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When Nursey Shaved Me
“Ahem! Ahem!'” coughed the patient Green, For ten long weeks my whiskers grew,
“Got the worst cold you ever seen, And grew-and Grew-and GREW!
Caught it last June, and ain't it funnyThey were stiff and tough as hardened glue,
Can't get rid of it for love or money." That's true, so very true.
“Sure," said the Irishman, thru mirth-made II.
tears, The nurse she said I looked a fright,
“I've had a cold like that for the past tin A fright-a Fright-a FRIGHT!
years." Those whiskers must be cut tonight. “All right”, I said, "all right.”
NOT: "Ask Mr. Foster!” Ask any III. So Nursey starts with soap and brush. T. B., anywhere, anytime, about anyAnd a dull old safety blade,
thing, and should you misplace your enTo hoe the stubble from my face,
cyclopedia- !! Just like a farmer-maid.
The nurse was new, good-looking and She chipped my ear-it hurt like sin
very, very flirtatious. The patient-well, She cut my lip and nicked my chin:
he was known as the Romeo of the San. But I ain't doing no hol-ler-in'.
The nurse knew of the patient's "rep", She did that job the best she knew; What more could any angel do?
and the patient knew of the nurse's; in AND
fact the patient had begged the nurse inV.
numerable times for-yes, we might as So when she asked me if my face
well tell it-a kiss; and, we might add, Felt like'd been rubbed with sand, I smiled and said, "Why, no, my dear,
she had promised him one for that very It feels ju-just simply grand!”
morning. (Shocking, isn't it?) Quite
naturally Romeo was on the qui vive The T. B. had read himself to sleep when nursey smilingly entered his room. with Shakespeare. A few hours later “Now, little boy,” chirped the beauty, the night nurse was rudely awakened by “close your eyes and prepare to receive a Mantellian voice, calling: "A Lung! Á something you have asked for many, Lung! My Kingdom for a Lung!" many times.” Romeo knowingly grinned,
closed his eyes and expectantly pursed THE T. B.'S. PRAYER
his lips. The next second those warm, "O Lord, deliver us from the profes- pulsing lips felt the contact of a-cold sional sympathizer.'
glass tube, and the very next second he
heard a suppressed feminine giggle as a The oft-repeated bromide the T. B. is door softly closed. Moral: She served forced to endure: "You're looking so him right, that's a nurse's business. And well; one wouldn't think there was a besides she may have a Romeo of her thing the matter with you,” reminds us own, and in the event of fistic reprisals of the two New Mexico doughboys when
what chance has a T. B.? He can't they woke up one morning and saw the fight, he can't run and some of 'em can't ocean for the first time. "Gee!" said even talk. one, “I haven't seen so much water in all my life.” To which his buddy replied:
So many claims, so many creeds, “Yeah! and just think, we're only seeing
So many hopes that lure and lure,
When just the art of getting cured what's on top!”
Is all the T. B. needs.
Are you trying Harder to do More Lungerdom's Ace of Aces: Gunethan you ever Dreamed you Could do? meyer, the French T. B.-aviator. He
Fought the Fight and Died the Death of What in the world do you imagine that a Hero of Heroes. French nurse meant when she complained of the T. B. that he had “shot
A great many folks have found it true his eye at her"? Surely it couldn't be that fighting T. B. is much like taking a that the rascal had winked at the “Wee- post-graduate course in the University wee."
PROPHYLAXIS IN TUBERCULOSIS
By EDWARD HORACE CLEVELAND, A.M., M.D.,
Superintendent, House of Rest, New York City Dr. Wm. A. White's suggestive remark on are not constitutionally robust, and give them the subject of inheritance in psychosis may the benefit of the out-door life for a sustained well be applied to the familiar liability of period of months or years, something definite weak physical constitutions to yield to the might be done toward lowering the mortality onset of tuberculous disease. Dr. White says, due to tuberculosis. It is among the younger “Every individual born into the world has, if patients that so-called arrested cases most freit could be determined, a definite potentiality quently occur. With continuous care and of development. The force of the impetus good management in the ordering of life, which starts it on its path is sufficient to carry such cases may avoid active recurrence of the it a certain definite distance. The predeter- disease, while older persons must commonly mined goal in each case will be reached if no be content with signs of restored health and accident intervenes to prevent. In many sub- general improve nent, which may prove perjects of this disease the original impetus has manent under favorable conditions. been weak, only sufficient to carry them a Prophylaxis in tuberculosis should begin as short way, and when its force is spent devel- early as possible, and have due regard to the opment stops, and the retrograde process is following important particulars: hastened or perhaps immediately initiated by Fresh Air: Never be without it, day or night, some special physical or mental stress occur- if you can help it. Oxygen without food is better ring at the critical point of puberty and ado- for you than food without oxygen. lescent evolution.”
Fasten your windows open, at the top, if only A distinguished professor in one of our a couple of inches, so that nobody can shut them. medical colleges stated, in a lecture on pre- Some folks have a mania for closing windows, ventive medicine, that whenever in general shutting blinds, pulling down shades, and drawpractice he furnished his patients with care- ing curtains. Keep the air in your rooms moving. fully considered rules for health, adapted to Dead air is devitalizing. Let in God's sunshine. each individual, advising them what to do Live in the sunshine. Air that has already been and what to avoid in order to maintain health, breathed, only once even, is deadly poison. Think writing it all out for the sake of greater cer- of the helpless babes and children who are trying tainty, his patients would respond to his kind- to sustain life and grow strong on stale air! It ness somewhat as follows: "Well, doctor, we cannot be done. Humans who are out-of-doors appreciate your thoughtfulness, and have no as many hours out of the twenty-four as possible, doubt it is intended for our good, but really have the highest resistance to contagion or infecto go right on doing as we always have done, tion. Houses are for shelter when needed, not for that is not our idea at all. In fact, we expect life-long imprisonment. Mothers who stay ineating and drinking whatever we like and doors all week cannot hope to have vigorous offtaking all sorts of risks the same as before. spring. The blood is the life, and fresh air, air Then, when we happen to be ill, we will send in motion, clean air, is essential to the purifying for you and expect you to come and look of the blood. Get up and go outdoors. after us till we are well again.”
Diet: Eat a good sensible breakfast every Notwithstanding this widely prevalent at- day, whether you happen to feel like it or not. titude of mind, it may be of use to offer cer- For aught you know, it may be the last meal tain practical suggestions, in the line of prophy- you will ever eat. Physical and mental exerlaxis, for the benefit of those who have highly tion without adequate material foundation, if resolved that for themselves and their chil- habitual, paves the way for physical deteriodren they prefer health to illness, ability to ration. There is no exception to this rule. disability, the home to the sanatorium, and Drink plenty of cool water, not iced, at meals freedom from tuberculous disease to the pos- and also between meals. sibility of finding themselves some day in the Water in abundance makes elimination of relentless grasp of a cruel and implacable foe. waste material, which will otherwise poison
It should be clearly understood that in the system, natural and easy. Use very little many, if not in most cases, the development coffee or tea or cocoa, and absolutely no beer, of tuberculosis is personally invited by lack ale, stout, wine, whisky other liquors. of care and by poor management in the order- These interfere, positively and seriously, with ing of one's life. Given a physical inheritance elimination and with nutrition, and tend to that is subnormal, or at best below the aver- wear out the kidneys and liver and other orage, and the practically universal opportunity gans, leaving poison in the system from top for infection in the period of childhood, the to toe, as gout and apoplexy abundantly prove. wonder is that so many of us escape the See to it that whatever goes down your throat manifestation of tuberculosis in adolescent or is constructive, and not destructive, for we maturer years.
dig our graves with our teeth, and some of Conditions, in brief what we call environ- us by crooking our elbow. What we call conment, in connection with inherited weakness, sumption is in reality starvation. will always be the key to this problem. If it Habits: Be sure you get proper bowel acwere possible to get hold of the children who tion daily. Use mild cathartics only, and only
when necessary, preferring these to enemas, which are to be reserved for special occasions.
Take a full bath, warm at night, or cool in the morning, with a good rub-down, avoiding extremes of temperature. Contrive to walk three or four miles daily, or have equivalent bodily exercise in the open air. Let there be as little home-work as possible for children who have to sit in crowded school-rooms five hours a day. The shortening of schoolhours, and a let-up in school requirements, will help to decrease tuberculosis.
Every boy and girl should have an intelligent method of bodily muscle-training, devised to suit individual physique and convenience, and should stick to such a system for ten or fifteen years at a stretch, if they hope to be active and vigorous in later life.
Make it a religious duty to retire for rest at a reasonable hour. No midnight oil, and no dancing till the wee sma' hours, for our boys and girls. Regularity and strictness in this regard will pay big dividends in nerveforce and mental capacity by and by, for late hours and irregular rest, and lack of regularity in eating one's customary three substantial meals per day, simply prepare the way for tuberculosis by reducing vitality. A majority of patients in our sanatoriums will testify to the truth of this statement.
Occupation: Have some good work to do every day, and do it. Thousands of people who die of tuberculosis die of mental and physical indolence. They have never been active enough in mind or body to keep themselves in good condition. We must really be alive in order to go on living, and it is a pity so many fail to learn this until their days are practically numbered.
If you have a weak constitution, try to develop it without over-taxing it. If you have a robust physique, do not imagine you can stand all sorts of exposure and fatigue and abuse of your strength, for the limit is apt to be reached long before you expect it, and then it will be too late. You or your children will surely pay for it.
Sociability: Cultivate cheerful ideas and associate as much as possible with hopeful and pleasant people. Nobody ought to be obliged to ruin his health and spirits trying to get along with crabbed and disagreeable companions. Such specimens should be grouped and labeled, for the warning of passers-by, and be made to enjoy each other's society as best they can.
Morality: Recognize the just claims of the Almighty upon your time and strength and
Don't be ashamed to pray every day for judgment and guidance, and don't be too timid to invest something worth while in the kind of bonds that mature in the endless future, and pay excellent interest as you go along. Don't fancy you can ignore and do violence to the Ten Commandments and go scot free. Too many have tried this. And they all have found out in the long run that these are the great original laws of health, without due observance of which there is no
such thing as a sound mind in a sound body. And be sure that if you offer your Creator anything short of the best mind and body for His purposes that you can muster, you will be withholding from Him a part of what is due and will be cheating yourself into the bargain.
Say to yourself every morning, "How can I best regulate myself and my efforts this day, so as to be as ready as possible to ward off every kind of infection in general, and that of tuberculosis in particular?” Intelligence and persistency and obedience to conscience will succeed.
It may be helpful to add that the same constant observance of health-principles that is necessary for the prevention of disease, will prove of utmost value in checking or controlling disease, especially lung disease, after it has become established. Although pathological conditions may be so firmly fixed as not to be permanently removable, they can at least in all ordinary cases receive temporary relief through the common-sense mode of living already outlined, and in tuberculosis we cannot look for satisfactory relief by any other method.
Change of climate has been found to be of very little help in such cases. Experts now agree that pulmonary patients thrive better, as a rule, in their native surroundings than they are likely to do elsewhere. People born without the bump of caution carry this handicap with them everywhere they go. Indeed, this lack of practical judgment, a certain inability to learn discretion from the hard lessons of experience, seems to be generally characteristic of this class of patients. The psychological effects of home-sickness is such an important factor in their problem, in many cases, that greater progress and improvement may be expected, the nearer the patients are to their home and friends and to the geographical location with which they have been long familiar.
When one contemplates the startling fact that one-tenth of all the people of any given region are ill at all times, and of this onetenth twenty-five per cent. are known to be consumptive, the importance of serious and sustained and systematic effort toward prevention is apparent. Probably one-half of all the sickness in the world is preventable. Some authorities say three- fourths of it is preventable. It has been carefully estimated that fifteen years of active usefulness could be added to the average duration of life by an intelligent application of the science of preventing disease.
More than half of this additional life would come from the prevention of tuberculosis, typhoid fever, and five other diseases, the prevention of which woud be accomplished by three things chiefly, pure air, pure water, and pure foods, coupled with hygienic habits of living. Fifteen more years of active life for every citizen would mean enormous increase in the strength and happiness of the
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ESSAYS ON TUBERCULOSIS XX. Some Phases of Resistance. Part IV: Immunity: Its General Types
By ALLEN K. KRAUSE, M.D.
Even though there were no special branch of Toward it the individual has now acquired an knowledge devoted to the study of disease there entirely new quality of resistance and has become are certain facts of resistance to infections which completely refractory. What this latter quality are so plain and prominent that the most casual consists of we do not know, nevertheless the observer would soon have to invent terms to phenomenon is very real. characterize them.
From this phenomenon there originated our Every child learns that if it has once had ideas of specific immunity. The term, immunmeasles it can ever afterwards come in contact ity, so far as it is applied to infections, was first with measles with impunity. For it measles is used to designate this acquired resistance to inno longer "catching.” It learns the same lesson fections. Its scope was then widened to include from chicken pox and whooping cough and a resistance that might exist among all the scarlet fever; and thus becomes familiar with one members of a race or an animal species to a of the great laws that govern the spread of given infection. Latterly it has in some hands many infectious diseases, namely, that they do taken on a broader and broader meaning, until not strike down individuals who have once had them. we sometimes find it being used almost synony
The causes of this peculiar and striking exemp- mously with resistance. There is little doubt that tion from the normal consequences of contact this tendency will breed confusion rather than with such diseases are thoroughly mysterious. clarity of ideas. Resistance should be the broader With more or less reason, yet perhaps more in and more inclusive term. Under it we should ignorance than with any knowledge, much has comprehend all defensive mechanisms of whatbeen made of certain habits and constitutional ever character these may be whether physical, factors as being determining influences in the chemical, thermal, specific or non-specific—which acquirement of infections, provided contact has the body employs to combat micro-organisms been established. We hear continually that bodily and their products. It would include immunity, weakness, undernourishment, loss of
which we should use only when we deal with stability, and vicious or abnormal habits of liv- bodily effects which are specific in the sense that ing, sleeping and eating, lay us more open to they are elicited by particular micro-organisms infections; or, as is commonly told us, these and only in response to these or related micro lower our resistance. I have no doubt that they örganisms. do tend to weaken our defense against the germs The tubercle, for instance, is a defensive strucof disease once infection has taken place and its ture, a mechanism of resistance, but in the present results have become apparent. But, as concerns
state of our knowledge we must look upon it as a number of acute infections at least, there is
a non-specific weapon of defense, which acts in a ample evidence that these take place irrespective mechanical way by creating a barrier, walling in of the general condition of the body at the time the bacilli and thus limiting the activities of the of infection,
latter. As an anatomic structure it is nonSo far as "taking" measles is concerned, it specific because in essence it is merely the tissue matters little at the time of exposure whether the reaction to a foreign body. On the other hand child is plump or scrawny, full blooded or the resistance to smallpox infection conferred by anaemic, strong or flabby, stolid or fidgety, or the virus of cowpox is a specific resistance and is whether it is manifestly in or out of health. immunity in the strictest sense of the term. The Given the proper first contact, the children who virus of cowpox is a modified form of that of will not take measles are so few that we can say smallpox; and the resultant resistance can be that every child will contract the disease. But of
produced only by one or the other and protects children who have once had measles, the child against only the one or the other. who, under any circumstances, will again contract Now it has always been plain that there is such it is so exceptional, that we may say that none a thing as an immunity to measles, or to smallwill fall ill with it. Then, the child in the poorest
pox, or to yellow fever, as well as to a large physical condition has apparently just as good a number of other infections. This immunity was defense against infection as one in the very best manifested in the way that we have already conof health.
sidered-in the fact that one attack protected Moreover, this resistance to infection is specific, against subsequent exposure to the same disease; that is, it is a resistance of one who has had and it was this idea of immunity that gradually measles to measles only, of one who has had took hold of our point of view until it had whooping cough to whooping cough only, of one usurped the field so far as any concepts of who has had chicken pox to chicken pox only. resistance
concerned. We fell into the Plain facts, such as these-facts which are com- loose and easy habit of saying that if there were mon knowledge—compel the conclusion that there no evidence of this immunity from second or is an aspect of resistance which is entirely inde- repeated attacks of the same infection then there pendent of transitory bodily habit or constitu- was no element of resistance connected with it. tion of the individual. An infection comes upon Later we found upon closer scrutiny that ima susceptible individual and goes. It goes com- munity need not be total or complete as is usually pletely; but leaves a very different individual so the case with measles. It might also be partial; far as the particular infection is concerned. that is to say, if successive attacks of the same infection are suffered, the second may be much less severe than the first because of a certain degree of protection that the latter conferred. There arose therefore also the idea of a partial or relative resistance. But the idea that there might be resisting or protective processes at work, while at the same time there were no evidences of a less severe infection than usual was not entertained,--at least, not until recently.
It is therefore not hard to appreciate why, not so very long ago, there was a very definite and general opinion that no element of immunity or resistance entered into tuberculosis infection. In the first place, it was universally believed that only the sick were infected; until recently no one knew and hardly any one thought that most healthy people have tubercle bacilli in themselves and in some way or other are holding them in check.
Yet this—and we have repeated it often—is true. And being true, it can mean only one thing, namely, that there is some resisting force or forces keeping the bacilli in check. We have already discussed how one force--the tuberclc itself-can work towards this end.
In the second place, because formerly tuberculosis was diagnosed as such only in its latest stages and because practically every advanced case died, it was hard to comprehend that the body was putting up any defense against the disease.
Finally, although it was a common observationi that many of these advanced consumptives had periods of improvement, and now and then even complete relief, it was just as common to find that these same patients suffered relapses,second, or third or many repeated attacks—until one eventuated in death. This led to the idea that, if consumption of the lungs did anything, it did not protect against subsequent attacks, but on the contrary, only made the patient less resistant or immune than normal and laid him more open to future illness of a like nature.
Just so long as consumption and tuberculosis were observed and studied only on the human patient these views held sway with scarcely a criticism or objection aimed against them.* They would undoubtedly obtain today had we not resorted to animal experimentation to learn more about tuberculosis and had we then not confirmed what we thus learned by comparing it with what the human patient discloses. Animal experimentation can furnish no better argument for its practice than the results of the study of this single phase of tuberculosis; for it is undeniable that the complexities and confusing features of the situation are such that continued and more intensified study of the patient alone would have served only to lead us further from the truth. The full force of this we shall see later. Let us remember meanwhile that one of the only two conceivable hopes of intentionally preventing tuberculosis that we can imagine lies in the invention of a successful method of artificial immunization.
An enormous amount of research and animal experimentation have been directed toward this end; yet the goal has not been reached-we arc still without a practicable method of successfully
. See observation by Marfan, May, 1919, number, p. 151.
preventing and protecting against tuberculosis. Nevertheless these studies have given us a surprising amount of information concerning the presence or absence of defensive processes against which the tubercle bacillus operates. In this essay I mean to review some of the more important work that has aimed specifically to protect animals against tuberculous infection. I consider this method of inquiry to promise most in helping us to an intelligent opinion concerning several particulars of tuberculosis immunity about which it is highly desirable and necessary that we know something. Though we may not attempt a solution in the following sequence, these particulars may be phrased by a series of questions: Is there such a thing as an immunity to tuberculosis? If so, is the immunity a partial or complete one ?—under what conditions is it established and under what conditions does it continue to exist ?—and is it possible to come to any explanation of its nature or mechanism? With these points settled one way or the other, we may then proceed to a rational discussion of the influence of early infection on the later career of the human individual.
In this quest for information I would have it clearly understood that I am concerned with only one type of immunity, and this is an immunity or specific protection against the implantation and subsequent development of tubercle bacill: in animal tissues,-in other words, against infection and the furher spread of micro-organisms. My concept of immunity will not include such matters as whether the bacilli contain or elborate substances which have a harmful effect upon the body (toxins) and whether the body does or does not protect itself against these; to discuss them satisfactorily here would only confuse the issue.
Preliminary to this review of the efforts that have been made to attain what we may call tuberculo-immunity, and in order to contribute to a clearer understanding of their purpose, their scope and their results, I desire to summarize briefly the general types of immunity which we recognize as being in existence or as being attainable.
THE GENERAL TYPES OF IMMUNITY.
In its broadest sense there are only two types of immunity to infections. These are (1) natural or native immunity, and (2) acquired immunity.
Natural or Native Immunity. It must be perfectly evident to everyone that the different species of animals vary greatly in their susceptibility to infections. The pig, the cow, the dog, the horse, in fact, every lower animal, can drink with impunity a polluted water which would bring on typhoid fever in man. The disease is limited strictly to man and there is no known way in which we can make these animals contract it. Anthrax has a wider range, and is infectious for several species of domestic animals as well as
Chicken cholera is very contagious for fowls, but never affects mammals. Hog cholera which is such a frightful plague is limited to swine. Bubonic plague spreads from man to man and from animals to man, as well as among several species of both domestic and wild animals. The closest association with man will not bring about in animals such highly infectious diseases as chicken pox, measles and influenza. In fact,