Papers ox Medici>*e. Public Health axd Saxitatiox 83 



the floor, in cracks, and rising in the dust, makes the 

 organism a possible menace to the creeping infant, 

 long after the carrier who left the organisms has gone 

 from the premises, moved from the community, or died. 

 The organism on the other hand, may be transmitted 

 to the child by inlialing the spray from the coughing 

 tuberculous person, or by direct contact when the tuber- 

 culous fondle the uninfected child. The carrier of tuber- 

 cle bacilli to the child may be without clinical evidence 

 of tuberculosis. Some such lesion as a cavity communi- 

 cating with the bronchus, frequently observed, may re- 

 tain the bacillus for long periods of time. An adult in 

 a high state of inununity to the tubercle bacillus may 

 have a tuberculous tonsil or sinus from which the bacilli 

 are excreted from time to time, and which local lesions 

 are not of serious moment to the patent, but the excre- 

 tions from which are capable of infecting the non-tuber- 

 culous child. 



From what has been said it ought to be plain, that 

 only infants from birth to two years are without tuber- 

 culous infections, except adults living away from civilized 

 communities. These two classes of people then, are 

 highly susceptible to tuberculous infection, originating 

 outside of their o^\ti bodies. The adult in a civilized 

 conmiunity acquires an active tuberculosis by a reacti- 

 vation of an ancient tuberculous focus, which focus has 

 been surrounded by a protective fibrous tissue wall, but 

 which has been unable to prevent further dissemination, 

 when the physical resistance of the individual remained 

 lowered over a great period of time. It, to me, seems 

 doubtful, in view of all of the evidence that has recently 

 been brought to bear, that tuberculosis in the adult is 

 ever acquired from association with the tuberculous. 



"What now are the lines along which the fight against 

 tuberculosis is being directed? The measures adopted 

 in the Army for the cure of the tuberculous soldier were, 

 first and most important, and without exception, if the 

 patient had an active lesion, to take complete rest in bed, 

 night and day, week after week, until the moisture in the 

 infected area had disappeared. During this period of 



