TUBERCULOSIS. 181 



ily and friends ; their individual knives, forks, spoons, 

 cups, etc. should be carefully kept apart secretly if the 

 patient be sensitive upon the subject from those of the 

 family, and scalded after each meal ; the napkins and 

 handkerchiefs, as well as whatever clothing or bed-cloth- 

 ing is soiled by the discharges, should be kept apart from 

 the common wash, and boiled ; and of course the expec- 

 toration should be carefully attended to, received in a 

 suitable receptacle, sterilized or disinfected, and never 

 allowed to dry, for it has been shown that the tubercle 

 bacillus can remain vital in dried sputum for as long as 

 nine months. A very neat arrangement for collecting 

 and disposing of the expectoration is recommended by 

 some boards of health. It consists of a metal case into 

 which a pasteboard box is fitted. When the box is to be 

 emptied the whole of the pasteboard portion is removed, 

 and, together with the expectoration, burned. The metal 

 part is disinfected, provided with a new pasteboard box, 

 and is again ready for use. (See Fig. 16, page 102.) The 

 physician should also give directions for disinfecting the 

 bedroom occupied by a consumptive before it becomes 

 the chamber of a healthy person. 



Boards of health are now becoming more and more in- 

 terested in tuberculosis, and, though exceedingly slow 

 and conservative in their movements, are disseminating 

 literature among doctors for distribution to their patients, 

 with the hope of achieving by volition that which they 

 would otherwise regard as cruel compulsion. 



The channels by which the tubercle bacillus enters the 

 organism are varied. A few cases are on record where 

 the micro-organisms have passed through the placenta, 

 so that a tuberculous mother was able to infect her 

 unborn child. It is not impossible that the passage of 

 bacilli in this manner through the placenta causes the 

 development of tuberculosis in infants after birth, the 

 disease having remained latent during fetal life, for 

 Birch-Hirschfeld has shown that fragments of a fetus, 

 itself showing no tubercular lesions, but coming from a 



