286 Dr. H. T. Biihtrode [May *15, 



The Peesonal Commitnic ability of Pulmonaey Tuberculosis. 



This subject of the cominunicability of tuberculosis has been 

 somewhat thrown out of perspective by inferences drawn from labora- 

 tory experiences. It has been inferred that because tuberculosis is 

 inoculable, and since those susceptible little rodents, the guinea- 

 pigs, develop tuberculosis when placed under conditions in which 

 they have little else to breathe or swallow than tubercle bacilli, that 

 therefore the malady in the human species is, in the _ ordinary 

 relations of social life, as communicable as the more acutely infectious 

 exanthemata such as smallpox and typhus fever. 



But if this were so, and if defective " resistance " were not a more 

 important factor in the production of the malady than the bacillus, it 

 is difficult to understand, as Dr. Samuel West has observed, why so 

 relatively few persons die from the disease. If pulmonary tuberculosis 

 — the most communicable of all forms of tuberculosis — were as in- 

 fectious as smallpox, we should have overwhelming evidence of the 

 fact in the wards of hospitals for consumption, as, indeed, we have of 

 the infectivity of smallpox and typhus fever upon nurses and others 

 in attendance upon patients suffering from these diseases.* 



On the other hand, in the consumption hospitals and sanatoria 

 in this country, there is, as Dr. Theodore Williams, and others, 

 have shown, no evidence which suggests that the nursing of con- 

 sumptive patients in these institutions is attended with danger, 

 and this notwithstanding the fact that the data as to this relative 

 immunity of the staff relate largely to periods antecedent to the 

 introduction of preventive measures such as are now being generally 

 applied. 



Moreover, were pulmonary tuberculosis possessed of a high degree 

 of infectivity, the incidence of the disease upon married couples — 

 one or other partner of which is already tuberculous — would in 

 the past, having regard to the prolonged exposure and intimate 

 relations, and, until recently, to a non-belief in the infectivity of 

 the disease, have been conspicuous. Longstaffe, however, as the 

 result of a most carefully reasoned investigation, concluded that 

 the incidence of the disease upon married couples was no greater 

 than would be expected as a mere matter of chance, and it has 

 to be admitted, as Whitelegge and Newman have expressed it in 

 their admirable text-book, "infection between married persons is not 

 yet satisfactorily settled." 



* Murchison, in his classical treatise, tells us that in twenty-three years 

 no fewer than 288 cases of typhus fever originated in the London Fever 

 Hospital alone, and as regards the Gateshead Fever Hospital, the medical 

 ofificer of health wrote : " Every nurse who has been more than a fortnight in 

 the typhus wards has suffered from typhus," 



