DISCUSSION OX TUBERCULOSIS. 715 



greatly ; thus Kitasato states that in Japan this must be a very 

 minor factor, because milk is so sparety used and the existing cattle 

 do not have the disease. 



Other observers, such as Woodhead, Behring, etc., consider 

 it of grave significance in the British Isles. 



The external means of dissemination begin from the time of 

 birth, some cases being on record where infected midwives have 

 been supposed to have infected new born children by breathing 

 into their mouths. 



Bacilli have been discovered by Dieudonne and Schutz and 

 others under the finger nails and on the hands of children in con- 

 sumptive families ; therefore it is obvious that one source of trans- 

 mission may be through the toys, handkerchiefs, etc., left about in 

 the dwellings of the consumptive poor. Contamination must be 

 extremely common through the use of handkerchiefs which come 

 in contact with the hands, pockets, dresses, etc., of the patient 

 and those with whom he associates. The parent may transmit the 

 bacilli to the child through food, household utensils, etc., and the 

 part taken by flies, cockroaches and lice in the carrying of the 

 bacilli has been proved by such observers as Spillman, Weber, Lord, 

 and others. 



It has been shewn that the virulence of infection appears to 

 be much greater when the bacilli are in a damp form than when dried, 

 in which latter case their vitality seems to be in some way impaired. 



The danger of direct infection lies chiefly from coughing, 

 sneezing ; ordinary breathing has been shown to carry no infection. 



The act of kissing on the lips is in the first place extremely 

 insanitary, and in the case of children should be firmly forbidden. 



The use of the communion cup as practised at present should 

 be denounced as insanitary and a grave menace to the health of 

 healthy individuals. The idea of drinking from a cup which has 

 just been used by a person with phthisis (or other infectious disease) 

 is revolting, and stringent measures should be adopted to insist upon 

 the introduction of some method whereby no person will have to 

 run the risk of infection from his neighbour whilst at the communion 

 table. 



Many persons are now debarred from communicating through 

 this sole cause that they cannot bring themselves to consume the 

 salivary emanations of a number of unknown people, any or all of 

 whom may have a disease of an infective nature. The use of a 

 separate cup for each person should be insisted upon. 



Mention should also be made of the barbarous and disgusting 

 custom which compels the officiating priest to himself drink the 

 dregs of the cup after all communicants present have drunk from it. 



