1907] Climate ix Relation' to Health 45 



first, its prevention, and second, its cure. 



Prevention of Tuberculosis. Assuming that tuberculosis 

 does not exist in a family or in a house, it is plain 

 that with cleanliness in the house, in its atmosphere, 

 in the food and clothing, the disease cannot come 

 there. Extend this to shops, street-cars, schools, etc., and it 

 could not be generated there. But experience and scientific 

 experiment both readily teach us that in our cities and towns, 

 'expectoration and coughing leave its germs in every public 

 place. Nevertheless, it is well known that persons with healthy 

 mucous membranes, if care is taken to destroy sputum and use 

 handkerchiefs when coughing, may act as nurses for years in 

 consumptive hospitals and yet not become infected. Clearly 

 then, house, school and shop cleanliness are first essentials. But 

 inasmuch as infected persons must be taught these facts, and 

 those nursing them as well, it is apparent that education by the 

 familv phvsician, by the district nurse, by the school-teacher, 

 and by public lectures is absoluteh^ essential to prevent infection 

 where the disease has once been present. 



But from what has been said regarding the atmosphere 

 of houses, as regards purity, moisture and heating, it is apparent 

 that municipal provisions, with the assistance of charit}^ workers, 

 bv which house construction, house sanitation and the number 

 of persons to a certain air-space are regulated, must be strictly 

 enforced. We thus see that the task is a large one, and one 

 which we have as yet scarcely begun to cope with. 



Cure of Tuberculosis. But assuming that we have 

 set all this in motion, we have yet to deal with the 

 actual cases of disease. As all have observed, it is seldom 

 that persons in rugged health take tuberculosis, and 

 it is usually where the vital powers have been reduced by some 

 acute disease, as pneumonia, typhoid or pleurisy, that naturally 

 healthv persons are infected. The reason for this is plain: the 

 germs do not enter the system ordinarily except by the respira- 

 tory tract, and obtain a lodgement only when its vitality is 

 reduced. If, however, house air is infected, if it is abnormally 

 dry, if its oxygen is lessened by over-crowding and non-ventila- 

 tion, if catarrhs prevent normal breathing through the nose, 

 if lack of exercise, lack of food and loss of rest occur, and all 

 these too often do occur amongst the employees of city factories, 

 shops and many homes, it is apparent that infection is almost 

 inevitable. But having occurred, it is apparent that the only 

 hope of preventing the progress of the disease is in removing 

 the patients at once from the effects of such conditions. 



