CONSUMPTION AS A CONTAGIOUS DISEASE. 35 



electric shock were one in five hundred, we would turn the wheels 

 of progress back twenty years rather than allow an electric light 

 or a trolley car to threaten our safety. No pains and no expense 

 are thought too great in maintaining a quarantine against cholera, 

 smallpox which the sensible part of the community is already 

 vaccinated against diphtheria, and the like. Large appropria- 

 tions are made that there may be tried a yet unproved defense 

 against diphtheria, but to the insidious enemy that numbers its 

 dead by hundreds where these other open foes count theirs by 

 scores we are blind. It is time that the veil should be drawn 

 from the loathsomeness of " the great white scourge," that the 

 false sentiment which poetry and prose have thrown over infec- 

 tion, blood poisoning, suppuration, and decay should be dissipated. 



In the case of a disease so fatal and so general as tuberculosis, 

 the considerations of cause and prevention become all-important, 

 especially since few cases are curable. The most sanguine author- 

 ity on the subject a New York physician whose patients can com- 

 mand every means of relief, and who usually seek medical advice 

 at the first suspicion of illness claims to cure only one consump- 

 tive out of six. Most physicians would consider this an extremely 

 high proportion, while with regard to well-established cases there 

 is no question that all or nearly all end in death. 



It has been demonstrated by the experimental inoculation of 

 guinea-pigs and other animals that the tubercle bacillus needs no 

 dormant period outside the body such as is requisite for certain 

 other germs but that the disease is directly transmissible. There 

 are two factors in the establishment of any disease the presence 

 of the germ and a certain predisposition. It is not a metaphor 

 but a plain statement of fact to compare the former to the plant- 

 ing of a vegetable, the latter to the adaptability of the soil. Some 

 germs will thrive only under the most favorable conditions, others 

 will grow in almost any person. In other words, some diseases 

 are liable to occur only under definite circumstances of predispo- 

 sition, and these may be readily prevented, while others are viru- 

 lent, attacking whole communities at once. Fortunately, the lat- 

 ter usually " exhaust the soil," so that if the patient recovers from 

 one attack he is not liable to a second, though there are excep- 

 tions to all such rules. Measles, scarlet fever, smallpox in fact, 

 nearly all the eruptive fevers find the proper soil in almost every 

 body, but the something on which they thrive is exhausted, so 

 that thereafter an immunity exists. Tuberculosis never "ex- 

 hausts the soil." Even if the patient recovers as not infre- 

 quently happens in surgical cases, hip-joint disease, inflammation 

 of bones, etc. he is always liable to a subsequent attack of tuber- 

 cular disease, not necessarily in the same organ. On the face of 

 the matter it would seem that a germ that kills a fifth or, to give 



