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support this theory, but they are to be found in all the leading medical journals, together with a complete account of the manner of manipulating the bacillus and all other details connected with the experiments. The character of the testimony which has been presented in support of the theory of the contagiousness of consumption should also receive consideration. It is to be borne in mind that this great mass of evidence comes almost entirely from the labors of pathologists and biologists. These workers have long been engaged, many of them for years, in studying this question, and it is a fact that these scientists, among them the most noted physicians of the age, entertain a most remarkable unanimity of opinion upon this question. This evidence, coming from the source it does and with its attendant circumstances, may be regarded as well-nigh conclusive.
On the other hand, it is to be noted that that part of the profession which opposes this view base their opposition almost entirely upon clinical experience. It would seem that in candidly considering the two sides, the latter is entitled to very little weight compared with the positive and overwhelming evidence of the former.
All the results of the etiological study of disease during the past ten years or more, confirm step by step the belief in a specific germ or cause for every specific disease. A great variety of bacilli have been discovered, some of which are known to be the cause of disease, while others, so far as their life history is known, are innocuous. So firmly is the belief in a specific cause for a specific disease fixed in the minds of the most advanced students and thinkers in the medical profession that experimental researches have been going on for years for the germ of a single disease, and although not yet discovered, the workers are as positive as ever that success will eventually reward their efforts.
The old idea that a specific disease may be produced by a variety of causes, does not hold good in the light of modern science; it is irrational in theory, and at variance with science, and it is not unreasonable to expect that the exact cause of every independent and specific disease may yet be discovered. The bacillus of consumption is an entity which is today well understood. It is successfully cultivated and transplanted to different animals with the result of producing the disease in a typical form in every case where there is not some accountable reason for failure.
The life history of the bacillus tuberculosis, so far as its behavior in living animals is concerned, is accurately and definitely known. Its growth has been successfully carried on outside the animal body, under favorable conditions, in the laboratory; but it is not generally believed that this bacillus multiplies outside the animal body, except under favorable conditions artificially provided ; neither is it believed to be propagated in any media in which it finds lodgment when expelled from the animal body. Various experiments have been made to determine, if possible, to what extent the vitality of the bacillus is perpetuated under the varying conditions, climatic and other, to which it would naturally be subjected upon leaving the body.
It is conceded that the bacillus is more largely distributed by the sputa than by any other means; it is also believed that the vitality of the germ remains undiminished for a long time after the sputa has become dried and perhaps pulverized. Successful inoculative experiments have been made with the dust collected from rooms occupied by tuberculous patients. Carnet experimented with dust obtained from the walls and floors of rooms which had been occupied by such patients, successfuly inoculating Guinea pigs that had been carefully excluded from every other source of infection. He collected dust from twenty-one rooms of seven Berlin hospitals for the treatment of tuberculous patients, and found the bacillus tuberculosis present in nearly every instance. He also collected dust from the rooms of tuberculous inmates at the insane asylums and penitentiaries, and in it readily found this bacillus. He also examined the dust in the dwellings of fifty-three tuberculous patients, and that collected on the premises of twenty of them was found to be virulent. The bacillus was invariably found in the dust from rooms of patients who expectorated upon the floor or into a handkerchief ; while it was not found where the patients used spit-cups. It is recognized as a fact by all observers that the bacillus is never wafted about or disseminated from moist surfaces, - a most important suggestion in connection with its restriction. Other investigators have examined the dust from rooms of tuberculous patients, and have arrived at practically the same conclusions as Carnet.
All examinations of the exhaled breath of consumptives have failed to reveal the presence of the bacillus. Tappeiner, Bolinger, Grancher, Cadeac, Mallet, and others, have made experiments to determine this question. Tappeiner caused a patient in the last stages of consumption to cough frequently into a box in which two rabbits were confined. The animals were subjected to this treatment for two months, but remained healthy. Bolinger caused tuberculous patients to breathe upon surfaces moistened with glycerine, but was never able to find any entrapped bacilli, and therefore came to the conclusion that the infection is not communicated by the breath. Grancher experimented with the breath of consumptives exhaled into rubber bags in which were Guinea pigs; the animals were treated in this way for several weeks, but no indication of tuberculosis showed itself. Other investigators have made like experments with similar results.
The theory that consumption is an hereditary disease is fast losing its hold upon the professional mind, although it is still regarded as possible, by some observers, that the disease may be transmitted from mother to child. If this be true, it is probable that the inheritance is always manifested in the earlier months of childhood, or at the farthest, during the first years of life. If the disease is transmitted, the child must be tuberculous at birth; and to believe that the inherited bacilli can remain dormant for half a century or more, and then spring into activity, is not in accord with the morphology of germ life.
Hutinel, of the Hospital des Enfants Malades, in a paper upon the heredity of tuberculosis, says that we are warranted in affirm. ing that communication of the disease by the father is not proven, and is exceedingly doubtful ; but that transmission by the mother may take place, but is extremely rare. Nevertheless, heredity exists, and if the children of consumptive parents are not born tuberculous, they are tuberculizable; that is, they have inherited what he terms a culture soil favorable to its development. In other words, there is transmitted an abnormal susceptibility to the disease, owing to more favorable conditions for the development of the germ, or through the absence of that resisting power found in persons of greater physical perfection. It is inconceivable how the bacillus can be transmitted to children and remain dormant for years, and then spring into activity. Such a position is untenable in the light of modern science, while the theory of transmitted susceptibility is wholly rational, and does not conflict with our latest and most accurate investigations. It would be fully as rational to speak of a typhoid diathesis as of a “ tuberculous diathesis," neither of which has any existence. It is true, and a matter of observation among all practicing physicians, that the offspring of diseased or physically imperfect parents, show a diminished power of resistance to disease, and are especially liable to tuberculosis. That the children of such parents readily contract this or any other infectious disease, should not lead us to pronounce such disease to be hereditary. We cannot doubt that there is a congenital lack of resistance to the infection of tuberculosis, as well as to some other diseases ; but that the disease itself is hereditary, there is no evidence capable of demonstrating.
In order to formulate methods for the restriction of tuberculosis, we must have an intelligent understanding of the manner in which it is communicated or spread. The history of the disease thus far given carries with it, inferentially, a more or less logical idea of what is necessary to prevent its propagation. There are many avenues, however, through which the disease may be received that have not been mentioned. In discussing this point, Koch expresses himself as follows:
In regard to the way in which the tubercle virus is communicated from the consumptive patient to the well, there can be no doubt. During attacks of coughing, particles of the viscid sputum are ejected into the air and, to a certain extent, atomized. Now numerous experiments have taught that the inhalation of atomized tubercular sputum makes animals tuberculous with absolute certainty, not only those which are very susceptible to tuberculosis, but also those which are usually immune. That man, in this respect, is an exception, is not to be assumed. When, therefore, accidentally, a healthy person inhales a particle of sputum freshly expectorated, we may presume that he may become infected. Yet infection will .not often occur in this manner, because the particles of sputum are not so small that they can remain suspended in the air. Far more likely to produce infection is the dried sputum, which on account of the careless way with which the expectoration of consumptives is cared for, evidently gets into the air in considerable quantities. Not only is the sputum
expectorated directly upon the floor in some cases, there to be dried, trodden upon, and to be swept into the air in the form of a powder, but the clothing and the coverings of the bed, and the pocket handkerchief are soiled with the infectious material that, drying, becomes pulverized.
Dr. Richard, in a paper read before the Société de Medicine Publique three years ago, in speaking of the danger from tuberculosis, says :
The expectoration begins to be really dangerous when in the effort of coughing, through awkwardness or heedlessness, it is projected upon the bed, the clothing, the bed clothes, the walls, the floor, or when it is received in the handkerchief. Then rapidly drying, it becomes friable, is pulverized and disseminated, and henceforth the atmosphere of the room may be considered as virulent for a long time. The sputum falling on the bedding, the mattress, sheets, blankets, or on the handkerchief, once dry, is detached at each movement of the patient, and especially when the bed is made it goes to rejoin that portion which has been launched directly upon the floor, and that which, after desiccation, has fallen from the walls. All is trampled under foot and is reduced to a powder finer and finer. This infectious powder goes and comes ; the currents of air, the frolics of children, the strokes of the broom raise it and make it float in the air, where it remains suspended for a while to finally fall on the bed, the furniture, the walls, the floor. That part which is taken up by the bed is the most stable, the woolen blanket or coverlid is like a sponge which stores up the powder with a prodigious facility; that of the furniture and walls is displaced often, and each time it is raised a new portion goes to increase the store which is in reserve in the blankets, which finally may be considered as the natural reservoir of all the powder in the apartment.
If this statement is not overdrawn — and scientific research is in accord with its declarations — we can readily account for the appearance of any case of tuberculosis that may come to our knowledge. There are many channels through which this germ is communicated to others. The conclusions arrived at by a commission appointed by the Congress of Tuberculosis, and reported to the Academy of Medicine of Paris, are that the bacillus of tuberculosis may penetrate the human organism either through the lungs by means of the inspired air, through the digestive tract, and through the skin and mucus membrane by means of abrasions, punctures, wounds, or ulcerated surfaces.
In discussing its communicability by means of foods, we would be obliged to go over the entire ground of bovine tuberculosis, which in itself is a deep and interesting study and has already developed to very great proportions, through the work done by