CONSUMPTION AS A CONTAGIOUS DISEASE. 37 



culturist may learn to dwarf the germs of scarlet fever, typhoid, 

 and similar diseases. Diseases, on the other hand, which are 

 essentially chronic, which remain or recur without a tendency to 

 self-limitation, must be attacked in another manner. The failure 

 of Koch's tuberculin was simply an illustration of this general 

 principle. 



At present the main obstacle to the carrying out of measures 

 of quarantine against tuberculosis is public sentiment. Public 

 sentiment requires all smallpox patients to be sent to a pest 

 house, though, with rare exceptions, such patients can be of danger 

 only to the ignorant who have refused vaccination. Public senti- 

 ment kept a poor Chinese leper confined in a bare stone cell with 

 almost the same neglect of humanity as characterized the treat- 

 ment of prisoners in the dark ages. Public sentiment checked 

 immigration and commerce in the effort to quarantine against 

 cholera. Yet this same public sentiment would characterize as 

 barbarous the isolation of consumptives, with every provision for 

 their comfort, in hospitals so arranged as not only to prevent the 

 spread of the disease, but to afford every possible chance for the 

 relief or cure of their inmates. 



While yielding to the inevitable, something may still be done 

 to limit the spread of tubercular disease without removing the 

 consumptive from his customary associations. Barring surgical 

 tuberculosis, in which the ordinary antiseptic dressings and the 

 destruction of old bandages by fire will suffice, we have to contend 

 against the dissemination of germs by the various excretions of 

 the body. Fortunately, in the vast majority of instances we can 

 restrict our attention to the expectorated matter. Few germs are 

 exhaled in the breath, yet it is unwise for any one with a severe 

 cold or bronchitis to be in the same room with a consumptive, 

 and no one should sleep night after night in the same bed. If it 

 is absolutely necessary for an attendant to sleep in the same room, 

 the freest ventilation should be insisted on. 



Our sleeping cars are, I believe, a positive source of infection. 

 A considerable proportion of travelers are consumptives seeking 

 warmer or drier climates. An almost equal number are persons 

 predisposed to the disease, but not yet infected, going to the same 

 resorts to escape our northern winters. Imagine such a person 

 passing three or four days in the confined air of a palace car, with 

 several consumptives sleeping in a berth whose hangings have 

 been infected from the exhalations of consumptives on previous 

 trips, and, on reaching his destination, spending a number of 

 months at a hotel which is practically a hospital for consump- 

 tives ! In many instances public hospitals are breeding places for 

 tuberculosis, patients with various depressing ailments, including 

 those that render the lungs particularly vulnerable, being assigned 



