126 
HAROLD C. ERNST. 
lus of tuberculosis to the disease was, to all intents and pur¬ 
poses, complete upon the publication of Koch’s monograph 
upon the subject. Nothing more in the way of proof was ac¬ 
tually needed, and, indeed, very little has been furnished. At 
the same time, confirmatory evidence was demanded by some 
who had, and many who had not, access to the original details, 
and this confirmatory evidence has been furnished in such 
overwhelming amount, that it is to-day but a waste of time to 
repeat, what is accepted the scientific world over, that in the 
organism described by Koch we have the specific cause of 
this pathological change, and that without its activity we do 
not have tuberculosis in any form or under any conditions. 
An imperfect understanding of the nature of bacteria in 
general, and of this organism in particular, has led to many 
attempts to arrest the pulmonary form of the disease it pro¬ 
duces, by therapeutic measures, most of which would have 
been seen to be useless at the outset, if a knowledge of the 
problem had been complete. It is not upon drugs or mechani¬ 
cal means that our reliance should be placed in attempting to 
stamp out this scourge of civilized man. Our attention must 
be turned in the direction of proper preventive measures, and 
until the necessity for this is impressed upon physicians in 
general, and by them upon the people at large, so that the 
preventive measures suggested after mature deliberation will 
be complied with, but little can be effected, and the knowledge 
gathered after so much hard labor must be considered as 
wasted, for the time being. 
In order to the suggestions upon which the slamping out 
of tuberculosis must depend, there is necessary a large amount 
of investigation into the methods by which it spreads and by 
which the virus is carried from person to person. Among 
these methods are undoubtedly the excreta—more especially 
the sputum—from persons affected with the disease; the ex¬ 
creta are carelessly treated and scattered broadcast, to the 
injury of persons susceptible but not previously affected. The 
methods of distribution in this way, and the behavior of the 
bacillus of tuberculosis outside of the body, have been well 
and recently treated by Cornet ( Zeit . f, Hyg., Bd. v. S. 191, 
1888). 
