CONSUMPTION AT 
HEALTH RESORTS, 
BY 
WALTER F. CHAPPELL, M.D., M.R.C.S., Eng. 
Attending Physician to the Chest and Throat Department (out-door), 
Presbyterian Hospital, Assistant Surgeon Throat Department 
Manhattan Eye and Ear Hospital, New York. 
{Reprinted from the North A merican Review by special permission. Copyright 1893, 
by Lloyd Brice.) CONSUMPTION AT 
HEALTH RESORTS. 
BY 
WALTER F. CHAPPELL, M.D., M.R.C.S., Eng. 
Attending Physician to the Chest and Throat Department (out-door), 
Presbyterian Hospital, Assistant Surgeon Throat Department 
Manhattan Eye and Ear Hospital, New York. 
(Reprinted from the North American Review by special permission. Copyright 1892, 
by Lloyd Brice.) CONSUMPTION AT HEALTH RESORTS. 
By Walter F. Chappell, M.D., M.C.R.S. Eng. 
{Reprintedfrom the North American Review by special permission. Copyright 1891, 
by Lloyd Brice.) 
During a recent visit to the hotels in the Adirondack® and 
many other health resorts in this country, I was greatly im- 
pressed with the slight attention paid to the prevention of the 
communicability of consumption, which physicians now con- 
sider an established fact. Many of my friends and patients 
have told me that while visiting these resorts they could not 
help feeling nervous about catching consumption when they 
siw so many persons around them suffering from this disease. 
For this reason I think the time is opportune for the public 
to be placed in possession of some definite information on this 
subject, which will give them an opportunity to judge intel- 
ligently of the possibilities of infection, and by their influence 
to insure that the proper precautions are taken to make it 
quite safe to inhabit the buildings and occupy the rooms their 
unfortunate consumptive brethren have used. 
It is now generally believed by the medical profession that 
consumption is caused by a specific agent, which if implanted 
in suitable soil will multiply, develop, and produce the condi- 
tion known as consumption. This agent is called the bacillus 
of consumption, and is a minute rod-shaped body belonging to 
one of the numerous families of bacteria. It is a recent dis- 
covery of the microscope. Its development and entire life- 
history have been carefully studied and are well known. It 
has been proved by many observers that the bacilff, if inject- 
ed into animals, will produce consumption ; a like result will 4 
be produced if they are allowed to inhale air or take food con- 
taining the bacilli. No direct experiments could, of course, 
be made to prove that this communicability extended to the 
human race ; nevertheless, a wonderful combination of cir- 
cumstances has arisen which makes it almost a certainty that 
this is the case, and that it is effected in the same ways. 
It is only a few months since the entire civilized world was 
filled with anticipation and wonder by Dr. Koch's discovery 
for the cure of consumption. Nothing in medicine or surgery 
ever created so much excitement, and hope was entertained 
that ^at last the disease which causes about one-fifth of the 
deaths of the human race had found its master, and in the 
future would be robbed of all its terrors. In the early days of 
this " craze " the celebrated German physician, Professor Vir- 
chow, warned the profession against the indiscriminate use of 
this remedy, as he believed that, in place of curing sufferers 
of consumption, it disseminated the disease through the body 
and hastened its course. He was immediately accused of jeal- 
ousy of Koch, and the craze and injection went on. At this 
time the composition of the Koch remedy was known only to 
a few physicians in Germany, and the physicians in other 
countries depended entirely on their faith in Koch, who had 
an established reputation for reliability and truth. As soon 
as Virchow's opinion became known, a few observers en- 
deavored to prove the truth or fallacy of his statement, and it 
was not long before they added their warnings to that of Vir- 
chow. There was an immediate reaction -when this was an- 
nounced ; for every physician began to have fears, when he 
learned that Koch's remedy was the product of the bacillus of 
consumption, that possibly he was only adding fuel to the fire 
in resorting to its use. Subsequent events have proved the 
truth of this to a great extent, and there are few physicians 
who believe in the efficacy of th;s cure for consumption, but 5 
its discovery and use have suggested strongly the possibility 
of inoculating consumption. 
That consumption can be communicated to the lower ani- 
mals by causing them to inhale air impregnated with bacilli, 
I have already said, has been proved by experience. To re- 
peat these experiments on the human subject is impracticable, 
but one case is on record in which the disease was unquestion- 
ably taken by inhalation. Tappenier was making some ex- 
periments on the possibility of communicating consumption to 
dogs by causing them to inhale the atmosphere of a room im- 
pregnated with its bacilli. His servant, a man forty years old, 
and free from all hereditary or personal taint, had been cau- 
tioned against entering this impregnated room. But in a 
spirit of bravado he did so many times. He was taken sick, 
and after an illness of fourteen weeks died ; on post-mortem 
examination it was found that he had the same form of con- 
sumption as the dogs that died from exposure in the cham- 
ber. 
Another remarkable instance is the case of the Fugeans, 
amongst whom consumption was unknown till a missionary 
and his wife went to reside there. The latter was suffering 
from consumption. She took some of the children from their 
savage state and clothed them and did all she could to 
educate them. After a short time acute consumption develop- 
ed amongst these children and many died ; but not a single 
case occurred amongst the children who remained in their 
savage surroundings. 
Many similar instances could be reported from medical 
literature, were this the proper place to do it. The accumula- 
tion of such evidence is becoming so great that every physi- 
cian of experience feels forced to share the belief in the com- 
municability of consumption. There are also few physicians 
who have not had one or more cases that for years they have 6 
thought had been contracted in this way. One reason why 
this fact of communication from one to another cannot be 
more closely followed up by physicians is that patients change 
their places of residence and their physicians so frequently 
that it is impossible to obtain that detail of the life-histories 
which will connect them together. 
How else than by communication are we to account for the 
rapid spread of consumption amongst savage nations, where 
this disease was unknown before civilized people began to 
visit them ? This is true of oui' own American Indians, the 
inhabitants of Central Africa, and many other people. Inter- 
marrying, or any other condition which might made heredi- 
tary transmission a possible cause, certainly could not account 
for its rapid progress. Besides, some of the best observers 
and investigators believe that consumption is not hereditary, 
and there is much evidence in favor of this view. 
With such evidence of the possibility of inhaling the bacil- 
li, the question would naturally be asked, How do the bacilli 
get in the atmosphere, when they are not found in the breath 
of sufferers from this disease? We know positively that in 
these cases bacilli are present in the mucus which is raised 
after coughing. In its moist condition it is impossible for it 
to be inhaled, but when it dries and becomes dust, it is blown 
about, and it is in this form that it becomes dangerous. 
That this is true can easily be proved by examining the 
dust or scrapings from the walls or furniture of a room whieh 
has been occupied by a consumptive. They will contain the 
bacilli, and if inoculated into animals, or if animals are made 
to inhale them, they will produce consumption. Some idea of 
the number of bacilli which eacli sufferer must dispose of can 
be formed from an observation made by Heller. He estimated 
on a slide under the microscope 1,000,000 germs in a cubic 
millimetre of the sputa of a consumptive ; and from this he 7 
further estimated that 300,000,000 bacilli were thrown out at 
each expectoration. This I think rather high; but it is cer- 
tain that the number thrown out at each successful cough is 
very great. 
Why some people contract consumption while others sub- 
jected to the same exposure escape, we are at present unable 
to say definitely. We only know that consumption follows 
the law of all diseases, and that it has a power of selection and 
needs a suitable soil in which to implant itself. 
I think it has been shown that the evidence of the com- 
municability of consumption from one person to another is 
very strong. The conditions necessary for this communica- 
tion have also been shown. It should, therefore, not be dif- 
ficult to answer the query so often made, How can consump- 
tion be avoided by those who are susceptible to its bacilli ? 
First-Every physician who has patients suffering from 
consumption should instruct them wherein the danger lies to 
others as well as themselves ; for it is not impossible for a con- 
sumptive to reinfect himself by uncleanly habits. Consump- 
tives should be impressed with the importance of a proper dis- 
posal of the sputa, and effectual means should be employed to 
prevent its conversion into dust. 
Second-The proprietors of hotels in health resorts for these 
guests should add two or three rules to the ones they have al- 
ready posted in their bedrooms, and I can safely leave them 
to the imagination. Suitable cuspidors should also be pro- 
vided, which should contain a non-smelling disinfectant, and 
they should be emptied and cleansed morning and evening re- 
gularly. It should be made imperative and stand as an un- 
written law that cuspidors should always be used. The bed- 
ding or any other linen about the room should be removed and 
cleansed before any sputa on it could become dry. When a 
guest leaves the hotel the walls, floor or carpet, and furniture 8 
of the room he occupied, should be wiped off with a damp 
cloth. This would be little more trouble than the present 
method of dusting and cleaning the room, and would take 
really no more time. Most of the bacilli would in this way be 
removed from the room, and a new guest would enter it with- 
out danger. 
Free ventilation should also be amply provided for. All 
suoji precautions are carried out in hospitals and places where 
consumptives reside which are under medical supervision, and 
this accounts in a great measure for the remarkable escape 
from consumption of the nurses and attendants in these insti- 
tutions. The best Adirondack hotels at the present time do 
carry out some of these suggestions, but still there is room for 
improvement. The part the general public should take in this 
matter of precaution is, by the force of their opinion to make 
it absolutely imperative that proprietors of hotels in health re- 
sorts for consumptives should take the precautions referred to 
so as to meet the prevailing belief in the communicability of 
consumption. 
This article is not intended to unduly alarm the public, but 
simply to bring to their appreciation the position they occupy 
towards this interesting and important subject. Their posi- 
tion is clearly this : that while the great majority can expose 
themselves with perfect safety to the possibility of inhaling 
the bacilli of consumption, there are others who would be 
running some risk. With this knowledge in our possession 
and the means in our power of reducing the danger to a mini- 
mum, it is plainly the duty of every body to assist in making 
these suggestions operative. When this is done, there can be 
no doubt that the number of consumptive cases will be very 
materially lessened.