TUBERCULOSIS. 309 



why the expectoration of consumptives has not rendered 

 our atmospheres pestilential. 



As long as tuberculosis exists among men or cattle, it 

 shows that the existing hygienic precautions are insuf- 

 ficient. While not so radical as to suggest the unreason- 

 able isolation of patients and destruction of property once 

 practised in the kingdom of Naples, I favor the registra- 

 tion of all tuberculous cases as a means of collecting 

 accurate data concerning their origin, insist upon 

 domestic sterilization and disinfection, and would have 

 special hospitals for as man}-, especially of the poorer 

 classes, among whom hygienic measures are almost 

 always opposed, as could be persuaded to occupy them. 



It has already been declared the duty of the physician 

 to use every means in his power to prevent the spread 

 of infection in the households in his care, and no disease 

 is more deserving of attention than this neglected one. 

 Patients should cease to kiss the members of their fam- 

 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. 20, page 178.) The 

 physician should also give directions for disinfecting the 



