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published paper by Dr. Hermann M. Biggs, Medical Officer of the Department of Health of New York City:

“Last year there were reported to the Department of Health more than 13,000 new cases. It may be safely estimated that this represents less than one-half of the cases actually existing in New York City, for many cases live for several years after they are brought to the attention of the Department, and are only included when originally reported, and many are not reported at all. For example, nearly 5000 other cases were reported in 1901, which had been previously reported. I think we may safely estimate that 30,000 cases of tuberculosis in a stage of the disease in which it could be easily recognised by a competent physician are present in New York City.

“I have had a census of the cases actually under treatment in the hospitals in New York City made annually for a series of years, and the total number never much exceeded 1000, or less than 4 per cent. of the cases actually present in the city. The vast proportion of the remainder are in tenement houses. I have estimated that the total expenditure in the city of New York in its public institutions for the care and treatment of tuberculous patients is not over $500,000 a year, or not more than 2 per cent. of the actual loss to the city annually. If this annual expenditure were doubled or trebled it would mean a saving of several thousand lives annually, to say nothing of the enormous saving in suffering.

“It is now fifteen years since the New York City Health Department first began, in a very small way, its efforts for the prevention of tuberculosis, and these have been rewarded by a reduction in the mortality out of all proportion to the expenditure in money and time which has been made. Still, more has been done in New York than in almost any city in the world. The measures, however, now in force are quite inadequate, as compared with the importance and magnitude of the problem. The sanitary authorities, however enthusiastic and efficient, and the medical profession, however influential and numerous, cannot grapple with this problem unless they have the hearty support of the people and the administration of the city. They must have generous appropriations for carrying on the work — for the provision of medical inspectors and disinfectors, for educational measures, for the establishment of dispensaries and sanatoria for the care of incipient cases, and of homes to which advanced cases may be removed, and where they may be made comfortable until the inevitable fatal termination comes. We must remember, in this connection, that every incipient case and every advanced case of tuberculosis which is removed from its home and surroundings and placed in a properly equipped and conducted institution is, in this way, not only given a fair chance for recovery of health, but is educated as to the means to be taken to prevent further extension of infection, and, at the same time, one focus of infection is removed from the city. On the average, every case of tuberculosis infects at least one other case, and if removed to a hospital early enough, the infection of this second case would be, in each instance, prevented, and thus the total number of cases would be reduced.

“ It is in an educational way that lay organisations for the prevention of tuberculosis may be of the greatest service. They serve to arouse interest in and to disseminate knowledge of the nature of tuberculosis; they form compact bodies of public-spirited citizens, whose influence is of the greatest value in so moulding public sentiment that funds shall be forthcoming to erect and maintain dispensaries, sanatoria, and homes for the consumptive poor. Through their assistance, and that of the public press, we may hope eventually to obtain State and municipal appropria. tions for the suitable care of the consumptive poor. New York State has made a small beginning in this way, and it is hoped that the State sanatorium, now in course of erection in the Adirondacks, may lead to very much larger appropriations for this purpose. The State is spending many millions of dollars annually for the care of the insane, and while this is absolutely necessary, for humanitarian reasons, I have no hesitation in saying that far greater returns would be obtained from the expenditure of one-quarter the amount in the prevention and cure of tubercular disease.

“I believe that tuberculosis may be practically stamped out. The reduction in the mortality from it in New York City, since 1886, has been about 40 per cent., which means if applied to the Greater City, a decrease of more than 6000 in the number of deaths annually caused by it. The vast significance of this is still more enhanced when we remember that to a very large extent these deaths take place in the working period, between fifteen and fifty-five years of age. I have no doubt that the measures, first begun in a very small way in New York City fifteen years ago, inadequate as they have been, have resulted in saving the lives of at least twenty thousand persons. The annual deaths in the Greater City still number between nine and ten thousand, and we know that these are, to a very large extent, unnecessary.

CHAPTER VIII

LEPROSY

OV

EPROSY is an infectious disease due to a bacillus, I discovered in 1879 by Hansen, a Norwegian physician. This bacillus is found in great numbers in the cells contained in the leprous nodules, which are characteristic of the disease. In its form the leprosy bacillus resembles the tubercle bacillus, but bacteriologists have failed in their attempts to cultivate it in artificial media and in communicating the disease to lower animals, as has been repeatedly done in the case of the tubercle bacillus. Nor has it been determined in a definite manner how the disease is contracted. It is not, unless in very exceptional cases, communicated by the sick to those in close association with them. Thus among the Sisters of Charity who have for many years taken care of the sick in the lepers' hospital at Havana, not one has ever contracted the disease. Inoculation experiments in healthy men, made with the knowledge and consent

of those inoculated, have been repeatedly made by investigators with a negative result. In these inoculations, blood, pus, and portions of the leprous tissues containing numerous bacilli have been used. In a single instance only was such an inoculation followed by the development of leprosy, but this man belonged to a leprous family and it is not cer

[graphic]

Fig. 6. Bacillus of leprosy, as seen in a thin section of a leprous nodule : magnified 1000 diameters.

tain that the disease in his case was a result of the inoculation.

The question as to whether leprosy is contagious has been much discussed by physicians, and while this has been most positively denied by many physicians, and certainly does not occur under ordinary conditions, the opinion seems to be gaining ground

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