DISCUSSION ON TUBERCULOSIS. 701 



it is right to say that sometimes a consumptive person not of the 

 pauper class finds it difficult to obtain admission to a hotel or 

 boarding-house on account of the unjustifiable fears of the occu- 

 pants. Also that from the same fears opposition is sometimes 

 offered to the establishment of a sanatorium in a neighbourliood. 

 The remedy for these difficulties is education of the people. They 

 know enough about tuberculosis to alarm them, but not enough 

 about the preventive measures which the careful consumptive 

 takes to make himself quite harmless to those about him. 



Dr. AsHBURTON Thompson, President of the Board of Health 

 of New South Wales, said : — 



The present discussion is on the dissemination of tuberculosis, 

 and whatever general interest it may have, its importance lies in the 

 guidance it may afford those who would devise practical methods of 

 preventing dissemination. Now, the ways in which tuberculosis 

 may be communicated are doubtless various, but they are of 

 vastly different degrees of efficiency. The value, in this sense, of 

 some of them still remains doubtful for lack of direct evidence. I 

 shall endeavour, therefore, to confine the few and brief remarks I pro- 

 pose to make to matters which are agreed by a great majority of 

 those who are best entitled to pronounce upon them. In the first 

 place, it is now generally admitted, I believe, that the most important 

 of the various sources of infection is the sick ; that for practical 

 purpo.ses the term " the sick " may be taken to mean only those who 

 suffer from that form of tuberculosis which is called phthisis ; and 

 that the efficiency of the phthisical as causes of tuberculosis in others 

 is roughly proportioned to the amount of expectoration thrown off 

 by them. Further, opinion seems to be forming that usually the 

 communication of the infection from the sick to the healthy is either 

 direct, or, if literally indirect, then mainly by intermediate means 

 which imply lapse of no long time. On the whole it appears to me 

 that this brief statement, crude as it may appear, includes the 

 points on which those who would reduce the prevalence of con- 

 sumption on a broad or national scale had better fix attention for the 

 present. 



If this \iew can be accepted as a guide to immediate and 

 practical effort, it follows indisputably that segi-egation of the sick 

 from the healthy should be our aim. But it would be unnecessary, 

 useless, impracticable and improper, to advise segregation as a 

 routine measure to be inexorably carried out in every case. All 

 consumptives are not dangerous ; few consumptives are dangerous 

 throughout their illness ; and even those consumptives who are 

 most dangerous can surely live among the healthy with safety to 

 them, by punctual observance of simple and easy precautions. 

 The proportion of the phthisical at any time existing who should be 

 segregated, depends, then, on circumstances. The circumstances 

 will be found to differ in different cases. They should be enquired 

 into by medical men, for no others can be in the least degree com- 

 petent to estimate their importance. With medical men the 



