THE COMBATING OF TUBERCULOSIS. 469 



mend subcutaneous injection which yields quite specially charac- 

 teristic and convincing results. For half a year past I have occupied 

 myself with such investigations, but owing to the rareness of the 

 disease in question the number of the cases which I have been able to 

 investigate is but small. What has hitherto resulted from this investi- 

 gation does not speak for the assumption that bovine tuberculosis 

 occurs in man. 



Though the important question whether man is susceptible to bovine 

 tuberculosis at all is not yet absolutely decided, and will not admit of 

 absolute decision to-day or to-morrow, one is nevertheless already at 

 liberty to say that, if such a susceptibility really exists the infection of 

 human beings is but a very rare occurrence. I should estimate the 

 extent of infection by the milk and flesh of tuberculous cattle and the 

 butter made of their millc as hardly greater than that of hereditary 

 transmission, and I therefore do not deem it advisable to take any 

 measures against it. 



So the only main source of the infection of tuberculosis is the 

 sputum of consumptive patients and the measures for the combating 

 of tuberculosis must aim at the prevention of the dangers arising from 

 its diffusion. Well, what is to be done in this direction ? Several ways 

 are open. One's first thought might be to consign all persons suffering 

 from tuberculosis of the lungs whose sputum contains tubercle bacilli 

 to suitable establishments. This, however, is not only absolutely im- 

 practicable but also unnecessary. For a consumptive who coughs out 

 tubercle bacilli is not necessarily a source of infection on that account 

 so long as he takes care that his sputum is properly removed and ren- 

 dered innocuous. This is certainly true of very many patients, espe- 

 cially in the first stages, and also of those who belong to the well-to-do 

 classes and are able to procure the necessary nursing. But how is it 

 with people of very small means? Every medical man who has often 

 entered the dwellings of the poor, and I can speak on this point from 

 my own experience, knows how sad is the lot of consumptives and their 

 families there. The whole family have to live in one or two small, ill- 

 ventilated rooms. The patient is left without the nursing he needs be- 

 cause the able-bodied members of the family must go to their work. 

 How can the necessary cleanliness be secured under such circum- 

 stances? How is such a helpless patient to remove his sputum so that 

 it may do no harm ? But let us go a step further and picture the condi- 

 tion of a poor consumptive patient's dwelling at night. The whole 

 family sleep crowded together in one small room. However cautious 

 he may be the sufferer scatters the morbid matter secreted by his dis- 

 eased lungs every time he coughs and his relatives close beside him 

 must inhale this poison. Thus whole families are infected. They die 

 out and awaken in the minds of those who do not know the infectious- 



