PROCEEDINGS OF SECTION I. 699' 



from consumption (Plate I., fig. 3). You will see that the temperature 

 did not rise after the injection. I will show you the temperature 

 chart of the patient, an image of whose expectoration you have just 

 seen (Plate II., figs. 4, 5, 6, 7). I show this patient's temperature record 

 for five months, and you will observe that during the whole of this time 

 the temperature never rose above 99° until tuberculin was used. The 

 dose of tuberculin was the same as in the previous case, and you see 

 that after an injection of 0-OOlcc. of tuberculin the temperature rose 

 to 104°, and then rapidly fell again to normal. This man, therefore, 

 gave a positive reaction to tuberculin — as we express it — and that 

 proves that he was suffering from consumption. As a matter of fact,, 

 he has it in a very advanced stage, and is hopelessly incurable. Here, 

 then, is a man in the last stage of consumption, whose expectoration, 

 nevertheless, does not contain any tubercle germs. Since a man can 

 only convey consumption to other people when his expectoration or 

 excreta contain the tubercle germs, this patient is perfectly harmless ; 

 he cannot convey the disease to others, even though he should try to- 

 do so. Yet, it so happens that this very man is isolated at the Govern- 

 ment institution for incurable consumptives, while that other man 

 who expectorated miles of living germs every day has been travelling 

 about the country. The poor fellow was ignorant of the evil he was 

 committing, and vre will not think unkindly of him ; he has since crossed 

 the bar. 



CLASSIFICATION OF CONSUMPTIVES. 



The matter I have just discussed is obviously of great importance, 

 and I cannot remember that it has ever been clearly brought before 

 the public. All consumptives can be arranged into two classes (see 

 diagram) : those whose expectoration contains tubercle germs, and 

 who are, therefore, capable of conveying the disease to others, and 

 those whose expectoration is free from these germs, or who have no 

 expectoration at all — that is, the harmless consumptives. 



Consumptives in the first class, whose expectoration . carries the 

 tubercle germs, may be further divided into those who have been 

 trained in the proper method of preventing infection and those who 

 have received no such training. 



In the interests of public health I consider this to be the most 

 rational and useful way to classify consumptives. This classification 

 should form the basis of those laws and regulations which must be 

 framed to prevent the spread of consumption. 



The compulsory isolation of every consumptive in tent colonies, 

 which at the present time is contemplated by the authorities at Buda 

 Pesth, is a measure far too drastic ever to be adopted by British people, 

 and perhaps it is unnecessarily severe. 



Nevertheless consumption, which is called a preventable disease, 

 is not in fact being prevented. It causes the death of thousands who 

 never would have contracted the disease if efficient laws had existed 

 for the proper control of consumptive people. 



