CONGRESS ON TUBERCULOSIS. 
451 
small means? Every medical man who has often entered the 
dwellings of the poor, and I can speak on this point from my 
own experience, knows how sad is the lot of consumptives and 
their families there. The whole family have to live in one or 
two small, ill ventilated rooms. The patient is left without the 
nursing he needs, because the able-bodied members of the family 
must go to their work. How can the necessary cleanliness be 
secured under such circumstances? How is such a helpless 
patient to remove his sputum, so that it may do no harm ? But 
let us go a step further and picture the condition of a poor con¬ 
sumptive patient’s dwelling at night. The whole family sleep 
crowded together in one small room. However cautious he may 
be, the sufferer scatters the morbid matter secreted by his dis¬ 
eased lungs every time he coughs, and his relatives close beside 
him must inhale this poison. Thus whole families are infected. 
They die out, and awaken in the minds of those who do not 
know the infectiousness of tuberculosis the opinion that it 
is hereditary, whereas its transmission in the cases in question 
was due solely to the simplest processes of Infection, which do 
not strike people so much, because the consequences do not ap¬ 
pear at once, but generally only after the lapse of years. 
Often, under such circumstances, the Infection is not re¬ 
stricted to a single family, but spread in densely inhabited tene¬ 
ment houses to the neighbors, and then, as the admirable inves¬ 
tigations of Biggs have shown in the case of the densely peopled 
parts of New York, regular nests or foci of disease are formed. 
But, if one investigates these matters more thoroughly, one finds 
that it is not poverty per se that favors tuberculosis, but the 
bad domestic conditions under which the poor everywhere, but 
especially in great cities, have to live. For, as the German statis¬ 
tics show, tuberculosis is less frequent even among the poor, when 
the population is not densely packed together, and may attain 
very great dimensions among a well-to-do population when the 
domestic conditions, especially as regards the bedrooms, are 
bad, as is the case, for instance, among the inhabitants of the 
North Sea coast. So it is the overcrowded dwellings of the 
poor that we have to regard as the real breeding places of tuber¬ 
culosis ; it is out of them that the disease always crops up anew, 
and it is to the abolition of these conditions that we must first 
and foremost direct our attention if we wish to attack the evil 
at its root, and to wage war against it with effective weapons. 
This being so, it is very gratifying to see how efforts are be¬ 
ing made in almost all countries to improve the domestic con- 
