Mystic Order of the Bug
There’s a lot of public ignorance about the man who comes home from a "San"
LAURENCE K. RYAN
JOE WAS an iron worker. A big cat-footed rivetter who waltzed around on skeleton steel girders as though they were a polished dance floor. Joe’s gang found it hard to reconcile a husky like him wdth their preconceived ideas that anyone with tuberculosis had to be a rag, a bone, and a hank of hair, with one foot in the grave.
Joe was shocked too. He wouldn’t believe it at first. Of course when his doctor jogged his memory, he did recall recurrent twinges of pleurisy, especially in damp weather. And that his appetite had become as finicky as a debutante’s on her first excursion to a night club. He hadn’t thought much about it, though, until he began to get up in the morning as tired as when he went to bed, and when along about mid-afternoon his chest felt as if he had been carrying a bag of cement on his shoulders all day. Not that even in his most imaginative moments TB ever entered his mind. He needed a tonic, of course. That was all.
Still, Joe wasn’t so dumb. He went to his doctor. He was lucky there, too, because his medical adviser kept up with the times enough to recommend an X-ray as the only certain method of making sure the trouble wasn’t more deep-seated than just overwork.
The revelation that he was “positive,” and that the X-ray showed there was a small cavity in one lung and a shadow on the other, conveyed nothing to him—nothing short of disaster. He put his doctor’s optimism down to a sympathetic attempt to break the news gently.
All right — he had the “White Plague.” Why try to kid him? Everybody knew you were never any good after that. Well, he could take it. No one would ever find him looking for a shoulder to cry on. So Joe left for the sanatorium as if he were going to face a firing squad at dawn . . .
Up Speaks A Patient
COUNTLESS articles have been published on thësubject of what ordinary people like Joe call the “White Plague,” but that is referred to in materia medica as pulmonary tuberculosis—and by initiates as just “The Bug.” Most of these have been written by physicians, social-service workers or some sob sister intent on a story calculated to pluck the human heartstrings. Seldom does the tuberculosis patient himself get a chance to speak.
Bulwarked by long experience beneath the white counterpane of a sanatorium bed, and fired by commiserating visitors who appear to look oyer the door for the inscription, “Abandon hope, all ye who enter here,” I venture to raise a voice for the hermit membership of the Mystic Order of The Bug. And perhaps I may dispel some of that
fear-created fog in which the public has been submerged by technical treatises and vague presentations of TB facts. Frightened by inadequate knowledge plus such fearsome phrases as “dread disease” and “White Plague,” the average person conjures up a false vision of a sanatorium as peopled by an emaciated throng condemned to a living death in some place akin to a leper colony.
The result is that the cured TB patient, returning to normal life, faces a barrier which places him in a position comparable to the Untouchables of India. From the point of view of medical science and the economic rehabilitation this is absolute folly.
The vital point which the general public should realize is that the cured TB patient, discharged from a sanatorium by the medical authorities, is
not a danger to his fellow beings. No sanatorium willingly releases patients with an infectious state of the disease, to go out into contact with other people.
Make no mistake—tuberculosis is still a very serious problem in Canada. Very definitely so. But today the greater problem lies in prevention rather than cure. Twenty years ago medical science was still groping for curative methods. Ten years ago it was experimenting in the realms of drastically new treatments. Now it has found them, and has proven their effectiveness for all but advanced cases. It is still searching for a master drug, serum, or other medium which will perform for tuberculosis the miracle which sulphanilamide and its derivatives have bequeathed to the victims of other, until very recently, “killer” diseases.
The main campaign of TB warfare is no longer against those known cases which have been hospitalized or are kept under medical supervision, but in the vastly wider field of locating, and prescribing for those not already And in educating the general public not only to observe sensible rules of health and diet, but also to recognize the early symptoms, those significant little danger flags which Mother Nature unfurls.
Most cured TB patients upon re-entering normal life have to wage an unequal fight against the widespread misconception that tuberculosis is incurable. In social life they are confronted by a vague uneasiness among their friends and acquaintances, a curtain of insidious but senseless fear shutting them off from the entirely free and natural associations to which they are entitled. The average recuperated patient does not ask for any special favors to assist him in kicking a toe hold in the economic Continued on page 30 Mystic Order of the Bug
Continued from page 17
world again. But, when his reply to a prospective employer’s query as to his immediately previous occupation is received much as if he had confessed to just finishing a term for embezzlement, he cannot help wondering if the scope of the right to life, liberty and the pursuit of happiness I has not been unaccountably narrowed to exclude those who have waged a victorious fight against TB.
Almost everyone knows the hoarywhiskered witticism which is usually told somewhat as follows:
Doctor, gravely bending over somnolent patient: “I’m afraid he’s gone,
Patient, suddenly sitting up: “I’m not, either.”
Nurse, severely: “Lie down. The doctor knows best.”
There are literally tens of thousands walking about today who have successfully negotiated a return trip from the peaceful suburbs of eternity to a normal existence of dodging taxicabs and falling downstairs in the dark, just because they insisted upon replying, “I’m not, either.”
In perhaps no disease is this more true than in pulmonary tuberculosis. Many specialists in this field credit the patient’s attitude of mind as being fully fifty per cent responsible for the length of time necessary to achieve a cure and, in many cases, with having considerable bearing on whether a cure can be accomplished at all. Most patients do attain that stubborn outlook of optimism and most do emerge victorious to take their places in the outside world again.
Perhaps you’ll understand better if we go along with one of them and see how he fares within the portals dedicated to the Mystic Bug. There’s no better example than the Joe mentioned at the start.
WHEN JOE surrendered his clothes, he had reached a state of depressed resignation. That was not surprising. After all, his knowledge of his own situation was summed j up in that glib phrase, “dread disease,” and consequently the future presented only a blank and unsavory prospect. During the next few days a whitegowned laboratory nurse drew a blood sample from his arm and another from a finger tip; an examining doctor gazed down his throat, checked over his teeth, stared into his eyes, probed his ears, and went over his chest with a stethoscope. All the while the doctor recorded cryptic symbols on an anatomical chart as Joe breathed deeply, coughed or muttered “ninety-nine” according to mystic instructions. Inch by inch, from stem to stern, he was poked and tapped. He spit in mysterious little bottles which were whisked away to an equally mysterious destination.
[f he had known that all this was just routine procedure in a general examination he might have enjoyed it with a healthy interest. As it was, uncertainty crowded his mind, formulating unanswered questions of, “Why did they do that?” and conjuring up an uneasy picture of himself as the victim of half a dozen “dread diseases” simultaneously.
However, the wheels of routine machinery were turning slowly and after a week Joe was transferred to a treatment floor. He was moved into a big sunny room with three other fellows. Here his initiation into the secrets of the Mystic Order of The Bug began quickly.
That first night he lay in the dark sorting out his confused thoughts. The room contained a bantering camaraderie which shattered his grim vision of hopeless future. Instead of finding the others morosely resigned, or at best attempting a forced cheerfulness, they appeared to be happy. Yes, actually happy. And speaking of what they were going to do when they got out as if they really believed it. Bill, in the next bed, was a college student. Across the room the other two were Dave, a factory worker, and Henry—a farmer. That was another thing Joe pondered over. He had thought that only people who were skinny, overworked, shut up in ill-ventilated offices or workshops, ever got TB. But here was a farmer. And himself, too. He had always worked in the open air.
As I said before, Joe wasn’t dumb. He began to suspect that the picture which the general public knew as TB had been painted by a surrealist’s brush.
End To The Mysteries
IN THE following days the cloak of mysticism was cast aside. The terms cavity and shadow, positive and negative, were no longer sources of vague unknown fears. He learned that a shadow meant not a dark outlook but merely the least discernible trouble which can be recorded by the X-ray; that a cavity is a further advanced stage where a definite lesion in the lung has developed to an open wound, perhaps no longer than a dime or in more extreme cases as large as an egg.
Positive and negative were revealed as the medical classification of infectious or non-infectious. a negative case being incapable of spreading the disease. He discovered that laboratory tests of sputum ascertained the presence of germs. The lesion or wound in the lung caused by the TB bacilli festered and gave off pus, just as an unhealed wound on the
body does, to be expelled in sputum. In this germ-laden expectoration lay the only danger of passing on infection, and consequently the most conscientious care in disposing of it was necessary.
When Bill explained it all to him, the simplicity of the principle of the cure brought him an entirely new viewpoint. Bill compared it to a burn or cut in the palm of the hand which could not heal unless rested. The opening and closing of the hand, the stretching of muscles and skin, kept the wound open and eventually it became a running sore. In the lung, expansion and contraction likewise prevented healing. One breathed more air sitting up than lying down, standing than sitting, walking than standing, and so on. Therefore the less effort exerted, the less motion occurred in the lung, providing greater opportunity for the progress of healing.
Joe grinned. That was simple when you understood it. He began to think about getting out into the world again, too.
Bill went on to explain that this healing was slow unless some artificial aid was added. When he recounted these aids as pneumo, phrenic, extra-pleural and the rib, Joe wriggled in apprehension again. The words had a smell of ether and a sound of “Calling Dr. Kildare” about them.
One by one, with the help of the doctors and his roommates, he got them sorted out and stripped of their mysticism. It helped a lot when he learned that Dave and Henry were both pneumo cases and that Bill was soon to go up to the operating room for that ominous-sounding Rib. They didn’t appear concerned. Why should he? And certainly the two across the room looked as if they would pass A -1 in the Army.
Soon he had all the pieces fitted into a comprehensive pattern, and perceived that all were an extension of that one fundamental principle of rest for the lungs or, more specifically, that portion of them which the disease had.affected. The main battle plans against the Mystic Bug shaped up this way:
Bed Red. Where a minimum of disease exists and relaxation in bed promises to clear it in six months or less, artificial aid is usually considered unnecessary. Conscientious rest and good food are the only aides-de-camp nature requires to chalk up a speedy victory.
1 ntra-pleural Pneumothorax. The most common method of treatment, its purpose is to secure immobilization of the infected regions. The human lung is encased in a double layer of thin elastic membrane known as the pleural sacs, best visioned as two fine rubber balloons one inside the other. Air, in controlled quantities, is injected between these two layers producing a graduallyincreased pressure which induces a partial collapse of the lung. Hence the name— literally, air in the chest between the pleural membranes.
This air pressure also tends to squeeze existing cavities to a reduced size and thus immeasurably assists speedy healing. The air is injected through a hollow needle rendered painless by local anaesthetic. Beyond the first few days after the initial injection there is no discomfort. Refilling of air is made periodically at short intervals. Most patients continue with this treatment for some years after returning to normal life in order that scar tissues may continue to build up a protective wall. When discontinued, the lung gradually resumes its full normal size.
Phrenic Crush or Phrenicotomy. A minor operation on the phrenic nerve which controls thediaphragm. Usually used in cases where the lesion is in the lower portion of the lung. When this nerve is crushed or severed, the diaphragm is paralyzed, rises, and partially immobilizes the lower section of the lung. If merely crushed, the diaphragm, over a period of months, gradually returns to normal. If severed, the contraction remains permanent.
Extra-Pleural Pneumothorax. In contrast to intra-pleural, this is air in the chest outside the pleural-sacs, but its purpose is identical. In some cases, especially those in which the patient has suffered a long period of recurrent pleurisy, scar tissues form adhesions between the layers of pleura, preventing their separation when air is injected. Thus it becomes necessary to induce an air pocket outside the membrane. This is done surgically, loosening the apex of the lung from the supporting tissues to provide an air space. Injection and refilling of air is accomplished similarly to the intra-pleural method, and likewise when discontinued reverts to its original state.
Thoracoplasty or “The Rib.” Literally, molding (plastic) of the chest (thorax). A major surgical operation used in instances of advanced cases when pneumothorax is not possible or is ineffective. Its purpose is to create a permanent state of rest for the lung. In one to three successive operations, spaced a few weeks apart, a number of the upper ribs are removed, allowing the chest wall to sag inward, partially collapsing and immobilizing the lung. Over a period ! of a few months the ribs re-form following the new contour. A patient is usually on his feet six months after a successful thoracoplasty. The most drastic of TB surgery, while classed as a major operation, it is no longer considered an unusually dangerous ! one.
“I’m Not, Either!”
JOE AVIDLY absorbed all these facts and many more. He came to know that not only did the sanatorium offer a medical program for regained health, but also made available educational and recreational possibilities. Radio earphones hung at his bedside, a finger on the pulse of the outside world, bringing him all the wide variety from idyllic symphony music to the latest grim news roundup from six continents. A library overflowed with books w’hich he had never had time to read before. Desire to study received the most enthusiastic co-operation.
His woeful vision of wasted months faded into oblivion.
Later, he was given a pneumothorax on one lung. The shadow on the other would clear with the period of bed rest. When his doctor advised him against going back to his old strenuous occupation, Joe was faced with another problem. Even if that were possible after a few years, what1 was he to do in the meantime? Study for something else while in the sanatorium, his doctor urged him. He would be given all the help possible They discussed what he liked to do, his special abilities and the different ?ourses which could most successfully be studied individually.
Out of a score of possibilities, Joe chose radio mechanics. With a year’s bookwork and practicing on small models while taking the cure, a few months’ polishing in a trade school when he got out would see him ready to step into a new job.
It was about that time that some of Joe’s friends drove up to see him one week end and left shaking their heads, muttering, “Poor old Joe, lying there in bed month after month, and actually kidding himself that he will be as good as new in a year or so.” Joe shook his head, too, when they left, but he was laughing. The Bug had no more terror for him. He had begun to say—“I’m not, either.”
In a year Joe won his first victory over the Bug. With the aid of the* pneumothorax nature had gone to work building up a calcified scar tissue over the infected spots, walling up the damage done by the TB germs. His tests turned negative, triumphant evidence that he had the enemy in retreat. Shortly after that he began to get up. Just a few minutes a day at first because long unused legs have to be coaxed back into carrying a load again. Slowly, at regular intervals, his periods of exercise were increased.
Life looked pretty good to Joe then. It always does to those who have faced the abyss and yet returned. He came to vision the cure in comparison to a successful military campaign. First, there was the period of active warfare till the enemy Bug was defeated. Next, the consolidation of gains made to guard against uprising and counterattack. Then the final happy return home bearing a proud flag of victory,
hoping to be greeted with an openarmed welcome.
Well, our friend Joe will be going home in a few weeks now, after eighteen months of battling the Mystic Bug. Not invalided home, but strong and healthy. Of course, he will have to be careful for a while not to overdo either work or pleasure, but he will be hungry to taste the tidbits of normal life again, morsels of social and recreational contact which will be all the more appetizing because he once thought them lost forever.
Joe is going to be mighty happy to be back on the outside among his old friends again. At least he will be if they don’t regard him as they would the family terrier who imprudently gave chase to an overgrown pussycat with two black stripes down its back.
Remember, it isn’t only Joe who insists that the Mystic Bug can be conquered—today all of medical science proclaims it with emphatic and positive proof. In the face of that assurance the unreasoning and unfounded fear of associating with anyone who has ever had tuberculosis, still harbored by a great proportion of the general public, becomes mere stubborn appeasing of a threat long since dead.
When Joe, or his sister Sally, are discharged from a sanatorium they bear a clean bill of health from competent medical authorities. They should not have to endure uneasy glances and ill-concealed hesitancy in their social contacts, or to lie, evade and connive to avoid clashing with an unwarranted prejudice on the part of employers.
To the mournful lament of “Poor fellows, they’re done for,” medical science today shouts in emphatic denial, “They’re not, either,” and the graduates of the Mystic Order of The Bug chorus, “We’re not, either.” Is there any sane reason why the general public should disagree?