288 Dr. H. T. Buhtrode [May 15 , 



house and infected articles are disinfected, and, if no more cases occur 

 among the " contacts," the trouble and expense are at an end. If a 

 patient suffering from this disease exposes himself in public, or enters 

 a public conveyance, he is prosecuted. 



Let us, in imagination, apply these conditions to patients suffering 

 from consumption. On recognition of the disease the patient would 

 be isolated, not for six weeks but for months, and, often, for many 

 years (until, in fact, death ensued, or his sputum, after repeated 

 examination, contained no tubercle bacilli). During this time, in the 

 case of the poor, the patient's dependants would be supported either 

 by friends or by the rates. These dependants would be kept under 

 observation, and upon symptoms of tuberculosis appearing they, too, 

 would be withdrawn from the public. 



In 1906, there were in England and Wales 56,841 deaths from all 

 forms of tuberculosis, and 39,746 from pulmonary tuberculosis alone. 

 It is the usual method in order to determine the actual number of 

 cases of phthisis, to multiply the deaths by three, a process which, in 

 this instance, yields over 109,000 cases. If all these cases were 

 sought out and isolated and their dependants supported, the problem 

 would, as regards cost, reach somewhat alarming proportions, though 

 as we shall see directly by a study of post-mortem records, this 

 estimate of 109,000 is, as regards actual prevalence, far below the 

 actual figures. But probably it is already 'obvious that to attack the 

 problem on smallpox lines is not one which can be seriously con- 

 sidered from an administrative standpoint. 



Some Current Views, as regards Pulmonary Tuberculosis, 

 AS TO THE Means by which, and the Times at which, 

 the Tubercle Bacillus is Introduced into the Body. 



The Vehicle of Infection. — It is not too much to say that the whole 

 of this aspect of the tuberculosis problem is in the melting pot. 



Up to within the last few years the prevailing belief, supported, 

 it was thought, by adequate experimental evidence, was to the effect 

 that the disease was chiefly spread by means of tuberculous sputum 

 which had undergone desiccation to such an extent as to enable it 

 to be detached from surfaces and transmitted, mainly by currents of 

 air, to the lungs ; and preventive action was largely based upon this 

 conception. Those who hold this doctrine belong to what may be 

 termed the " dust school." 



Within recent years, however, another school, which may con- 

 veniently be spoken of as the " droplet school," has arisen, and those 

 who are its adherents hold that the greatest danger is to be con- 

 templated not from dust, but from the droplets given off when 

 phthisical persons cough, sneeze, or^speak excitedly. It is generally 

 conceded that in quick [respiration no micro-organisms are given off 

 with the breath. 



