« הקודםהמשך »
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
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 as 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 his 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 tissue 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 truth 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 maying 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 canse, 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
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
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
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 more 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. * When,” 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 asease ! 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 sision 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 Ger. rendered 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 bis 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 himself, 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 bome 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, esthetic 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
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 alond 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- bor 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 motive, 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 einbrace 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
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
yearly average of 4,020 attendants, showed moderation observed in food and drink, the number of deaths during the period all tend to the preservation of health. mentioned to be 2,099. of these 1,320 They live in peace, free from the irreguwere caused by tuberculosis. In the larities of outside life, and their contentState, as a whole, the proportion of deaths ment and circumstances generally are calfrom this malady to the total number of culated rather to prolong their days than deaths is known to be very high, reaching to shorten them. from one-fifth to one-seventh of the whole. Cornet is very warm in his recognition In the hospitals this proportion was enor of the devotion of these Catholic nurses, mously increased. It rose on the average two-thirds of whom are sacrificed in the to almost two-thirds, or close upon 63 per service which they render to suffering hucent. of the total number of deaths. In manity. And they are sacrificed for the nearly half the hospitals even this high most part in the blossom of their years ; proportion was surpassed, the deaths in for it is the younger nurses, engaged in these amounting to three-fourths of the the work of sweeping and dusting, whose whole. Scarcely any other occupation, occupation charges the air they breathe however injurious to health, shows a mor with virulent bacilli. The statistics of tality equal to that found in these hospi. their mortality Cornet regards as a monu· tals.
mental record of their lofty self-denial, The following statistics furnish a picture their noble, beneficent, and modest fidelof the state of things prevalent during the ity to what they regard as the religious five-and-twenty years referred to. A duty of their lives. healthy girl of 17, devoting herself to But, he asks, is it necessary that this hospital nursing, dies on the average 217 sacrifice should continue ? His answer is years sooner than a girl of the same age an emphatic negative, to establish which moving among the general population. he again sums up the results which we A hospital nurse of the age of 25 has the have learned from his first memoir :-It same expectation of life as a person of the is universally recognized that tuberculosis age of 58 in the general community. The is caused by tubercle bacilli, which reach age of 33 years in the hospital is of the the lungs through the inhalation of air in same value as the age of 62 in common which the bacilli are diffused. They come life. The difference between life-value in almost exclusively from the dried sputum the hospital and life-value in the State in- of consumptive persons.
The moist creases from the age of 17 to the age of sputum, as also the expired breath of the 24 ; nurses of this latter age dying 22 consumptive patient is, for this mode of years sooner than girls of the same age in infection, without danger. If we can prethe outside population. The difference vent the drying of the expectorated matafterward becomes less. In the fifties it ter, we prevent in the same degree the amounts to only six or seven years, while possibility of infection. It is not, howlater on it vanishes altogether. The rea ever, sufficient to place a spittoon at the son of this is that the older nurses are disposal of the patient. The strictest surgradually withdrawn from the heavier veillance must be exercised by both physiduties of their position and the attendant cians and attendants, to enforce the proper danger of infection.
nise of the spittoon, and to prevent the In these hospitals deaths from typhus reckless disposal of the infective phlegm. and other infectious disorders exhibit a Spitting on the floor or into pocket-handfrequency far beyond the normal ; l'ut the kerchiefs is the main source of peril. To enormous total augmentation is mainly to this must be added the soiling of the bedbe ascribed to the frequency of deaths clothes and the wiping of the patient's from tuberculosis. The excess of mor- mouth. The handkerchiefs used for this tality is to be referred to the vocation of purpose must be handled with care, and nursing, and the chances of infection in- boiled without delay. Various other volved in it. Curnet examines other as sources of danger, kissing among them, sumptions that inight be made to account will occur to the physician. A phthisical for the mortality, and gives cogent reasons mother, by kissing her healthy child, may for dismissing them all. The tranquil seal its doom. Notices, impressing on lives led by the nurses, the freedom froin the patients the danger of not attending all anxiety in regard to subsistence, the to the precautions laid down in the hospi
tal, ought to be posted up in every sick- which, I am rejoiced to learn, has, after room, while all wilful infringement of the due consideration, been licensed by the rules ought to be sternly punished. Thus President of the Board of Trade. Whatmay the terrible mortality of hospital ever my illustrious friend, the late Mr. nurses be diminished, if not abolished ; Carlyle, may have said to the contrary, the wards where they are occupied being the English public, in its relation to the. rendered as salubrious as those surgical question now before us, are not“ mostly wards in which no bacilli could be found. fools ;” and if scientific men only exhibit
the courage and industry of their oppoReflecting on the two investigations nents, they will make clear to that public which I have here endeavored to bring the beneficence of their aims, and the before the readers of The Fortnightly Re- fatal delusions to which a narrow and perview, the question—" What, under the verted view of a great question has com. circumstances, is the duty of the English mitted the anti-vivisectionist. -Fortnightpublic and the English Government ?" ly Review. forces itself upon the attention. Will the former suffer themselves to be deluded, [While correcting the proof-sheets of and the latter frightened, by a number of this article, the Times of August 11th loud-tongued sentimentalists, who, in view reached my hands. Its leader on the of the researches they oppose, and the Congress of Hygiene and Demography fatal effects of their opposition, might be contains the following words, to which I fairly described as a crew of well-meaning heartily subscribe : “ The most pressing homicides. The only way of combating work of sanitary reformers is not now so this terrible scourge of tuberculosis and, much to legislate as to educate ; to make indeed, all other infectious diseases, is ex the mass of the people, in some degree, perimental investigation ; and the most participators in the knowledge of the effectual mode of furthering such investi causes of disease which is possessed by men gation, in England, is the establishment of of science."] the “ Institute of Preventive Medicine,”
A WOMAN'S WOMAN.
There are two phrases that are often spoken, whether the terms, “a man's used in common speech, but which for man" or a woman's woman,
are intend. some reason or other have rarely found ed to be complimentary or not; the only their way into print ; possibly because general rule that can be laid down with reevery one who uses or hears them attaches gard to them is, that they have a totally an understanding to them of his own, and different significance in the mouth of the in the case of different persons that under different sexes, and that when a man instanding is not always identical. What tends a compliment, a woman intends the do people mean exactly when they speak reverse. There is no doubt whatever of " a man's woman" or“ a lady's man”! about the sense in which one of these exIn nearly every case, the words are ap- pressions is used in an article that has just parently intended to be slighting, and the appeared in the pages of an American pub. expressions may be taken more or less as lication, Literary Life, which has suggestterms of reproach ; and yet there is noth- ed to us the present inquiry. Miss Cleveing in the words themselves that reflect land, a sister of the late President, in writany particular discredit upon the persons ing an account of another well-known of whom they are spoken, and very often American lady, Mrs. Frank Leslie, deit is with an air of humility that members scribes her as being “ that most gracious of either sex disclaim any right to the pos- and attractive of all human beings, -a session of the titles. With regard, too, woman's woman." Now, that is, we beto the converse of these expressions, there lieve, the sense in which every woman seems to be even more confusion of mean would read the words—indeed, we'too ing, and it is impossible to be sure, with- would willingly confess that a woman who out knowing of whom the words are finds favor in the sight of other women NEW SERIES. - VOL, LIV., No. 4,