IS TUBERCULOSIS A DISEASE OF ENVIRONMENT ONLY?

By H. McHatton, Macon, Ga.

In this paper it is proposed to show that considerable numbers of individuals of the Caucasian, Asiatic and negro races have been practically immune from this disease under certain surroundings, whereas under other conditions they have been its victims in large numbers.

Prior to 1860, a vast majority of the negroes in the Southern States and in Cuba lived on plantations. These plantations were to all intents and purposes isolated communities of from one hundred to five hundred inhabitants. The negro quarters were invariably placed in the healthiest available spot, the houses usually consisted of two rooms and were never over-crowded; each room had its open fireplace and fuel was abundant—thus the best ventilation was secured all the year around. There was ample air-space between the houses and the quarters always had an abundance of shade trees. On account of the climate, most of the idle time was spent out of doors. Absolute cleanliness was enforced in and around the quarters. Each house, whether wood or brick, had its coat of whitewash inside and out three or four times a year, and oftener if any disease threatened. Communication between plantations was not encouraged, and when any disease become prevalent, absolutely prohibited. The water supply was always a source of solicitude, and the best obtainable secured. All innocent amusements, so dear to the heart of the African, were not only permitted but encouraged. Dissipation of all types was prohibited, and under existing conditions, this prohibition could be easily enforced. There was no mental solicitude, no competition in the ordinary sense and no care for the future. Work was never excessive, always in the best hygienic surroundings and of the healthiest type, also in proportion to the age, strength and sex of the individual. Food was cooked in the plantation kitchen, abundant, nutritious and well prepared. Clothing was always sufficient and in accordance with the season. As soon as a woman was over her lying-in period the infant was transferred to the nursery, where it was only nursed at regular intervals, and fed according to its age. Each negro reported in the morning, sick or well; if sick, he went to the infirmary. The doctor visited each plantation once or twice a week, and was called in any emergency. Thus each negro who was not physically perfect was under constant medical supervision.

In Cuba the arrangement of the quarters was different, they being on the type of the old Spanish barracoon. All other surroundings were practically the same as in the South. On all plantations early to bed and early to rise was the rule, with a long midday rest and meals by the clock. Among the very small per centage of negroes who lived in the cities the plantation rules were carried out as far 0002 2as practicable. I can state without fear of contradiction that no race of human beings ever lived as healthy a life as the plantation negro in the South. Tuberculosis was practically unknown. I was born on a plantation in Louisiana, and lived on plantations in the South and in Cuba until I was twenty-three years old, and never saw a tubercular negro.

Freedom came. The entire proposition is reversed. They flock to the cities with about as much capacity for self-care as children; hard work, inadequate clothing, poor food, poor houses, over-crowding in insalubrious localities, no attention to the most elementary laws of hygiene all the mental cares and solicitude that freedom brings. Scant wages, spent in the lowest and most degrading vices at the sacrifice of absolute necessities, irregular hours, with practically no medical attention, or care in sickness. To-day the town negro in the South is probably the most tubercular being in the United States.

It is nothing unusual in my practice to see entire families wiped out. In 1900, twenty-one per cent. of the total negro mortality in Macon was from tuberculosis.

About 1860 Spain entered into a Coolie contract with China. Under this contract about two hundred and fifty thousand Chinese were imported into Cuba in the '60s and '70s, the vast majority going to the plantations where they were put under the identical surroundings of the negro.

These Coolies were all men ranging from eighteen to thirty years of age. They were the scum and off-scourings of the cities—principally Canton and Macao—bringing with them the city diseases as well as the city vices, for which China is noted. For obvious reasons, both vices and diseases could be rapidly controlled, and these men were soon put in nearly as good a physical condition as the negro. There was always, even with the most careful selection, a fair percentage of tubercular cases in each gang of Coolies. I can safely say that within the first year this was eliminated either by death or cure. After that there was no more development of the disease. The half-breeds from the mixture of the two races, of which there was a large number, were equally immune.

About 1790, there landed at Trujaillo, on the Caribbean Sea, a party of Spanish emigrants. This party consisted of members of ten families of the Spanish nobility-families who were so tuberculous that they decided to emigrate rather than become extinct. They worked their way in the course of time across Central American and settled on the Pacific slope not far from Tegucigalpa, and at an altitude of about twenty-five hundred feet in probably one of the most even and healthy climates in the world. They have always been purely agricultural and pastoral. Even to-day there is not a road leading to this colony-nothing but trails, and it is a journey of days to reach them from the nearest port. Their village is built in accordance with the climatic requirements. They hold themselves far 0003 3above the surrounding Indians, and there has been practically no intermarriage between them and their neighbors. They present the purest strain of Spanish blood in America.

The Indians ten or fifteen days' ride from this colony never fail to speak of it always as “El pueblo de los blancos,” “the village of the whites,” and to extol the physique and endurance of the men as well as the beauty and virtue of the women, which opinion the few specimens that I saw fully upheld.

The history of these people was given me in a personal interview by Don Torencio Sierra, President of Honduras, and a most highly educated gentleman.

Dr. O. B. Hunter of San Pedro Sula, a graduate of Tulane University, learning their history, became so much interested in them that he spent some time in their village with the sole object of learning their present condition. He met some of the children of the original emigrants, now old men and women, who in every way corroborated the above history.

Dr. Hunter informs me that they are the finest race of people in Central America. After careful inquiries he could get no history of tuberculosis for a long period back, and at present none of them give physical evidence of this disease in any of its numerous forms.

In direct contrast to this, I have under my care a family of five children ranging from fifteen up, all tubercular, with the following family history:

Father and mother physically perfect. Paternal grandfather 82, goes to his work daily at 4 a.m. Grandmother 80, does her own house work and keeps no servant. Two aunts over 45, healthy. Maternal grandfather 83, farmer. Maternal grandmother died young of an acute disease. No other children on the maternal side. A remarkably good family history. All of these people expecting the children in question have led and are leading healthy and active lives. The father in early married life was placed in easy financial circumstances, built himself a modern house, and brought up his children in the usual modern manner: balls, parties, most assiduous avoidance of all vicissitudes of the weather, late to bed, late to rise, nervous system hypercultivated at the expense of the physical, no rational exercise, no duties to perform; in fact, the complete history of such children so familiar to us: no known source of infection excepting such as all city dwellers are exposed to daily. It is probably unnecessary to multiply examples.

What would be the rational deduction from those already cited? The negro of the South, practically all Creoles, and a non-tubercular race, changed in a scant forty years to probably the most tubercular race in our country. This by a change of environment only, which change did not include even that of climate.

The Chinese Coolie, a most debased subject, with as large a percentage of tubercular cases as would be found in the same number of people from the slums of this city rendered by change of environment 0004 4non-tubercular, which immunity extends to his half-breed children.

More remarkable still the Spanish colony in Honduras. This is not a matter of personal observation, but facts obtained on the best of authority, and of which there seems to be absolutely no question.

Ten families, probably closely related, leaving their own country only on account of tubercular infection-an isolation of more than a century-necessarily a continuous inter-marriage, and resulting in a superior non-tubercular race.

The American family mentioned need not to be commented on. It is so common that all of you have seen examples.

Gentlemen, again I ask the question: Is tuberculosis a disease of environment only?