AND MEDICAL SCIENCE 323 



though the tendency of late has been to believe in contagion only. 

 The great change of view that has been generally adopted by 

 the medical profession in regard to this matter within the last few 

 years is most remarkable and unprecedented. This change, too, 

 has developed, not so much by reason of fresh and conclusive 

 evidence as to the frequency of contagion in the human subject, 

 but almost entirely from theoretical considerations and from un- 

 willingness to believe that a disease caused by a Bacillus, and 

 capable of being freely propagated experimentally among lower 

 animals inoculated therewith, can also arise de novo. At the 

 present time it is regarded as quite heretical to think it possible 

 that phthisis can arise independently ; while as late as 1896 we find 

 Crookshank in his " Bacteriology and Infective Diseases " (p. 387) 

 writing as follows : " Whether the disease in man is contagious is an 

 open question, though numerous cases of supposed communication 

 between husband and wife, brothers and sisters, have been 

 reported, and Ransome showed that tubercle Bacilli were present 

 in the breath in phthisis. On the other hand, the experience in 

 consumption hospitals does not support this view, there being no 

 evidence of the communication of the disease to nurses and 

 hospital attendants." Such, then, have been the remarkable 

 discrepancies in the common view entertained upon this question 

 within a brief period of less than ten years. 



At present there is a beneficent enthusiasm for " sanatoriums " in 

 this and other European countries for the relief or the cure of 

 patients who are afflicted with this common and very fatal 

 affection. Phthisis is unquestionably capable of being mitigated 

 — and even cured in many cases where it is not too far advanced — 

 by plenty of fresh air and the best hygienic conditions.' This 

 seems to me rather to lend favour to the view that it is commonly 

 an affection produced de novo and altogether apart from con- 

 tagion, as we formerly believed. If good hygienic conditions 

 and improved vitality will lead to the cure of the disease, then 



• Sometimes, too, even a simple surgical operation, such as drainage of the 

 abdomen in a case of tuberculous peritonitis, will lead to a cure of the patient, 

 notwithstanding the presence in his tissues of untold legions of the specific 

 Bacilli. In his admirable address to the British Medical Association at its recent 

 meeting Mr. Mayo Robson says ("British Medical Journal," August i, 1903, 

 p. 24s) : " I have seen patients reduced to the last extremity of weakness, 

 where the mesentery was standing stiff with tubercle and the abdomen was 

 swollen to an enormous size, recover completely and be thoroughly restored to 

 perfect health from a condition apparently completely hopeless." 



