ATMOSPHERE IN RELATION TO HUMAN LIFE AND HEALTH. 255 



sputum itself of consumptives, may infect healthy persons, but mostly 

 those who have some tissue delicacy or predisposition. But another 

 very common cause, especially in the largely fatal tuberculosis of infants, 

 is the use of milk from infected cows. Now, these cows are themselves 

 diseased through media very similar to those which disarm the human 

 subject, rebreathed foul air and dirty places; in fact, want of cleanli- 

 ness, and, above all, want of fresh air. 



Well-ventilated cow sheds, and immediate separation of sick animals, 

 prevent the spread of tuberculosis among cows; thus children are 

 saved from the danger of tuberculous milk. The breath of the con- 

 sumptive in well-ventilated rooms may be considered harmless. 

 Animals have been infected by breathing the dust of sputum dissem- 

 inated in the air, and no doubt the same mode of infection is very 

 common among mankind, but only in close association with the sick or 

 in stuffy apartments. The State board of health of Maine has issued 

 valuable instructions to prevent the practice of expectoration except 

 in spittoons, which may be wooden or pasteboard, and should either be 

 burned daily or cleansed with boiling water and potash soap. 



The reduction of consumption by such means and by better regard 

 for ventilation is not only probable, but certain. In England the death 

 rate has considerably declined with sanitation. From 1851 to 1800 it 

 was 2,079 per million per annum. In 1888 it was 1,511. In New 

 Hampshire, United States, the deaths from the several diseases named 

 were as follows: From 1881 to 1888, consumption, 1,039; diphtheria 

 and croup, 983; typhoid, 750; scarlatina, 187; measles, 100; whoop- 

 ing cough, 109; smallpox, 2. Here the very large proportion of deaths 

 due to consumption, and the importance of effecting a reduction, are 

 strikingly shown; but a similar proportion exhibits itself in every 

 thickly inhabited State, both in Europe and America. 



Booms occupied by consumptives should be periodically disinfected 

 and always kept clean. The danger is there, but it can be averted. The 

 experience of the Brompton Hospital shows that with proper hygienic 

 precautions cases of infection from patients are very rare. Koch has 

 shown that enormous multitudes of bacilli may be distributed on the 

 ground and in the air from only one patient, and how infection is 

 explained by their long survival in a moist or dry state. Cornet 

 showed how the walls and carpets, cornices, etc., retain them still 

 potentially virulent. Thus certain houses remain for a long while 

 centers of infection, and newcomers are attacked out of all propor- 

 tion to the cases among neighboring uninfected dwellings. 



Prisons, barracks, etc., which when crowded and badly ventilated 

 were very fatally affected with consumption have been rendered whole- 

 some by thorough ventilation and greater cleanliness. Out of an 

 average prison population of 1,807 in the year 1890 in England, only 

 9 died of phthisis, excluding cases in which sick prisoners were 

 removed home. 



