only here and there a ice ; but no bacilli has, in any of these case of infection.
The action of the tubercle bacillus is pronounced. This, with human beings, determined by the state of the surface is the normal state of things. with which it
into contact. Take the case of a veteran who has been Wounds or lesions, caused by previous to the front in fifty different battles, who, diseases, such measles, whooping right and left of him, has seen his comcough, and scarlatina, may exist along the rades fall, until haply he remains the sole respiratory canal. By illness, moreover, survivor of bis regiment, without scratch the epithelium may be impaired, the or contusion. Shall we call him bullet inhaled bacilli being thus offered a con- proof? Will his safety be ascribed to an venient domicile. If it be thought desir- absence of “predisposition" to attract able to call such a state of things “pre- the bullets—thus enjoying an immunity disposition," Cornet will raise no objec- which the superstition of former ages tion. Wherever a wounded or decaying would have ascribed to him ? Is he inore tissne exists the bacillus will find, unop- bullet proof or less vulnerable than the posed, sufficient nutriment to enable it to comrade who by the first volley in the increase in number, and to augment in first battle was shot down ? How vigor, before it comes into contact, and often, says Cornet,“ do such cases reconflict, with the living cells underneath. peat themselves in life? and are we able It is not any such predisposition, but pre- to do more than describe them as accidisposition by inheritance as a source of dents ? Unscientific as this word may apphthisis that is contended against by Cor- pear, it is more in harmony with the truih net. That Koch entertained a different than any artificial hypothesis." opinion is declared to be absolutely erro- The opportunities for incorrect reasonneous. The admission that a disease may ing in regard to phthisis are manifold. be favored, or promoted, by this or that It is observed, for example, that a hospital circumstance is not tantamount to the as- attendant, 'who has had for years, even sertion that in all, or nearly all cases, for decades, consumptive patients in his this circumstance is the cause, concomi. charge, has, nevertheless, escaped infectant, or necessary precursor of the disease. tion. The popular conclusion finds vent This is the view generally entertained re- in the words,
" It cannot be so dangerous garding " predisposition.'
after all !'' Here, however, attention is Cornet's further reasoning on this sub- fixed on a single fortunate individual, ject reveals his views so clearly that I will while the hundreds who, during the same endeavor, in substance, to reproduce it time, have succumbed are forgotten. The here. Let a box be imagined filled with danger of infection in different hospitals finely divided bacillus dust, and let a cer- is a variable danger. In some we find tain number of guinea-pigs be caused, for bacilli, while in others we do not find a very short time, to inhale this dust. them. It is no wonder, then, that among A few of them will be infected, while the attendants who are thus exposed to differgreat majority will escape. If the inhala- ent degrees of danger, some should be intion be prolonged, the number of animals fected and others not. When, in cases infected will increase, until at length only of diphtheria, typhus, cholera, small-pox, one or two remain. With an exposure which are undeniably infectious diseases, still inore prolonged the surviving ones an attendant escapes infection, we do not would undoubtedly succumb. Why, then, exclaim, “They are not so dangerous in the first instance, does one animal con- after all !" But this is the favorite extract tuberculosis and another not? Have pression when pulmonary consumption is they not all inhaled the same air, under in question.
adds Cornet, the same conditions ? Are the animals with a dash of indignation,
we observe that have escaped the first contagion less the enormous increase of phthisis among
disposed” than the survivors to the dis- the natives of Mentone, and find this ascase ! Assuming the animals to be all cribed to the abandonment of land labor, perfectly healthy, such differences will be instead of to intercommunication with the observed. But, supposing them to be consumptive patients who spend their weakened in different degrees by previous winter at that health resort, it would seem disorders, the differences revealed in the as if some people shut their eyes wilfully case of healthy animals would be more against the truth.”
Again and again our author insists on the mortality among physicians by phthisis the necessity of the most searching over- does not far exceed the average. And sight on the part of physicians who have even should this mortality show no great consumptive patients in charge. “I can- preponderance, it is to be borne in mind not,” he says, accept as valid the asser- that the number of physicians who, thanks tion that in well-ordered hospitals pro- to their education, are able to discern the vision is invariably made for expectoration first approaches of the malady, and to into proper vessels, the conversion of the master it in time, is by no means incon. sputuin into infectious dust being thereby siderable. In the health resorts of Gerrendered impossible. Take a case in many, Italy, France and Africa, we find point. One of the physicians to whose numbers of physicians who have been kindness I owe the possibility of carrying compelled, by their own condition, to on my investigation, assured me in the establish their practice in such places. most positive manner that the patients in his hospital invariably used spittoons. A The memorable paper of which I have few minutes after this assurance had been here given a concentrated abstract congiven, and under the eyes of the director cludes with a chapter on Preventive ħimself, I drew from the bed of a patient Measures,” which are assuredly worthy of a pocket-handkerchief filled with half- grave attention on the part of governdried phlegm. I rubbed from the wall of ments, of hospital authorities, and of the the room, at a distance of half a metre public at large. The character of these from the bed of this patient, a quantity measures may be, in great part, gathered of dust, with which, as I predicted, tuber- from the foregoing pages. It is more culosis was produced. If, therefore, phy- than once enunciated in Cornet's memoir sicians, attendants, and patients do not that the first and greatest danger to which work in unison, if the patient and his at the phthisical patient is exposed is himself. tendants be not accurately instructed and If he is careless in the disposal of his strictly controlled, the presence of the phlegm, if he suffers it to become dry and spittoon will not diminish the danger.” converted into dust, then, by the inhala.
In the dwellings of private patients the tion of a contagium derived from the disperils here glanced at were most impres- eased portions of his own lung, he may sively brought home to the inquirer. In infect the healthy portions. "If, therefifteen out of twenty-one sick-rooms, that fore,” says Cornet, “the phthisical pais to say, in more than two-thirds of tient, to avoid the guilt of self-murder, is them, Cornet found in the dust of the compelled to exercise the utmost caution, walls and bed furniture virulent tubercle he is equally bound to do so for the sake bacilli. He refers to his published tables of his family, his children, and his serto prove that in no ward or room where vants and attendants. He must bestow the organism was found did the patients the most anxious care upon the disposal confine themselves to expectoration into of his sputum. Within doors he must spittoons, but were in the habit of spitting never, under any circumstances, spit upon either upon the floors or into pocket-hand- the floor, or employ his pocket-handkerkerchiefs. In no single case, on the other chief to receive his phlegm, but always hand, where spitting on the floor or into and everywhere must use a proper spitpocket-handkerchiefs was strictly and ef- toon. If he is absolutely faithful in the fectually prohibited, did he find himself carrying out of these precautions, he may able to produce tuberculosis from the col. accept the tranquillizing assurance that he lected dust.
will neither injure himself nor prove a A point of considerable importance, source of peril to those around him. more specially dealt with by Cornet in a Though mindful of the danger of interfurther investigation, has reference to the fering with social arrangements, Cornet allegation, that physicians who attend follows out his preventive measures in tuberculous patients do not show among considerable detail. Hand-spittoons, with themselves the frightful mortality from a cover, he recommends, not with the phthisis that might be expected. This is view of preventing evaporation, but beoften adduced as proof of the comparative cause flies have been known to carry inharmlessness of the tubercle bacillus. No fection from open vessels. Without coninvestigation, however, has proved that demning the practice, he does not favor
the disinfection of sputum by carbolic acid upon the notion that neither physicians and other chemicals. He deprecates the nor nurses suffer from this proximity. use of sand or sawdust in spittoons. On No definite and thorough inquiry had, æsthetic grounds, he would have the spit- however, been made into this grave questoons of those who can afford it made or- tion. In face of the vague and contranamental, but earthenware saucers, such dictory statements which issued from the as those placed under flower-pots, are rec- authorities of different hospitals, the probommended for the use of the poor. The lem cried aloud for solution. For aid and consumptive patient must take care that data, under these circumstances, Cornet not only in his own house, but also in the resorted to Herr von Gossler, the Prussian offices and workshops where he may be Minister of State, who, at that time, had engaged, he is supplied with a proper medical matters under his control. From spittoon. In public buildings, as in pri- him he received the most hearty furthervate houses, the corridors and staircases ance and encouragement. Dr. Von Gossought to be well supplied with these neces- ler has recently resigned his post in the saries. The ascent of the stairs often Prussian Ministry, but his readiness to provokes coughing and expectoration, and forward the momentous inquiry on which the means of disposing of the phlegm Cornet was engaged merits the grateful ought to be at hand. The directors of recognition of the public, and the praise factories, and the masters of workshops, of scientific men. as well as the workmen themselves, ought The number of female nurses in Prusto make sure that, under no circumstances, sia, as shown by the statistics of the Royal shall spitting on the floor or into a pocket Bureau of Berlin for 1885, was 11,048. handkerchief be tolerated.
Of these the Catholic Sisters of Mercy One final word is still to be spoken. If numbered 5,470, or 49.51 per cent. ; we are to fight this enemy with success, Evangelical nurses, 2,496, or 22.59 per the public must make common cause with cent.; nurses belonging to other societies the physician. The fear of spreading and associations, 352, or 3.19 per cent.; panic among the community, and more while of unclassified nurses there were particularly among hospital nurses, must 2,730, or 24.71 per cent. of the whole. be dismissed. Unless nurses, patients. The male attendants, at the same time, and public, realize with clear intelligence numbered 3,162. Of these, 383 were the dangers to which they are exposed, Brothers of Mercy, 205 were deacons, they will not resort to the measures neces- while of unclassified attendants there were sary for their protection. Should the 2,574. sources of infection be only partially re- The sifting of these numbers was a lamoved, the marked diminution of a mal- hor of anxious care to Dr. Cornet. It ady, which now destroys more human had already been remarked by Guttstadt beings than all other infective diseases that the commercial attractions of hospital taken together, will, as pointed out by service were insufficient, without the help Cornet, be “our exceeding great re- of some ideal notive, to secure a permaward.'
nent staff. This motive was found in de.
votion through a sense of religious duty to Dr. Cornet's great investigation, of the service of the sick. The sifting of which some account is given above, is en- his material made it clear to Cornet that, titled, “ The Diffusion of Tubercle Bacilli to secure a safe basis of generalization, by exterior to the Body.” It was published causing it to embrace a sufficient number in 1888. A shorter, though not less im- of years, he must confine himself solely to portant inquiry, on “ The Mortality of the nurses of the Catholic orders. The the Nursing Orders," was published in greater freedom enjoyed and practised by 1889. These two memoirs will be found Protestants, in changing their occupation, permanently embodied in the fifth and in entering the married state, or through sixth volumes of the Zeitschrift für other modes of free action, rendered them Hygiene. From a former paragraph it unsuitable for the purpose he had in view. will be seen that Cornet's attention had Cornet's inquiry extended over a quarter been directed to those who, more than of a century. The returns furnished by others, come closely into contact with in- thirty-eight hospitals, served by Catholic fectious diseases, and that he throws doubt sisters and brethren, and embracing a