222 BACTERIA. 



pounds, all exert an inhibitory effect on the growth of tubercle bacillus ; the 

 compounds of cyanogen and gold, especially, even in a solution diluted to one 

 part of cyanide of gold to two millions of the solvent substance, checking the 

 growth of tubercle bacilli. Carbolic acid also kills the bacilli if it is allowed 

 to act in considerable strength and for a lengthened period ; but none of 

 these can, for a moment, be compared as regards not only efficiency and 

 cheapness, but for facility of application, with steam or boiling water. All 

 disinfection should be just as completely carried out when a phthisical patient 

 leaves a room or ward as if a case of scarlet fever had been treated there ; 

 the walls, floor, and even the roof should be thoroughly washed and disin- 

 fected by means of hot water or lime. During treatment in such apart- 

 ments no patient should be allowed to expectorate on the floor ; and glass 

 or porcelain spitoons, which can easily and safely be boiled in water, should 

 be placed for the reception of all sputa. During the time that corridors, 

 steps, and rooms are being cleaned and disinfected, they should be kept 

 quite moist, in order that as little dust as possible may arise from the clean- 

 ing operations. No room that has been occupied by a phthisical patient 

 should be used until it has been thoroughly disinfected ; the bedding and 

 curtains should be well boiled, the blankets steamed, the mattresses dis- 

 infected, all the furniture washed with soap and water, the carpets and 

 upholstering thoroughly beaten in the open air, the dust of which should 

 be caught in straw (such straw and the paper taken from under the carpets 

 should always be burned), the floor thoroughly washed with soap and hot 

 water, and the wall paper rubbed down with freshly baked bread. In 

 San Remo all these methods of procedure have been brought under the 

 notice of the hotel-keepers, and they are advised to carry them out in 

 connection with the whole of their rooms at the end of each season, not 

 only the sleeping rooms, but also the public rooms. 



The alimentary canal is probably the next most important 

 channel of infection. Evidence of infection by this channel 

 was first obtained by the feeding experiments already referred 

 to, but further evidence of it has been noted in the ulcera- 

 tion of the intestine that is so frequently met with in 

 phthisical patients, and which appears to be due to the action 

 of bacilli contained in the sputum passing down the gullet 

 through the stomach in cases where the gastric juice is not 

 very active, and so to the intestine in which ulceration occurs 

 in the course of the tubercular process as the result of the 

 pathogenic activity of the bacilli. In children this mode of 

 infection is comparatively common, and tubercular ulceration 

 of the intestine, or tubercle of the glands connected with the 

 intestinal tract, is of frequent occurrence. 



In 127 cases of tuberculosis in children that I examined this tubercular 

 ulceration was found in 43 ; whilst in 100 cases, or nearly 79 per cent, of 

 the whole, the glands were in some stage or other of tubercular degenera- 

 tion. It would thus appear that tuberculosis connected with the intestine 

 is of frequent occurrence in children, and we should therefore argue that 



