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disease. In the Bulletin of the Health Department of that city for the month of May, 1903, the following statement is made :

"Since the first of January there have been 2891 deaths from pneumonia, as compared with 1321 from consumption and 1238 from all other communicable, contagious, or infectious diseases, including diphtheria, erysipelas, influenza, measles, puerperal fever, scarlet fever, smallpox, typhoid fever, and whooping-cough. This is an excess of 382 pneumonia deaths over the deaths from all the other preventable diseases-1570, or 118.8 per cent. more than the deaths from consumption, and 1653, or 133.5 per cent. more than those from the other specified diseases."

The micrococcus of pneumonia, unlike the tubercle bacillus, is able to live in the mouths of healthy persons, where it finds the necessary pabulum for its multiplication in the normal salivary secretions. While pneumonia may prevail as an epidemic, as a result of the transmission of the disease from the sick to those associated with them, it is well known that many solitary cases occur, in families, which cannot be traced to preceding cases and in which the disease does not spread, although no precautions have been taken in the way of isolating the patient or disinfecting his sputa. The infection in such cases probably results from the presence of the micrococcus in the salivary secretions of an individual whose lungs, as a result of "catching cold" or of an attack of measles or of influenza, have become vulnerable, — that is, are sus

ceptible to infection because of a localised congestion or inflammation of the mucous membrane, or a lowered vitality of the tissues due to some of the causes previously mentioned (alcoholism, crowd-poisoning, etc). My own researches and those of other investigators show that this micrococcus is present in the salivary secretions of a considerable proportion of healthy persons, both in this country and in Europe. Also, that it varies greatly in pathogenic virulence as obtained from this source and from the sputa of patients with pneumonia.

Epidemics of pneumonia, in prisons, and on shipboard, have occurred with sufficient frequency to show that the disease may be communicated by the sick to those associated with them. That this does not occur more frequently is probably due to the fact that patients with pneumonia are confined to bed and that the abundant expectoration, among decent people, could scarcely fail to be deposited in a receptacle of some kind, or to be wiped from the mouths by handkerchiefs or cloths which are destroyed by fire or sent to the laundry. Also to the fact that the micrococcus of pneumonia has far less resisting power to desiccation than the tubercle bacillus or the diphtheria bacillus and would be less likely to survive in dust. The tenacious sticky nature of the sputa also prevents, to a great extent, the coughing up of minute droplets,

which in tuberculosis and in influenza play an important part in the propagation of the disease. The micrococcus of pneumonia may, however, retain its vitality for a considerable time in dried masses of sputum. It is destroyed by exposure for a few hours to direct sunlight, and by a temperature of 140° Fahr. within a few minutes; also by all germicidal agents in comparatively small proportion. The directions already given for the disinfection of the sputa of patients suffering from tuberculosis or diphtheria apply as well to the material expectorated by patients with pneumonia, and this should never be neglected.

The prevention of pneumonia will, to a large extent, depend upon the avoidance by individuals of the predisposing and exciting causes of the disease. Proper food, proper exercise, dress suitable to the climate and season, avoidance of all excesses, and especially of the habitual use of alcoholic drinks, will all tend to preserve the individual from infection by the micrococcus of pneumonia. On the other hand insufficient food, insufficient clothing, alcoholic excesses, insanitary surroundings, and a recent attack of certain other infectious diseases (measles, influenza, typhoid fever) are potent predisposing causes. posure to cold, to draughts, or wet feet may, in conjunction with the presence of the specific micrococcus, become the direct exciting cause of an attack.

Ex

CHAPTER XII

WHOOPING-COUGH

HOOPING-COUGH is another infectious dis

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ease in which the germ is no doubt present in

the secretions from the mucous membrane of the respiratory passages, although this germ has not yet been demonstrated to the entire satisfaction of the medical profession. The disease is propagated by contact or close association with the sick, but the infection does not persist in the sick-room or attached to the clothing of the sick, as is the case in diphtheria, measles, and scarlet fever. Probably the germ quickly perishes outside of the bodies of the susceptible individuals who serve to propagate it. It has been noted that the disease is rarely conveyed by a third person and, when the clothing of those in attendance on the sick is changed, the danger of its being transmitted in this way is very slight. But susceptible children contract the disease after very brief contact with one suffering from it. The infection

can be conveyed from the very outset of the attack, and probably in protracted cases for several monthsjust how long has not been definitely determined. The susceptibility to the disease among children is very great, but diminishes with advancing age. Adults and even old persons, however, occasionally suffer an attack. The immunity resulting from a single attack is very great.

The number of deaths reported from whoopingcough, in the United States, during the census year 1900 was 9958. The death-rate per 100,000 of the population was 12.7. The comparatively non-fatal character of the disease is shown by these figures, as it is one of the commonest and most widely spread of infectious diseases. A considerable number of deaths are, however, indirectly due to an attack of this disease as it is recognised as one of the predisposing causes of tuberculosis. The death-rate in the United States is more than twice as great among coloured children as among whites. There has been a considerable decrease in the mortality from whoopingcough during the ten years ending in 1900. census returns show that the greatest mortality occurs among infants, less than one year of age. Beyond the age of five the mortality is very slight. The months of greatest mortality are March, April, and August; of lowest, October and November.

The

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