The Administrative Aspects of Tuberculosis. 



I. The Tubercle Bacillus— Tuberculine— Heredity. 



How does the problem of tuberculosis present itself to the adminis- 

 trative mind ? To that question I shall try to give some answer. 



For the modern administrator, the history of tuberculosis began 

 when Koch isolated his bacillus. That the disease was an infection, 

 communicable from man to man, is a fact as old at least as the days of 

 Isocrates, and older. Through the ages, the belief in its infectivity can 

 be traced in literary and scientific records. The Nineteenth Century 

 cannot claim to have discovered the fact, nor can the Twentieth Century 

 yet claim to have exhausted the pathology of the disorder. But it 

 remains true that, for the ends of administration, the whole history of 

 the disease before Koch may be blotted out of our books. Even with 

 the isolation of the bacillus, the administrative problem was weighted by 

 a thousand irrelevancies. The pre-Koch pathology is far from dead. 

 It still perverts the clinical mind. It is still repeated in the text-books. 

 It still crowds the lectures with antiquarian rubbish. It clouds the mind 

 of the student with useless knowledge. It blocks the way to frankness 

 of outlook and precision of practice. Curiously, it has faded most 

 rapidly where the lay mind has had to be convinced. For, to teach the 

 farmer, or the salesman, or the butcher, or the dairyman, or the mother 

 of children, or any of the other innumerable units that constitute an 

 organized society, all the delicacies contained in the ancient theories of a 

 wasting disease would have been a hopeless and futile task. Even the 

 youngest medical officer of health — fresh, enthusiastic, full of Virchow 

 and not ignorant of Darwin — would have been beating his head against 

 the rocks had he tried to rouse in the lay mind any interest answering 

 to his own. Until Koch, the disease was too difficult, too complex, too 



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