View report page

35
APPENDIX I.
The importance of Nutrition in connection with the incidence of, and
mortality from, Tuberculosis.
In this connection the following extracts from the "Medical Officer" and "British Medical
Journal " are of interest:—
"The authors of this report first interviewed Professor Kayserling one of the foremost German
authorities on tuberculosis. He began by saying that in 1900 at the International Congress for Tuberculosis
in London, statistics were shown covering the previous thirty years of tuberculosis in London,
and the English and Germans were agreed in predicting that if the same rate of progress in the control
of the disease cold be maintained in the future, some forty years more would see its practical extinction
in those two countries. Now all the progress of years has been swept away, and Germany is back at
the point she had reached in the eighties. In 1914, the deaths from tuberculosis in German cities of
over 15,000 inhabitants was 40,374. By 1916, it had risen only to 48,779, but by 1917 it was 67,860.
Since tuberculosis is not a disease that kills quickly, Professor Kayserling expects that the rate for 1918
and 1919 will prove to be still higher. It must also be remembered that the numbers of people in the
susceptible ages were decidedly diminished by the loss of young men who had fallen in the war. The
almost complete lack of fats, including cod.liver oil, the first instalment of which reached Germany
through Dr. Rotten in May of this year, make it impossible to strengthen the body against infection or
help it to combat infection after it has taken place. Matters were still worse after the Armistice, when
the demobilised soldiers suddenly returned to the cities to share in the scanty food supply at the same
time that transportation became more demoralised than ever because of the surrender of rolling stock.
So striking has been the effect of partial starvation on tuberculosis among all classes that Kayserling
savs German physicians are beginning to say that tuberculosis should be regarded primarily not as an
infectious disease but as a disease of nutrition, to be controlled much more by feeding than by preventing
infection.
Miss Addams and Dr. Hamilton heard still more about tuberculosis in the great hospital of the
Charite connected with the University, when they visited Professor Czerny's wards there.
Fully half of all the children here are tuberculous, a condition which they attribute first to
increased infection, for so many mothers have contracted tuberculosis through overwork and underfeeding,
and so many fathers have come back from the front tuberculous, and second, to the loss of
resistance in the children's bodies because of starvation for fats. The men in charge in this hospital
and in the Kaiser and Kaiserina Frederick Spital for children told us that they feel sure the effects of
the blockade will be apparent throughout the lifetime of this generation and perhaps longer. These
effects cannot be rightly estimated by simply looking at death records. Most of the children infected
with tuberculosis will not die now, the majority do not as yet even show signs of the disease. But
each coming year for twenty years will show a far higher rate of sickness from tuberculosis than Germany
has known for decades; because the seeds of disease which have fastened themselves on these weakened
children will do their work later on, perhaps in puberty when resistance is always lowered, perhaps in
the twenties under the strain of child.bearing or of industrial life. Nor is it only tuberculosis which
will have increased ; all infectious disease will meet with a lessened resistance, all overstrain and hard
work will do a greater injury, and even the children of the war children may be below the normal
standard.
In the wards for tuberculous children, we saw varieties of the disease, which used to be regarded
as medical curiosities, so extreme as to be seen only in primitive people with no racial immunity to the
disease. Germany's racial immunity, if there really be such a thing, was destroyed by the blockade,
and now in her hospitals one can see the most terrible forms of this infection, and not as exceptional
cases, but fairly commonly. Not only in the Charity, where one expects to see picked cases, but in the
hospitals of Halle, Leipzig and Frankfurt we saw children with enormously pronounced tuberculosis
of the glands, with tuberculosis of several bones at once, sometimes as many as twelve, and cavity
formations, such as ordinarily occurs only in grown people. There were tiny children with tuberculosis
of the breast bone, of the bones of the skull, even of the bones of the upper jaw, and many cases of the
formerlv rare tuberculosis of the skin (lupus). There was added tragedy in the impotence of the physicians
who, while equipped with all that science in this field has taught and so entirely capable of dealing with
each case in the best possible way, could only struggle with makeshifts and look on at their own failures
because without nourishing food the fight against this disease must be a losing one. Yet if only food
could be procured these child cases of bone and gland tuberculosis could be made to improve amazingly.
While at the Charite we went to Kraus' wards for tuberculous adults, and were received by his
assistant, Professor Leschke, who showed us cases of the new form of this disease in adults. Before
the war, the so.called galloping consumption was a great rarity in Germany, now they are having a
great mortality in young adults, after an illness of only four months. It appears in those who have
lost many pounds in weight. As it is impossible to give them the abundant fats they need they go
rapidly downhill, having apparently lost all resistance to the disease. This rapid consumption is greatiy
on the increase, and probably will continue at a high figure for several years. Nor is it confined to the
hospital patients; it is common among the well.to.do. Dr. Leschke had at that time no less than
30 cases in his own private practice.
55580