We could hardly believe the evidence of our senses when studies of the
saliva of perfectly healthy individuals showed this deadly little
bacillus to be present in considerable numbers in from fifteen to
forty-five per cent of the cases examined. Why, then, does not every one
develop pneumonia? The answer to this strikes the keynote of our modern
knowledge of infectious disease, namely, that while an invading germ is
necessary, a certain breaking down of the body defenses and a lowering
of the vital resistance are equally necessary. These invaders lie in
wait at the very gates of the citadel, below the muzzles of our guns, as
it were, waiting for some slackening of discipline or of watchfulness to
rush in and put the fortress to sack. Nowhere is this more strikingly
true than in pneumonia. It is emphatically a disease where, in the
language of the brilliant pathologist-philosopher Moxon, "While it is
most important to know 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, vigor, 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 laboring man, the old man with rigid arteries and stiffening
muscles or waning life vigor, the chronic sufferer from malnutrition,
alcoholism, Bright's disease, heart disease--_these_ are its chosen
victims.
Another interesting feature about the pneumococcus is its vitality
outside of the body. If the saliva in which it is contained be kept
moist, and not exposed to the direct sunlight and in a fairly warm 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 words, under the conditions
of dampness and darkness which often prevail in crowded tenements it may
remain alive and malignant for weeks; in decently lighted and ventilated
rooms, less than two hours. This explains why, in private practice and
under civilized conditions, 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 by no means uncommon.
This is vividly supported by the fact brought out in our later
investigations of the sputum of slum-dwellers, carried out by city
boards of health, that the percentage of individuals harboring the
pneumococcus steadily increases all through the winter months, from ten
per cent in December to forty-five, fifty, and even sixty 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 the flue.'"
Public-domain text, read in full here on John Shaqi.
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