THE ADMINISTRATIVE ASPECTS OF TUBERCULOSIS 7 



in science are capable of offering those perfunctory half-thoughts as if 

 they were established truths. Before we determine dogmatically who 

 shall die, we should exhaust our means of discovering who can live. 



IV. General Sanitation versus Direct Control. 



Ever since Koch's discovery, conviction has been gaining ground 

 that the spread of tuberculosis can be limited by administrative 

 methods. In many parts of Europe and America, it has been so 

 limited. There is a good deal of evidence for the proposition that the 

 isolation of phthisical cases has materially reduced the total number of 

 cases. It is true that, for fifty years, the death-rate from phthisis in 

 Britain has fallen year by year until to-day it is only about 50 per cent 

 of what it was. It has been assumed, without much effort at analysis, 

 that this steady decrease has been the result of improved "general 

 sanitation." Doubtless, general sanitation has contributed something, if 

 under "general sanitation" we include the draining of soils, the sewering 

 of towns, the improvement in houses, the increase in cleanliness of 

 habit, and most of all the steady, remorseless, systematic campaign 

 against infection of every form. What destroys one infection destroys 

 another. Incidentally, in our efforts to limit typhus, typhoid, puerperal 

 fever, scarlet fever, diphtheria, septicaemia, pyaemia, and many other 

 infections, we have been dealing, intimately and in detail, with the same 

 conditions as the tubercle bacillus thrives in. In killing typhus and 

 typhoid, we have, doubtless, without intending it, killed also tuberculosis, 

 but the tubercle bacillus is a slowly invading and most persistent 

 parasite. It gets to places that few other parasites can invade. Every- 

 where it finds a nidus so easily that it is naturally the last to be 

 expelled. Precisely because it kills slowly, it kills most. That is 

 probably why, when most of the other parasites steadily fall back before 

 isolation, disinfection and prophylactic injections, phthisis needs more 

 determined and subtle dealing. But with every allowance for the 

 insidiousness of this slow parasite, we are now justified by the evidence 

 in our conclusion that by direct attack, as in typhus, typhoid, scarlet 

 fever and the others, we shall be able to reduce the spread of the disease 

 by securing that the patient shall confine his infection to himself. To 



(81) G 



