CONSUMPTION AND CONSUMPTIVES. 341 



land, found that only eleven of one thousand cases wliich lie in- 

 vestigated had lost husband or wife by the disease, and our own 

 Dr. Flint states that there were but five such instances in 670 

 cases observed by him. 



Previous to the discovery of the bacillus, such observations as 

 those last mentioned led many to doubt that consumption was 

 communicable at all. It may be well, then, to consider a few 

 other facts pointing to the same conclusion, as they are important 

 in arriving at correct views on the whole matter. Chief among 

 them may be mentioned the experience of the Brompton and Vic- 

 toria Park Hospitals of London, where consumptives have been 

 treated for many years. It is well to recall at the same time that 

 special precautions against contagion have not been taken until 

 recently. It was stated in 1882 that of sixty or seventy physi- 

 cians employed at these hospitals during twenty years, but five 

 had been attacked by consumption, of whom two died. The rec- 

 ord of the large number of nurses emyjloyed during the same 

 period, and whose relations with the sick were more intimate 

 than those of the doctors, was still better ; there were but two 

 cases, and one of these was doubtful. One of the physicians to 

 these hospitals. Dr. Williams, says that though he has been 

 watching for twenty years he has not yet met with a case in 

 which alleged contagion could be sustained, after close investiga- 

 tion. He adds that while the disease may be contracted in this 

 way, the circumstances must be extremely favorable. At the 

 Vienna General Hospital, where 2,736 deaths from consumption 

 occurred in three years, not a physician or nurse was known to 

 have contracted the disease. Nearly every one has known of 

 relatives or friends who have lived in the most intimate relations 

 with consumptives for long periods and have suffered no injury 

 whatever. 



Now, it does not follow from these observations that we are 

 mistaken in assuming that consumption is communicable. "We 

 shall see in a moment that there is a good reason for exceptional 

 instances. It is quite possible, though, that in our enthusiastic 

 zeal to deal with it and stamp it out on this basis other important 

 considerations are being neglected. Destruction of clothing and 

 renovation of rooms seem to have been pretty thoroughly prac- 

 ticed in Naples and other places a hundred years ago without 

 making any impression on the death-rate. Improvements in gen- 

 eral sanitary conditions at Naples, however, have in these later 

 times had a marked effect. It is, to be sure, highly important to 

 destroy or disinfect sputa, and to discourage in general the per- 

 nicious practice of expectorating. The sputum is the very foun- 

 tain-head from which the army of bacilli is re-enforced. This does 

 not necessarily imply, however, that the concentration of our 



