DISCUSSION ON TUBERCULOSIS. 699 



The third factor in the causation of tuberculosis is the environ- 

 ment. If this be healthy, the vitality of the bacillus of tubercle is 

 lowered or even destroyed, and under such a condition hundreds of 

 bacilli may fall upon the lungs or come in contact with the intestinal 

 mucous membrane without producing any ill effect. The seed 

 finding nothing in its environment to favour its growth, perishes. 

 When the opposite conditions prevail, when the surroundings are 

 unhealthy, and especially when the atmosphere is tainted by the 

 exhalations from the lungs and skins of a large number of people in 

 a confined space, or even by those of one person breathing the same 

 air for hours together, as, for instance, in a small bedroom with 

 closed doors and windows, then the vitality of any bacilli of tubercle 

 which may be present, is preserved, and should they enter the 

 respiratory or alimentary passages of a susceptible person, will take 

 root and grow. Darkness, dampness, an impure subsoil, and dirt 

 also constitute an environment which is exceedingly favourable to 

 the life and growth of the bacillus. 



It follows from what has just been said that to prevent the 

 spread of tuberculosis we must endeavour to secure three things : 

 (1) An atmosphere free from the bacilli of tubercle ; (2) an in- 

 vigoration of the body which will enable it to resist infection ; and 

 (3) a healthy environment. These three things must be done if 

 we are to make a successful fight against tuberculosis. All the 

 measures of prevention which are or should be employed have one 

 or all of these objects in view. Time will not permit me even to 

 enumerate them all, but I may say that for the individual con- 

 sumptive the most important preventive measures which he should 

 observe are : (1) Care of the sputum, its reception into a covered 

 vessel containing some antiseptic liquid to protect it from flies and 

 to prevent it from becoming dry, mixing with the dust of 

 the atmosphere and becoming inhaled or contaminating food ; 

 finally, its destruction by fire or powerful germicides. (2) The 

 placing a handkerchief before the face when coughing or sneezing 

 to prevent the bacilli suspended in the spume which is ejected from 

 contaminating the air or food or from falling upon clothing or 

 furniture. (3) The avoidance of kissing, especially upon the mouth, 

 a practice which should be generally discouraged in view of the 

 possibility of infection. (4) The use of paper handkerchiefs, which 

 should afterwards be burned, for wiping the mouth. (5) The disin- 

 fection of faeces, urine, and tuberculous discharges. (6) The boiling 

 of milk unless it is certain that it has been obtained from cows that 

 have not reacted to the tuberculin test. (7) The avoidance of 

 suckling when the mother is tuberculous. (8) The separate bed. 

 (9) Living out of doors as much as possible and sleeping in the open 

 air. (9) Absolute cleanliness in the widest sense of the word. 



We pass now to the measures of prevention which should be 

 adopted by the State. These are the enactment of laws making 

 notification compulsory, and indiscriminate spitting a punishable 

 •offence ; making regulations for the suppression of smoke and dust ; 

 ior the compulsory disinfection of houses that have been occupied 



