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SCIENCE 



[N. S. Vol. XXX. No. 770 



was shown a few years ago by Professor 

 Pluegge and his co-workers, that tuberculous 

 patients, in coughing and sneezing and also 

 in speaking, project into the air within a dis- 

 tance of two and one half to three feet small 

 droplets of saliva containing fresh and viru- 

 lent bacilli, which when inhaled constitute a 

 special source of danger, unless the patient 

 takes care to hold his hand or handkerchief 

 before his mouth. It is held by many, and we 

 believe correctly, that droplet infection is 

 even more dangerous than the inhalation of 

 infected dust. The author describes very 

 lucidly the methods of the four sources of 

 infection and points out that the touch of the 

 clean conscientious consumptive can not give 

 tuberculosis to others. Chapter III. deals 

 with the duties of the physician towards his 

 patient, the family and the community at 

 large. We heartily endorse the opinion of the 

 author that it is wrong, if not a criminal 

 neglect, to hide from an intelligent adult the 

 fact that he is tuberculous or that a member 

 of his family is affected with the disease. 



All that is required is tact, and the task of 

 inspiring confidence is not diificult when we 

 can assure our patients that with proper coop- 

 eration and treatment over 80 per cent, of 

 cures of incipient cases have been reported. 

 The chapter also contains excellent sugges- 

 tions for leaflets of instruction, inauguration 

 of general preventive measures, when to send 

 patients away, maxims in the choice of cli- 

 mate, selection of occupation for persons pre- 

 disposed to tuberculosis, compulsory notifica- 

 tion, disinfection of the sick room, the treat- 

 ment of the patient's mind, etc. The author 

 very properly favors notification of tuberculous 

 cases to the health authorities, so as to locate 

 the sources of infection, to trace and remove 

 the underlying causes of the prevalence of 

 tuberculosis and last but not least resort to 

 disinfection of the premises upon the death or 

 removal of the patient. 



The author's twelve maxims on the subject 

 of climatic treatment are sound and should 

 receive careful consideration by physicians 

 and patients. We fully endorse his strong 

 opposition to sending an impecunious patient 



to a far-away climate in the hope that in a 

 few weeks he may find light employment, when 

 as a matter of fact he is likely to swell the 

 number of inmates of the hospitals and chari- 

 table institutions of the far west. Chapter 

 IV. is of special interest, as it tells us in a 

 most instructive manner how the sanatorium 

 may be adapted to and initiated in the home 

 of the consumptive. In view of the fact that 

 over 90 per cent, of our cases are either too 

 poor or otherwise unsuitable for climatic cures, 

 the practical value of this chapter must be 

 apparent. Indeed we are beginning to realize 

 more and more that while certain climatic 

 conditions are valuable as auxiliary factors, 

 our main dependence is after all an abundance 

 of pure air, and a hygienic and dietetic 

 regimen. 



Chapter V. tells us in a most interesting 

 manner how sanitation and proper housing 

 conditions may aid in the prevention of tu- 

 berculosis. We quite agree with Dr. Knopf 

 that unsanitary dwellings, overcrowding, lack 

 of pure air and sunshine, are most important 

 predisposing factors to the disease. 



His views of the effects of polluted air in 

 the cities, workshops and dwellings, and his 

 plea for wide streets and lower buildings, sani- 

 tary houses and model tenements, should be 

 heeded, since general sanitation constitutes one 

 of the most effective weapons in the combat 

 against the disease. The present writer has 

 recently studied the general movement of 

 tuberculosis in this country and Great Britain 

 and finds that the death rate from tuberculosis 

 in Washington has fallen from 446 per 100,000 

 of population in 1880 to 280 in 1907. In New 

 York City from 433 to 271. In the United 

 States at large from 326 to 183. In Great 

 Britain and in Massachusetts the reduction 

 since 1850 amounts to over 50 per cent. These 

 reductions began long before the combat of the 

 disease was a subject for popular education 

 and are coincident with the introduction of 

 sewers, improved water supplies and the erec- 

 tion of sanitary homes. The marked reduc- 

 tion in the prevalence of consumption after 

 the introduction of sewers observed in Eng- 

 land and elsewhere may, to a great extent, be 



