1908] on The Present Phase of the Tuberculosis ProUem. 291 



lesion whatever of tuberculosis. We must be cautious, however, 

 not to generalise too freely from post-mortem records, since it is, 

 as a rule, only the poorer classes who reach the post-mortem table, 

 and, as is well known, tuberculosis has a much greater death-rate 

 amongst the poor than amongst those better-off. Some instructive 

 figures may be quoted. Dr. Harris, working at the Manchester Eoyal 

 Infirmary, found in 39 per cent, of all the post-mortems evidences of 

 tuberculous lesions. Brouardel, in the Morgue of Paris, found that 

 amongst the bodies of persons who had lived over ten years in Paris, 

 and who had met their death mainly by violence in the streets, 

 50 per cent, presented tuberculous lesions. Lubarsch, dealing with 

 800 cases, found 61 per cent, with such lesions, and Naegeli, of Zurich, 

 detected similar manifestations in 90 per cent, of 500 autopsies. 

 Finally, it may be mentioned for what it is worth, that the applica- 

 tion of the tuberculous test to a Bosnian-Herzegovinian regiment gave 

 a positive reaction in ^'6 per cent. 



There will probably be differences of opinion as to the value of 

 the foregoing figures, but it must be admitted that there is ground 

 for the statement of Professor Osier that : " The germ of tuber- 

 culosis is ubiquitous ; few reach maturity without infection, none reach 

 old age without a focus somewhere," a condition of affairs which 

 is similarly conveyed by the German adage, " Jedermann hat am ende 

 ein bischen tuberculose." In addressing an audience such as this, one 

 would hesitate to repeat the following statement once made in an 

 address by Sir Clifford Allbutt, " I am guilty of no extravagance 

 when I suggest that one-third of you who hear me wittingly or 

 unwittingly are or have been infected with tubercle," for the reason 

 that our knowledge of the distribution of tuberculous lesions amongst 

 the rich is limited, owing to the fact that post-mortem results of this 

 class are few ; a gap in our knowledge which would be soon filled up 

 were the example followed of the illustrious surgeon, who expressed 

 a desire in his last testament that after death his body was to be 

 examined with special reference to a possible tuberculous lesion in 

 the apex of his left lung. The autopsy was duly made, and a 

 tuberculous nodule in his left apex discovered. 



But all these messages from the post-mortem room are full of 

 hope for consumptive patients. They tell us that, as Cardswell said, 

 " Pathological anatomy has never, perhaps, given a more decided 

 proof of the cure of a disease than it gives in the case of pulmonary 

 tuberculosis." 



Such records from the post-mortem room also show that tuber- 

 culosis is curable amongst the very poor, and therefore that the old 

 French aphorism that " There are two kinds of consumption : that of 

 the rich, and that of the poor ; from the first recovery takes place 

 sometimes, from the latter never," has no very sound basis in fact. 



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