EPIDEMIOLOGY OF TUBERCULOSIS KOCH. 671 



tinue to spread infection abont them. Newsholme endeavors also to 

 prove that in Norway, too, the mortality from consumption is on the 

 increase because insufficient care is taken for the placing of phthisical 

 patients in hospitals. I might remark here that in Norway this 

 defect has alreffdy been recognized and care has been taken to remedy 

 it by founding special hospitals for consumptives. It appears that 

 on account of this precaution the mortality curve in quite recent 

 years no longer ascends. Newsholme says further that the very high 

 mortality in Paris results from the insufficient hospital facilities, in 

 consequence of which patients are not kept in long enough to insure 

 protection of others against infection, 



"With reference to this I entirel)'- agree with Newsholme that a 

 commitment to hospital for as long a time and with as careful atten- 

 tion as possible is the most effective means of preventing infection 

 and thereby the spread of consumption. My experience also shows 

 that wherever consumptives are kept in sufficient numbers in hospi- 

 tals there consumption is most diminished, and vice versa. It is 

 also apparent that in no way can the danger of infection, which 

 attends every phthisical patient, be so successfully combated as by 

 isolation in a hospital. The value of hospital isolation is shown in 

 a striking manner by such treatment of leprosy, as by its means we 

 have attacked that disease with good results. 



Besides this factor there is still a second one that plays a very 

 important part. This is the housing of patients. The more con- 

 tracted this is — the more lack there is of light and air — the more is 

 infection favored. By many authors poverty and density of popu- 

 lation have been mentioned as having a decided effect on the fre- 

 quency of phthisis, and quite correctly so ; but, in truth, this is 

 caused by the defective and too small dwellings in which, through 

 poverty and the increased density of population, people are forced 

 to live. I might even go a step further and say that it is not so much 

 the contracted character of the dwellings as a whole as the condition 

 of the sleeping rooms that favors infection. Even in a spacious 

 dwelling, in itself hygienic, the danger of infection may become 

 very great if the inhabitants crowd together at night in a small 

 sleeping room. It is certainly not an accident that with us the 

 highest mortality from consum^jtion is not found in the poor regions 

 of the eastern provinces, but in the relatively .prosperous and amply 

 cultivated regions along the coast of the North Sea, where from 

 olden times the evil custom has prevailed of using for sleeping 

 rooms small, cell-like apartments built in the wall, the so-called 

 cubbies (Butzen), which are shut up at night, and that in the north- 

 ern parts of Sweden, with a climate that is notoriously healthy, the 

 highest death rate for consumption occurs where people also sleep 

 in closets quite similar to the cubbies of Frisia. 



