medical and veterinary scientists. It is conceded by most, if not all, the practical workers in this field, that bovine and human tuberculosis are identical. This fact is so well established that at the present time there is little controversy over this point.

The interesting and practical question in connection with it is, To what extent is the human family subjected to the dangers of infection through bovine tuberculosis? Upon this subject much has been written of late, and all the conclusions formulated lead to the belief that bovine tuberculosis is responsible for quite a large proportion of tuberculous cases in the human family. Fleming estimates that five per cent of all the cattle in EngDr. Brush, in a paper read land are affected with tuberculosis. before the Medical Society of the State of New York a short time since, stated that the inspectors of the Bureau of Animal Industry of the United States, have found a much larger percentage of our cows affected with the disease. Among some of the thoroughbred Jerseys, twenty per cent or more have been found to be infected. Professor McLean, who is connected with the Bureau of Animal Industry, states that where cows are affected with tuberculosis in great numbers, the death rate from this disease is correspondingly large in the human family in the same districts.

Dr. Brush, in the paper referred to, expresses the belief that human bacilliary tuberculosis is all derived from the bovine species, and that where this animal does not exist, pulmonary consumption is unknown. The Kirghis on the steppes of Russia, who have no cows, have domesticated the horse, using its milk, meat, and skin, and a case of pulmonary tuberculosis has never He also states that the been known to exist among the tribe. Esquimaux have no cows, neither have they pulmonary phthisis. The belief that pulmonary tuberculosis is due to the wide-spread existence of the same disease in the cow, is also entertained by many other observers.

The bacillus may be found in the milk, muscles, and blood of the infected animals. Until recently it was not supposed that the bacillus could be communicated to the milk until the udder had become diseased; but this has been disproven. Dr. Peters, the able veterinary biologist at the experimental station in Massachusetts, where he has had for months a herd of tuberculous cows under inspection and investigation, informed the

writer that he had succeeded in finding the bacillus of tuberculosis in the milk of cows whose udders showed no indication of the disease. Bolinger, in investigating this point, found the milk infected in eighty per cent of the tuberculous cows examined. In cows with moderate tuberculosis, the milk was infected in fifty-five per cent of the cases, and in cows in which the disease was only slightly indicated, the milk was infectious in thirtythree per cent of the cases.

These are only a few of the many facts now on record, relating to bovine tuberculosis. Upon examining all the evidence there is left scarcely room to doubt that tuberculosis is not infrequently communicated from the bovine species to man. It would seem, then, that the human family is subjected to the infection of this disease from two great sources, tuberculous persons and tuberculous cattle. This every candid student of the subject must admit; but there is still room for controversy and wide differences of opinion regarding the channels through which it is alleged the disease may be communicated; this causes a difference of opinion as to how far preventive measures should be carried.

From the facts already considered, the question, Should the profession advise more strenuous means of prevention? would seem to be superfluous. The answer must be emphatically in the affirmative. From the history of the disease thus far known, three propositions may be formulated :

1. That the bacillus tuberculosis is the cause of the disease. 2. That the disease, when developed after the first years of childhood, is not inherited but acquired.

3. That the disease is strictly preventable.

If these propositions are capable of demonstration, and we believe they are, the medical profession has an imperative and conscientious duty to perform in the field of prevention. Every intelligent physician of the present era recognizes that the prevention of disease should be as much a part of his duty as the treatment of sickness. The question of gratuitous philanthropy is not for a moment to be considered in this connection, for the true physician will use every rational and scientific means within his power for the prevention and restriction of disease, whatever may be the pecuniary result to himself.

Before any efficient work in the restriction and prevention of this disease can be done, the people, and our patients themselves, must have a full understanding of its nature. The simple assertion that the disease is communicable is not sufficient, for in many families, who have no definite understanding of the term, there would be constant fear of infection which would have a very detrimental effect upon the entire family. They ought rather to be taught the exact and definite channels through which the infection may be received; the manner in which the tuberculous person renders himself dangerous, and the most efficient methods of avoiding the disease. It would be false and cruel to give a family the impression that any member of it who might be afflicted with tuberculosis was, per se, a source of constant danger to the others. The fact is that a consumptive having a reasonable understanding of the nature of his disease and who is discreet and careful in his habits need not endanger his associates.

The following may be stated as the chief requirements to be urged upon the public, and they are simple rules which the physician can readily and successfully teach in his own community, and that, too, without exciting any unnecessary apprehension or

alarm :

1. That the greatest danger of infection is from the sputa of the consumptive.* For this reason, when confined to the house, a spit-cup or spittoon should be used, and when upon the street a handkerchief to receive the expectorations. The spit-cup and spittoon might preferably contain a disinfectant, but if these vessels are frequently and thoroughly cleansed with boiling water, disinfectants are not an absolute necessity. The handkerchiefs used should be immersed in boiling water at least daily, - before the sputum has become dried.

2. No person should occupy a sleeping-room with another who has tuberculosis, although such practice is almost universal and many persons escape infection.

3. The eating utensils of a consumptive should be washed in boiling water, and care should be exercised that the same glasses, spoons, etc., are not, before being washed, used by children and

Since this paper was written, the American Public Health Association, at its annual meetng, 1889, after a thorough consideration of the subject adopted the following:

Resolved, That it is the sense of this Association in the interest of public health that the community should be instructed that the destruction of the sputa of tuberculous patients is n absolutely essential part of the means of preventing the spread of the disease.

others. The patient should also avoid kissing others or placing in his mouth any article likely to be used or handled by others. 4. The dejections of consumptive patients, in cases where the bowels are affected, should be thoroughly disinfected.

5. Perfect cleanliness of the apartments occupied by consumptives should be urged in all cases. The bed linen, towels, etc., should be very frequently put through the operations of the laundry, while the walls should be frequently cleansed and dressed anew. In fact, the whole question of restriction may be expressed in the one word "cleanliness."

With a knowledge of what should be done in consumptive cases, the people will understand in a very great measure how to avoid the dangers arising from direct communication with them. Beyond the measures suggested by such knowledge are the dangers arising from tuberculous milk and meat. From the evidence already submitted we are led to believe that the liability of infection from these sources is very great. To insure public protection against this source of danger, it would be necessary to exercise a careful sanitary supervision over the sources of our meat and milk supplies. This can be done thoroughly only by the state or nation, but the medical profession can do much in bringing to light tuberculosis in cattle and reporting the same to the local authorities, who, under a law recently enacted in this State, have full powers to destroy such animals and re-imburse the owners.

The measures of prevention which have just been outlined are brief, simple, and not calculated to arouse undue fears in families or communities. It has been said that if nine avenues through which a disease may come are closed and one left open, protection is not secured; but it should also have been said that nine tenths of the danger is thereby removed, other things being equal. So with the preventive measures suggested in this paper; if they are not sufficient to eradicate the disease, they will at least greatly reduce the liability to its infection.

Pulmonary consumption is the most terribly fatal disease that affects mankind. It is contagious and infectious; it is also preventable, and if the medical profession as a unit would accept this view and instruct the people in the means of its restriction and prevention, its mortality might be reduced one half in a single generation.

II.

There are nearly one thousand deaths annually in New Hampshire from the "great white plague," commonly known as pulmonary consumption, and if to this were added the deaths from other causes complicated with tuberculosis, the total would reach a much higher figure. The history of the disease has been the same from time immemorial; it has destroyed and is destroying more lives than any other disease known to mankind. It has been studied for generations by the ablest physicians in all parts of the world, but never till the present period of wonderful biological advancement has its true nature and character been revealed. The seed that produces this terrible harvest of death has been discovered, thereby placing pulmonary consumption on the list of "preventable diseases." It is only, however, through a slow process of education, of wide-spread, intelligent information, that a discovery or an invention calculated to further the public interests can be brought into the greatest practical utility, unless perchance it can be introduced through the medium of large pecuniary gains, which is not the case in dealing with the prevention of disease.

In order to secure the adoption of even the simplest measures necessary to restrict the spread of consumption, the public must be fully informed of its extensive prevalence, its contagious and infectious character, and its liability to appear at any age of life. In the foregoing paper its communicability and the necessary preventive measures have been briefly discussed.

The extent to which it prevails and its liability to infect persons of any age are more fully shown in the following diagrams. The first diagram illustrates the relative prevalence of the nine most prominent causes of death, as registered in this State during the years 1885, 1886, 1887, and 1888. It will be seen at a glance that consumption greatly exceeds the other causes of death given.

Although the registration of vital statistics in this State covers accurately only a very few years, it is reasonable to assume from the registration records of other States, covering a period of many years, that pulmonary consumption has always held the same relative position in the causes of death.

When this terrible death line is transferred to its proper class,