356 TUBERCULOSIS AS A TYPE OF BACTERIAL DISEASE 



simulating tuberculosis (protozoal infections, parasitical disease, etc.), 

 but to designate a pathological condition set up by a special group 



11. The expectoration is infective. This is one of the commonest modes of 

 infection, and to it is held to be due the large amount of respiratory tuberculosis 

 (consumption, phthisis). The expectoration from the lungs must contain, from the 

 nature of the case, a very large number of bacilli. As a matter of fact, a single 

 consumptive individual can cough up in a day millions of tubercle bacilli. When 

 expectoration becomes dry, the least current of air will disseminate the infective 

 dust, which can by that means be readily reinspired. Infective saliva on pave- 

 ments and floors, as well as on handkerchiefs, or even in books, may thus become a 

 source of danger to others. The discharges from the bowels of infants suffering 

 from the disease also contain the infective material. 



12. Milk, though a much more likely channel for conveyance of tubercle than 

 meat, is only or chiefly virulent when the udder is the seat of tuberculous lesions. 

 The consumption of such milk is only dangerous when it contains a great number of 

 bacilli and is ingested in considerable quantity. Practically, the danger from using 

 raw milk only exists for those persons who use it as their sole or principal food, e.g. , 

 young children. All danger is avoided by boiling or pasteurising the milk. 



At the same time there is an increasing amount of evidence forthcoming at the 

 present time which goes to prove that milk is not infrequently tainted with tubercle 

 (see pp. 204-206). The tuberculin test should be applied to all milch cows, and the 

 infected ones isolated from the herd. They need not necessarily be slaughtered. 

 Milk supplies should be more strictly inspected. 



13. There are several methods by which meat infection can he prevented. In the 

 first place, herds should be kept healthy, and tubercular animals isolated. Cowsheds 

 and byres should be under sanitary supervision, especially as regards overcrowding, 

 dampness, lack of light, and uncleanliness. Public slaughter-houses under a 

 Sanitary Authority would undoubtedly be advantageous. Meat inspection should 

 also be more strictly attended to; efficient cooking, and avoidance of "roll" meat 

 which has not been thoroughly cooked in the middle, are also wise measures to adopt. 



14. Consumptive patients may diminish their disease. Dr Arthur Ransome* has 

 laid down five axioms of hygiene for phthisical patients which, if followed, would 

 materially improve the condition of such persons. At Davos, St Moritz, Nordrach, 

 Nordrach-on-Mendip, and many other places where they have been practised, the 

 beneficial change has been in many cases extraordinary. 



(1) Abundance of light, nutritious, easily digested food, which must comprise 



a large allowance of fat ; small meals, but frequent. 



(2) An almost entirely open-air life, with as much sunshine as can be 



obtained. 



Suitable clothing, mostly wool. 

 Cleanliness, and bracing, cold-water treatment. 

 (5) Mild but regular exercise. 



15. Consumptive patients may also assist in preventing the spread of the disease. In 

 the first place, they should follow the hygienic directions just mentioned, because the 

 fulfilment of such conditions will materially lessen the contagiousness of the disease. 

 Next, the expectoration must never be allowed to get dry. A spitting-cup containing 

 a little disinfectant solution (one teaspoonful of strong carbolic acid to two table- 

 spoonfuls of water) should always be used, or the expectoration received into paper 

 handkerchiefs which can be burnt. Spoons, forks, cups, and all such articles should 

 be thoroughly cleaned before being used by other persons. The patient should not 

 sleep in company with another, and should occupy, if possible, a separate bedroom. 

 Isolation hospitals for consumptives, as for patients suffering from the ordinary 

 infectious diseases, are now being established. 



16. House influence has some effect, both directly and indirectly, upon tubercular 

 diseases. Damp soils, darkness, and small cubic space in the dwelling-house exert a 

 very prejudicial effect upon tubercular patients. Sir Richard Thorne Throne t has 



* Arthur Ransome, M.D., F.R.S., Treatment of Phthisis. 

 t Practitioner, vol. xlvi. 



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