entire surface of the body. At all events it is very contagious, and the infection clings to clothing and other articles which have been in contact with the sick. This being the case, our chief reliance for the prevention of the disease must be on the isolation of the sick, and careful disinfection of all articles that have been exposed to infection and of the patient's body and excreta. This is to be accomplished by the same measures recommended in the case of smallpox.

Owing to the fact that typhus fever is communicated by personal contact, and in the absence of any known method of establishing immunity by inoculation, physicians and nurses are especially liable to contract the disease. During the epidemics in Ireland, between the years 1813 and 1848, it is reported that 568 physicians contracted typhus fever and of these 132 died. During the Crimean War, the mortality from this disease, among physicians and nurses, was very great.

One attack of typhus usually confers immunity upon the individual, but second attacks may occur. The mortality from the disease is slight among children under ten years of age, but increases with age, being highest between the ages of thirty and fifty (41.97%).

CHAPTER VII

TUBERCULOSIS

T is a well-established fact, which is generally re

IT

cognised, that pulmonary consumption is due to a minute bacillus, discovered over twenty years ago by the famous German bacteriologist, Robert Koch, and that this bacillus is present in large numbers in the purulent matter coughed up from the lungs of those suffering from the disease. We also know that the propagation of the disease depends largely upon the introduction of the bacillus, suspended in the inspired air in the form of dust, to the lungs of susceptible individuals, by way of the respiratory passages. That dust in hospitals and dwellings occupied by consumptive patients may contain living tubercle bacilli has been repeatedly demonstrated, and it is evident that the only way to guard against this danger is to destroy by fire or disinfecting agents all expectorated material coming from the lungs of consumptive patients. If this is done, such persons do not endanger those with whom they are associated; if it is not done,

they become active agents in the transmission of this infectious disease—“the great white plague "—which is responsible for twelve per cent. of the deaths which occur within the limits of the United States.

The last census report shows that in the census year, 1900, 109,750 deaths occurred from pulmonary consumption. This is a smaller number in proportion

FIG. 5. Bacillus of tuberculosis, as seen in the sputum of a patient having pulmonary consumption; magnified 1000 diameters.

to the population than occurred in 1890. A decided gain is shown during recent years by the mortality statistics of some of our large cities, in which special efforts have been made to instruct the public as to the method in which the disease is propagated, to prevent expectoration in public places, and to disinfect the sputa of recognised cases of pulmonary tuberculosis.

New York City, under the able leadership of Dr.

Hermann M. Biggs, Medical Officer of the Department of Health, has taken the lead in carrying out these measures for the prevention of the disease, and with most notable results. The death-rate from tuberculous diseases has been gradually and progressively reduced from 4.42 per cent. in 1886 to 2.89 per cent. in 1902. Dr. Biggs says in a recent paper:

During the first six months of 1902, 4673 deaths from tuberculosis occurred, equalling a reduction of 10 per cent. on the death-rate of 1901, which was the lowest ever recorded."

As to the methods adopted in New York, Dr. Biggs

says:

66

In 1888 a commencement was made by issuing circulars setting forth the essential facts regarding the nature of the disease, the usual methods of its transmission, and the precautions necessary to prevent its spread. Small circulars of information were also freely distributed in the tenement-house districts and the public press was utilised for the education of the public as to the communicable nature of tuberculosis. This campaign of education was continued until 1893 when the City Board of health required all public institutions to promptly report all cases of pulmonary consumption coming under observation and requested physicians in private practice to do the same. In 1897 a section was added to the Sanitary Code declaring pulmonary tuberculosis to be an 'infectious and communicable disease, dangerous to the public health,' and requiring physicians to report to the Health Department all cases coming under their observation."

Dr. Biggs concludes his paper, from which I have quoted, as follows:

"It seems evident that sure progress is being made, and with the cordial support of the medical profession, as a whole, which is now freely accorded by the best elements of the profession, followed as this must be by the universal popular appreciation of the true nature of tuberculosis in place of the unreasoning fear or careless indifference which has largely prevailed, we may confidently anticipate, as the result of continued effort, the almost entire eradication of this, the most fatal disease with which sanitary authorities have to deal."

The last census return (1900) shows that in the registration area the death-rate from consumption was 187.3 per 100,000 of the population, while the preceding census gave a rate of 245.4 per 100,000.

Similar progress is reported in those countries of Europe which have given the most attention to sanitary matters. In Prussia a notable diminution in the mortality from tuberculosis commenced about the year 1887, five years after the discovery of the tubercle bacillus. This has been continuous up to the present time. Prior to the date mentioned, the mortality rate from tuberculosis in Prussia had for some time remained stationary at about 310 per 100,000 inhabitants; since the year 1887, it has fallen to 210 (in the year 1900). Similar progress in the future would lead to the practical extinction of the disease in twenty or thirty years. In England, during the same period, a reduction from 240 to 190 per 100,000 has occurred. The last census return shows that the District of Columbia has "the highest death-rate