DISTRIBUTION OF TUBERCULOSIS 107 
It would not be right to draw conclusions from these experiments in themselves, 
but as they bear out the results of many other experiments we may safely do so. 
The one house, the dust of which proved infective, was the only one in which 
there had been carelessness in the disposal of the sputa, and in which ordinary 
cleanliness had not been observed during and after the patient's death. 
It shows what a menace the consumptive's room may be to those who spend 
any time in it, either during the patient's illness or for some time after. When a case 
has occurred in a lodging-house or hotel many may become infected by occupying, for 
a short time only, the room in which the patient lay. 
It is satisfactory to know that the death rate throughout England from 
Tuberculosis has gradually decreased during the past 40 or 50 years with improved 
sanitation. With proper care in the disposal of the sputa it could be made remarkably 
less. 
It is first essential that the patient understands thoroughly his disease is con- 
sumption. A patient who is expectorating, if told by his physician that his lungs are 
' weak ' or ' slightly affected,' will not see the necessity for destroying his expectoration. 
The physician should tell him frankly what his disease is, and, at the same time, give 
him to understand that it is not necessarily fatal, or at any rate not immediately so ; 
that he has good chances for recovery, if in an early stage, and if the physician's advice 
is carefully followed. 
The statement generally accepted is that Tuberculosis, directly or indirectly, 
causes the death of one in every seven throughout England, and one in every four or 
five of the working classes. In Liverpool, as we have seen, about one death in every 
nine is directly ascribed to Tuberculosis. These figures impress us with the necessity 
of doing everything in our power to control its spread. 
In order to reach as many cases as possible, it should be a rule to examine 
the chest of every case presenting for treatment at the out-patient department of the 
hospitals and dispensaries, whether medical or surgical. This was begun some time 
ago in some of the American dispensaries, and so many unsuspected cases were 
discovered that it is now done as a matter of routine, and is bearing excellent results. 
It would be advisable, also, to have a small pamphlet for distribution amongst 
such cases, instructing them about the disposal of their expectoration. It should be 
carefully prepared, so as to avoid alarming them or their friends, for if the danger be 
made too prominent it may result in making them practically outcasts, to be avoided. 
I have seen this in other places, where people with a slight knowledge of the danger of 
consumptives in a community have so exaggerated matters as to forbid them in certain 
hotels and boarding-houses. The pamphlet should advise them as to diet, clothing, 
and hygiene, as well as to care with the expectoration ; and I am confident this 
would materially add to the influences at work in the decrease of the mortality from 
this disease. 
