14 



little has been furnished. At the same time, contirraatory evidence 

 was demanded by some who had, and many, who had not access to 

 the original details, and this confirmatory evidence has been 

 furnished in sueli overwhelming amount tliat it is to-day but 

 a waste of time to repeat, wliat is accepted the scientific world over, 

 that in the organism described by Koch we have the specific cause of 

 this pathological change, and that without its activity we do not liave 

 tuberculosis in any form or under any conditions. 



An imperfect understanding of the nature of bacteria in general, 

 and of this organism in particular, has led to many attempts to 

 arrest the pulmonary form of the disease it produces, by therapeutic 

 measures, most of which would have been seen to be useless at the 

 outset, if a knowledge of the problem had been complete. It is not 

 upon drugs or mechanical means that our reliance should be placed 

 in attempting to stamp out this scourge of civilized man. Our atten- 

 tion must be turned in the direction of proper preventive measures 

 and until the necessity for this is impressed upon physicians in gen- 

 eral, and by them upon the people at large, so thai tlie preventive 

 measures suggested after mature deliberation will be complied with, 

 but little can be effected, and the knowledge gatheic d after so muoli 

 hard labor must be considered as wasted, for the time being. 



In order to the suggestions upon which the stamping out of tuber- 

 culosis must depend, there is necessary a large amount of investigation 

 into the methods by which it spreads and by which the virus is carried 

 from person to person. Among these methods are undoubtedly the 

 excreta — more especially the sputum — from persons affected with the 

 disease ; the excreta are carelessly treated and scattered broadcast 

 to the injury of persons susceptible but not previously affected. The 

 methods of distribution in this way, and the behaviour of the bacillus 

 of tuberculosis outside of the body, have been well and recently 

 treated by Cornet {Zeit. f. Hyg., Bd. v. S. 191, 1888). 



Other methods of distribution are of importance, however, and until 

 within a few years have not received attention from the medical 

 profession at all commensurate with their value. These methods of 

 infection are those arising from the ingestion of food materials coming 

 from the domestic animals, especially the flesh and milk of cattle. 



InKoch's Etiology of Tuberculosishe uses the following expressions : 



•' Since by far the greatest number of cases of tuberculosis begin in the lungs, u 

 is to be supposed that the infection in all these cases has taken place in the manner 

 just suggested — by the inhalation of phthisic sputum dried and made into dust. 

 The second principal source for the tubercle-bacilli, viz., tuberculosis of the domes 

 tic animals, appears not to have anything like the importance of the phthisic 

 sputum. The animals, as is well known, produce no sputum, so that during 

 their life no tubercle-bacilli get from them into the outer world by means of the 



