ANNUAL ADDRESS 
BEFORE THE 
State Board of Health 
OF 
PENNSYLVANIA. 
By SAMUEL G. DIXON, M. D., 
Professor of Hygiene in the University of Pennsylvania. 
HARRISBURG, PA.: 
E. K. MEYERS, STATE PRINTER, 
I893- ANNUAL ADDRESS 
BEFORE THE 
State Board of Health 
OF PENNSYLVANIA, 
By Samuel. CL Dixon, M. D., 
Professor of Hygiene in the University of Pennsylvania. 
Gentlemen: Before entering- upon the important topics which I pro- 
pose to discuss before you this evening, I will take the first opportunity 
that presents itself of expressing the great pleasure and honor which I 
experience in having been requested to deliver the address before a 
body of gentlemen whose high function it is to act as the guardians of 
the health of the people of this great state, and to keep a vigilant eye 
upon all measures, which, whether local or general in their application, 
are-calculated, in your judgment, either favorably or adversely, to affect 
the public health. 
It is difficult, gentlemen, to overrate the importance of your mission, 
and it is a matter for congratulation that the age in which we live is far 
and away in advance in its recognition of the importance of hygiene as 
a public question than were the days in the earlier periods of our his- 
tory. 
Facts which were then ignored or scoffed at are now generally ad- 
mitted, even if not fully realized and acted on; and the era of ignorance 
and unbelief, which was followed by that of speculation—times, no 
doubt, exceedingly trying to your predecessors intrusted with the ex- 
1 2 
ecution of sanitary improvement and maintenance of proper precau- 
tions—has passed away. 
And yet much remains in the way of public enlightenment before you 
can be expected to accomplish the full measure of your calling-, or re- 
ceive that general and cordial co-operation, without which your hands 
are tied and your work hampered. 
Public sanitation can only be accomplished by a public body repre- 
senting the state; individual effort, however much directed by zeal, may 
be altogether without knowledge; and thus a single ignoramus may 
cultivate enough propagating germs of disease to infect a whole town 
or district, and so frustrate the good work of a representative board. 
Therefore, it is upon a board of health, such as I see before me this 
evening, in a great measure depends the health of the people; but, at 
the same time, the best efforts you may make are doomed to failure, 
unless you receive those plenary powers which will enable you to carry 
out your plans. 
And it is important to remember that while curative medicine is still 
but an art, which has progressed but little during the last fifty years, 
preventive medicine or sanitary knowledge has advanced to the dignity 
of a science, which may be destined within a few years to monopolize 
the attention of the medical profession, to the partial exclusion of the 
old-fashioned methods in which we have been reared. 
The accession or increase to our knowledge as to the origin and growth 
of disease during the last ten years has been very great, and particularly 
is this the case respecting the recent researches into tuberculosis, thereby 
throwing upon us a greater degree of responsibility in using all means 
at our command to prevent and minimize the spread of this fell disease. 
If we should sit still and permit the enemy to plant his guns right 
within our midst, it follows as a matter of course that we are beaten be- 
fore the battle begins; and so if our citizens refuse to fall into the ranks, 
shoulder their muskets, and volunteer their aid under the orders of their 
superior officers, is it reasonable to hold the latter responsible for the 
killed and wounded ? Certainly not. We may preach, and counsel, and 
exhort, and more than that, prove what we teach until we are tired; but 
unless we can obtain the zealous and intelligent co-operation of our fel- 
low-citizens, we might as well talk to the moon. 
A few weeks ago a wave of excitement swept over the land at the pos- 
siblity of a rupture in our peaceful relations with Italy; and it looked 
at one time as if a recourse to arms of precision would be resorted to in 
default of an amicable arrangement; but, thanks to the skilful handling 
of the matted by our secretary of state and the return to common sense 
on the part of the statesmen of Italy, this calamity was averted. 
Well, gentlemen, such an outcome to the dispute would have been a 
matter gravely to be deplored, but I doubt whether it would in the long 
run have proved more disastrous to us than is the constant and ever- 3 
increasing flood into this country of the lowest, most degraded and often 
plague-stricken populations of the Latin, Hungarian and Sclavonic races. 
These people bring with them here and perpetuate the unsavory and 
insanitary habits of life under which they existed in their own lands with 
an utter disregard of those elementary principles of health which do 
obtain among the poorest classes of our own citizens; and thus when an 
outbreak of disease or epidemic occurs, these foreign settlements of 
Italians, Huns and Sclavs, etc., form nuclei or hotbeds of infection from 
which points of vantage disease and death hold high carnival. 
I do feel most strongly that it is the imperative duty of our represen- 
tatives in congress to give these matters urgent attention, and take 
measures to protect the health of our people by excluding from these 
shores this deluge of undesirable people from other lands, who really 
add nothing to the prosperity of our country, but in the majority of in- 
stances return after many years to their homes, carrying back with them 
the money which they have made here, in consequence of the higher 
wages and prevailing happier economic conditions. 
The elements of disorder which accompany this wholesale immigra- 
tion are patent to everyone, and some startling illustrations have been 
afforded us in our own state within the last few months; but this phase 
of the question is not within our province, although we are fully within 
our domain in approaching the subject from the standpoint of public 
health. 
There are many moments when we, who devote the best part of our 
lives to the endeavor to trace back to its source man’s greatest foe—dis- 
ease—to find out its hidden ways and to devise means for overcoming 
its hidden and stealthy marches upon its unsuspecting victims, must of 
necessity feel much discouragement at the scanty sympathy accorded 
to our work. 
It would almost seem as if the energies of our statesmen were concen- 
trated upon the health of the American hog and bullock. They are the 
subjects of much affectionate solicitude, and the resources of our great 
legations are exhausted in the endeavor to induce foreign governments 
to cast favorable eyes upon these much-maligned animals and permit 
them entrance into their countries. 
If cholera breaks out among hogs immediate attention is given them 
by the local authorities, or if pleuro-pneumonia shows itself in cattle 
nothing is left undone to stamp it out; and in the same way, if our corn 
or potatoes are attacked by a parasite the whole science of the country 
is brought to bear upon the question. 
In doing this our legislators and local authorities simply obey the 
mandates of the people whose servants they are, or ought to be. It is 
not that they undervalue human life, or set animal life above it, but 
simply that in the one case the results appeal directly to their pockets, 
while the other lies more in the region of feeling and sentiment. 4 
During1 the cattle plague that devastated England some years ago 
thousands of valuable beasts either died from pleuro pneumonia or were 
slaughtered to prevent the spread of the disease; and the loss in money 
amounted to millions of dollars; butii the same number of human beings 
had died from an epidemic, the loss in money would have not amounted 
to anything; and yet how immeasurably greater the one calamity than 
the other. The subject is a thorny one andalmost impossible of correct 
presentment. 
What, however, we of the medical profession feel, and feel strongly, 
is that there ought not to be anything in the shape of a “favored-nation 
clause ” in regard to public effort and expenditure for the prevention of 
disease among animals as distinguished from that among the human 
race. 
» The neglect and supineness which exist among our authorities some- 
times strike me as almost criminal. Take, for example, the question of 
the sewers in Philadelphia. I have no hesitation in saying that they are 
probably the worst in the world, at least in a city of her rank and im- 
portance. The day will assuredly come when, the conditions for it be- 
ing favorable, some terrible outbreak will drive the lesson home in a way 
that now seems impossible. 
But certain it is that not until our people in Pennsylvania realize that 
without health nothing is worth having, will the State Board of Health 
take that place to which it is entitled, and be regarded as the most im- 
portant body in our state government. A minister of agriculture is a 
very useful and important personage, and the health of our flocks and 
herds is of vital moment to us, yet it cannot be compared with the su- 
preme question of human health and, therefore, happiness. 
When we who are willing to march daily into the camps of the tuber- 
cle bacillus—the more deadly anthrax bacillus, those of diphtheria and 
typhoid fever—come tc be regarded as soldiers who risk their lives for 
those who are living in their comfortable offices and counting rooms, 
then, and not until then, can we expect that support which is justly due 
to those who will face leaden bullets and give their lives to benefit their 
fellow-creatures. 
The discoveries which have been made within recent years encourage 
us to go forward in the endeavor to stamp out disease before it reaches 
a point beyond our grasp. “ Venienli occurrite morbo ”—Hasten to meet 
the coming disease—is the true watchword of our profession. 
We know now that disease is either originated or, to say the least, 
much aggravated in most cases by a mico-organism which enters the 
body from without, thereby bringing more lives to a premature end than 
has ever been caused by the fiercest of wars and bloodiest of campaigns. 
With this knowledge before us we are encouraged and stimulated to take 
our lives in our hands in order to study and learn the life history of these 
our greatest foes- and, therefore, it seems appropriate that we should 5 
take the subject of tuberculosis this evening- as one of the diseases which 
has proved so deadly and caused so much suffering, and speak of what 
we know concerning its origin, growth, etc., etc. 
Yet, gentlemen, there is no subject that has been so thoroughly diag- 
nosed during the last year as tuberculosis in regard to its causes and 
effects,, its treatment and prevention, and I doubt whether it be possible 
to summon a set of professional men who are more conversant with this 
malady than those comprising the- health board of Pennsylvania, whom 
I am now addressing; therefore, all 1 can hope to accomplish is to lay 
open this subject in all its varied aspects for your more thorough dis- 
cussion from a sanitary point ot view, for there is now abundant evid- 
ence of the preventability of this disease to a greater or less degree. 
In speaking of this disease, I must confine myself to phthisis and 
those maladies accompanied by the tubercle bacillus. Whether the 
tubercle bacillus only becomes a specific irritant, or is per se the cause 
of tuberculosis, after making caseous degeneration of inflammatory pro- 
ducts its habitat, we do not know; we must not, therefore, scoff at Klein, 
Gibbes et al., who are endeavoring to show that the tubercle bacillus is 
not always to be found in the very early stages of this disease. Work 
in this direction brings about a healthy condition of original research. 
At present we possess but little knowledge regarding the life history of 
this microbe. 
In our searches for this single-celleci organism, as it is found in dis- 
eased animal tissue outside the animal body, we have only found it in 
such places and under such circumstances as justify us in believing that 
it has been secondarily deposited there either by the excretions of tub- 
erculous animals or dead tuberculous tissue. 
What its cycle of life is outside the animal economy we do not know, 
but we do know that on certain artificial culture mediums we can grow 
it to such an age that instead of its morphology being a straight rod, as 
usually described, it will be seen throwing out branches. 
From the fact that we find these branches of such varying lengths, I 
am inclined to believe that it is not the result of a union established 
through coalescence, but to the displacement of the cells. This condi- 
tion, however is not at all permanent, as a fresh culture medium will, 
from masses of these branched forms, grow the simple rod-shaped bacilli, 
yet after continuing the transplantation of the micro-organism in this 
more complex stage onto a fresh medium twenty-five times or more, its 
power to produce tuberculosis in the animal economy is much reduced; 
in fact, I have young dogs, guinea-pigs and rabbits resisting large ino- 
culations of these growths, while the control animals inoculated with 
the second removal of bovine tubercle bacilli have developed general 
tuberculosis, or a form of disease which means death to the animal af- 
fected, and, at the same time, have present all those features which are 6 
thoroughly characteristic of human tuberculosis in its histology, etc., 
etc. 
This result, however, will make us halt at the threshold of the germ 
theory of disease, and prompt us to ask whether or not it is a toxic 
agent that is carried in with the bacillus, or whether the bacillus has been 
cultivated after living on caseous tissue to break down healthy cells into 
the caseous condition which may be essential for its own existence. 
The very fact that we all breathe the so-called tubercle bacillus, and 
many resist its attack, shows, beyond doubt, that it holds, at least, an 
intermediate place between the lion and the maggot. The former over- 
comes and destroys the deer in full and perfect physical health, while 
the latter can only prey on lifeless matter. The tubercle bacillus may 
be saprophytic 
These speculations must stimulate us to carry the line of investigation 
still further, so that the results thus far obtained may be brought to 
bear in disproof or confirmation of one of these theories. If further in- 
vestigation shows that the pabulum is the factor concerned in reducing 
its virulence, we must conclude that the tubercle bacillus at most only 
becomes pathogenic or disease-producing when cultivated on a particu- 
lar pabulum. 
Another interesting observation, that it has been my pleasure to 
watch, is that a mass of bacilli, far removed by artificial culture from the 
original tuberculous tissue whence it was taken, will not, when intro- 
duced subcutaneously into the animal economy, produce the immediate 
general toxic effect observed from the introduction of a mass only twice 
or thrice removed. 
Again, my observations enable me to conclude that the power of the 
tubercle bacillus depends largely upon the health of the animal into 
whose system it is introduced. 
If an animal is poorly fed the power of the bacillus is much more 
marked, as it is also in animals kept in small cages or exposed to bad 
ventilation, and, again, in those kept in filthy pens. 
My animals, kept for experimental purposes in the country, under 
proper sanitary conditions, being well fed, in clean cages, placed in pure 
air, and permitted to enjoy the sun's rays for many hours of the day, 
when not too hot, have a much greater resisting power than those kept 
in my city laboratory. 
These experiments are quite consistent with the known facts that, 
where there is the greatest exemption from the malady, viz., on the high 
mountains, in the deserts, in the Arctic and Antarctic regions, it is yet 
to be found under insanitary conditions. 
These facts I will apply further on in my address. 
AVhile acknowledging, however, our ignorance regarding the life-his- 
tory of the bacillus, as well as just how much power it has to produce 
tuberculosis when taken into the lungs or stomach of a perfectly healthy 
man, unless accompanied by much of the toxic substance so generally 7 
found with it, we do certainly know, beyond all doubt, that by feeding- 
carnivorous, herbivorous and omnivorous animals with caseous masses of 
bovine tubercle bacilli, we can produce deadly tuberculous conditions, 
let them be quite similar or not. 
I have accomplished this by feeding raw bovine tuberculous lung to a 
puppv-dog six months old. 
This being established with the dog, in which animal exists a great 
similarity between the mucous membrane and that of man, plus the fact 
that the digestive juices of the dog’s stomach are the more acid of the 
two, we are forced to the conclusion that man can contract tuberculosis 
by eating raw bovine tuberculous meat. 
To bring this still nearer to a condition likely to be met with in every- 
day civilized life, I roasted in an oven a piece of bovine tuberculous 
lung, -weighing, I should suppose, about two pounds, until it was cer- 
tainly better done than most of the roast beef eaten by our epicures. 
From the center of this piece of lung I opened a tubercle and grew from 
it bacilli. This should have been carried still further in a practical line 
by injecting a mass of it into the body of some one of the lower animals, 
so as to eliminate, as far as possible, the element of conjecture; yet, gen- 
tlemen, the experiments were quite sufficient to confirm me in the belief 
that, in all probability, a man can contract tuberculosis from eating the 
muscles of the cow, sheep, horse or fowl containing tuberculous lymph- 
atics, let alone the more dangerous viscera, such as the liver, spleen, 
lung, kidneys, etc. 
If the tubercle bacillus is a spore-forming fungus, as I am inclined to 
believe it is, we do not know just how much heat is necessary to render 
the spores sterile ; this can only be determined when we learn to recog- 
nize them when present. 
As long as my conclusions in this regard remain unimpeached, 1 must 
look upon tuberculous meat as a very dangerous article of food, at any 
rate for those who are at all disposed to a caseous breakdown of the tis- 
sues ; and as that condition is often not manifested until the system has 
taken on tuberculosis, it behooves you, as our guardians of health, to for- 
bid the rearing, selling or eating of such meat. 
From our present knowledge on this point we must deem it prudent, 
nay, we must prohibit the consumption of any food containing micro- 
organisms recognized as tubercle bacilli. 
Cows suffering from tubercular mammitis will produce milk and cream 
containing those bacilli, and I expect yet to be able to find them in the 
milk of cows affected with pulmonary phthisis only; however, in well- 
marked tubercular mammitis I have never failed to prove the presence 
of bacilli in the milk. 
If a test-tube of this milk is set aside for a few hours the micro-organ- 
isms are found in greatest abundance in the sediment, while a few can 
generally be discovered in the cream. Some of the bacilli I observed so 8 
closely resembled those found in human sputum that I would have diag- 
nosed them as growing in that medium. Some were quite as large, 
while others presented that beaded appearance that has so often been 
spoken of by bacteriologists as characteristic of those grown in the 
human economy. 
This, however, was not at all surprising to me, as I have never been 
able to believe that the very slight morphological distinctions made by 
Klein, Gibbes and others were of any significance so far as the power 
of the germ or its toxic agent was concerned in producing a very simi- 
lar disturbance in the animal economy. 
Not that the bovine bacillus, as found in the giant cell of bovine tuber- 
culosis, does not average smaller and of a more even texture, but from 
the fact that many are quite the same size, and that on removal on a 
nidus rich with glycerine immediately grow bacilli equally as long and 
as beaded in appearance as those found in the sputum of man; and 
again, when passed once through the tissues of a guinea-pig they have 
produced the same morphological characteristics, therefore I cannot, 
from my own practical experience, differentiate as far as infection is 
concerned between the human and the bovine tubercle bacillus. 
Certain it is that we can, by inoculating the dog with human tubercle 
bacillus and its debris, produce a wasting disease, accompanied by 
tubercles quite similar to those generally found in man. 
Scientifically it will be of particular interest to have the bovine and 
human tubercle bacillus differentiated, yet at present, for all sanitary 
purposes, we will have to consider the tubercle bacillus of the cow, ac- 
companied with its nidus, as being destructive to human life, for it is 
well established that the bacillus of man will produce in the lower ani- 
mal economy, such as the cow, dog, guinea-pig, rabbit, opossum, etc., a 
deadly malady, and that the bacillus from the cow will also bring about 
a like disturbance in the same line of animals, and, further, bacilli from 
the rabbit, etc., will, in turn, reproduce tuberculosis in the cow. 
From this intercommunicability we must believe the tuberculosis 
lymphatics interspersed in the muscles and the liver and the kidney, 
and other of the viscera that are subject to the growth of bacilli, such as 
found in the cow or fowl, are capable, when ingested into men, of pro- 
ducing a disease quite similar. 
We must also look upon milk, cream, and consequently butter, as 
another channel through which like diseases, fatal to man, may be com- 
municated. 
It would seem well settled that matter containing either bovine, 
human or chicken tubercle bacilli when subcutaneously injected into a 
variety of animals, will produce a deadly disease that many of us are 
yet unable to differentiate from a tubercular malady. 
Again, we have undeniable evidence that like matter will manifest the 
same power of harm when fed to such animals as respond to the inocu- 9 
lation, yet, at the same time we must admit that there is no direct 
proof of the transmission of such a malady to man by his feeding- upon 
what is now designated as tuberculosis meat or milk. And I fear it will 
be a long time before we can establish it by direct evidence, as man is 
exposed to this dire disease in a hundred and one ways during the long 
time elapsing between the period of infection and the manifestation of 
any symptoms. 
Among the arguments against the probability of tubercular disease 
being communicated to man by the ingestion of tuberculous matter is 
the one that tuberculosis in man rarely manifests itself as a primary 
lesion in the intestine. This, however, is not all conclusive, for it is 
quite probable that the lymphatics, situate so near the frontier, where 
they are continually skirmishing with the enemy, become, to a limited 
degree, immune, consequently the invader will only gain the victory by 
making his way into a more remote portion of the territory where there 
is less resistance and there become established. 
It may be taken into the lacteals, on into the chyle, and thence into 
the circulation, by which it cau be carried to the most remote parts. 
In children we often find tubercular lesions of the abdominal glands 
only, all other viscera being entirely free from any form of tuberculosis. 
I feel sure that time will soon reveal the fact that this is more often the 
case with adults than is generally believed. 
However, from the fact that a tuberculous condition is transmissible 
through the digestive tract from man to many of the lower animals, and 
from one lower animal to another, backward and forward, we must, for 
the present, conclude that a tuberculous malady can be transmitted from 
tuberculous meat, milk and butter to man; also by dentists’ instruments 
conveying sputum from one to another, by cooking and cooking uten- 
sils handled by those having tuberculous matter on their hands— for 
instance, bread or other dough-containing foods, pulled candies and the 
like. 
In my individual search for tubercle bacilli I have found them in 
human sputum, in tissues of man, horses, cows, dogs, cats, rabbits, 
opossums, guinea-pigs, hogs, ostriches, fowl, street railway cars, dwell- 
ing houses and bacteriological laboratories, and in tooth brushes. 
If the tubercle bacillus is to be found in street cars and dwellings we 
must believe it to be in the air of most inhabited places, and the more 
thickly populated and the more filthy the air the greater will be the 
proportion. 
This being the case, it is for us to decide on general principles and 
facts whether or not we are to conclude, for our present purpose, the 
probability of tuberculous material infecting the animal economy when 
commingled with the inspired air with which our diseased mucous mem- 
brane and outside skin are being constantly bathed. 10 
It seems to me we must suspect the abraded mucous membrane of the 
respiratory and oral tracts or injured skin when covered with eczema or 
other skin diseases, of being1 likely points of entrance. 
By lacerating the gums and the lining of the oral cavity of the mouth 
of a guinea-pig—not more than the dentist often lacerates man’s—and 
powdering the wounds with a mass of tuberculous material, I have 
caused to be produced a sub-maxillary disturbance microscopically re- 
sembling tuberculosis, while the microscopical examination revealed 
tubercle bacilli. 
While most of the inoculations on guinea-pigs for experimentation 
are made by subcutaneous injections, I have also succeeded in producing 
infection by rubbing a mass of the bacilli on a superficially lacerated 
skin and sealing it over with rubber-cloth and sticking-plaster. 
Other experimenters have irritated the respiratory tract with ground 
glass and then compelled the animal so treated to inhale particles of 
the tuberculous material, and thereby produced what they have described 
as tuberculosis. 
We must, therefore, believe, for practical purposes, that the lower ani* 
mals can be infected with a deadly disease closely related to tubercu- 
losis either by the inspiration of tuberculous matter on the injured 
mucous membrane of the respiratory tract or through the injured skin 
when besmeared with tuberculous material. 
These facts, coupled with those already alluded to, showing that 
human tuberculous material is capable of infecting the guinea-pig, 
rabbit, opossum, calf and other animals in almost, if not in precisely 
the same manner as the tuberculous material of a cow will affect the 
same kind of animals; and further, that tuberculous material from a 
guinea pig will infect the other animals in exactly the same manner as 
when taken from man or cow, compel us to conclude that man suffering 
from inflammatory processes, or traumatic conditions of the mucous 
membrane or skin, may contract a deadly disease from germ particles 
in the air. 
Just how long tubercle bacilli or their spores, if such exist, can retain 
vitality after isolation from a favorable nidus such as tissue or pus, we 
do not know, yet we have a good right, reasoning from the life of higher 
fungi on up through green vegetable life to that of fish and mammals, 
to conclude that the act of separation from the nidus does not per se 
cause immediate death of the cell, but that some time elapses before the 
germ dies in its non-life-sustaining surroundings. 
If this be so, and the separation is constantly going on in man’s im- 
mediate presence, why should the toxic agent not again implant itself 
on his abraded skin or mucous membrane while it still has vital power? 
Even should we have to admit that the very act of separation of the 
disturbing germ from its original pabulum is presently fatal to its life, 
we must not forget what experiment has already demonstrated—that a 11 
very slight current of air can carry with it not only the germ but also 
its nidus. 
From the fact that in studying microscopic preparations of lung tissue 
we often find particles of coal that have worked themselves down into 
the very alveoli, we must, at least, suspect the possibility—in fact strong 
probability—of the tuberculous matter also working its way into the 
finer ramifications of the air passages. 
The function of the respiratory apparatus is to convey air from with- 
out into the body. Its construction is such that, in full health, it screens 
out most of the light, short particles of deleterious matter, yet, when at 
all diseased it must, we believe, lose this power to a greater or less 
degree. 
Dr. Arthur Ransome has shown that in bronchitis and catarrh, and 
other diseases in which there was much expectoration, the proportion- 
ate amount of organic matter exhaled from the lungs was only one half 
of that from the healthy person—not that there was less organic matter 
excreted, but because it wras held by the mucous before it reached the 
mouth—and Professor Tyndall, as you must all remember, has demon- 
strated, by means of the illuminated tube, the filtering action of the 
respiratory organs. 
Under such conditions as chronic bronchitis the cilise must, of neces- 
sity, lose their power to expel foreign material. The muscular walls 
become weakened, and dilatation and plugging, in all probability, take 
place, and the bacilli find a quiet habitat and a medium wherein to 
fructify. 
Catarrhal pneumonia furnishes a goodly example of this condition 
predisposing to tuberculosis. 
We cannot, however, make any estimate of the possibility of the harm 
arising from the entrance of such material into even the most remote 
and inactive portions of the healthy lung tissue. 
This, however, is not necessary for you to consider as sanitary offi- 
cers, inasmuch as there are few men with perfectly healthy respiratory 
organs who ought to look to you for protection against the invasion of 
this most fell disease. This, coupled with the fact that the healthy, if 
any, are constantly commingling with the unhealthy, makes it incum- 
bent on you to render all places sufficiently harmless to both, particu- 
larly if you believe that tuberculosis in the air is hurtful to man in such 
health as the average human being enjoys. 
It would appear from what has been said that it is probable that man, 
when in a certain condition, is susceptible to tuberculous infection when 
exposed to the materies morbi, and that it may make its entrance into 
the animal economy either through the stomach, the mucous membrane 
of the digestive or respiratory tracts, or through the abraded skin ; and 
further, that man is constantly exposed to the toxic agent, and yet all 
men are not affected with tuberculosis. 12 
I have little or no doubt but that all of you can remember instances 
when men have been severely exposed to tuberculous material and lived 
to a good old age untainted with the disease, while others who have 
been, in all probability, but slightly exposed have taken on the infection. 
This special susceptibility demonstrates that some must furnish a suit- 
able soil, and that, in such cases, the affinity of the constituents of the 
tissue must be weak, and thus enable the toxic agent to break it up and 
pass through the process of tuberculosis. 
This condition, we must admit, is often hereditary. We have seen very 
many instances of members of the same family, living in different and 
far-distant localities, who have, at or near a certain age, succumbed to 
tuberculosis. 
We cannot explain all the possible inherited factors, yet we can readily 
conceive mere abnormal and inconsistent proportions of the viscera as 
being a predisposing cause; a mere mechanical course pursued by the 
air passages, weak cilke in the air passages, digestive glands that secrete 
a weak gastric juice, papilli of the intestinal canal incompetent to make 
a proper selection of food, or a weak phagocytic power may each afford 
a cause for susceptibility. 
There is certainly inherited not only a tendency to contract but a 
marked readiness to yield to an attack. 
Hereditary predisposition is often intensified by intermarriage. If we 
find in the bovine foetus tubercle bacilli we have an heirship. The pa- 
rent in this case certainly, to say the least, bequeaths to its offspring that 
which it actually possesses. 
After an experience of breeding over a hundred animals, I am con- 
vinced, that interbreeding intensifies either strong or weak characteris- 
tics. However, this predisposition only furnishes a soil or habitat for 
that material so universally found in tuberculosis. 
A predisposition in man can also be cultivated. Vitiated air is one 
potent cause; under this condition the blood is not properly oxidized, 
therefore the digestive function becomes impaired, the tissue weakens, 
and susceptibility is acquired. 
Prebreathed air or house air with a lack of physical exercise is re- 
sponsible for much tuberculosis acquired by man, not only but 
also indirectly, by rendering the cattle he eats predisposed to tubercu- 
losis. 
Active ventilation in our dwellings and public buildings, factories, and 
mills, etc., is essential for the prevention of the disease. 
We have no scientific proof that foul air in any way nourishes the tu- 
nercle bacillus or that it increases its virulence, yet we do know that it 
reduces the resisting power of the animal economy, and that a lack of a 
free interchange of air permits of an accumulation of the bacilli. 
For instance, if 10,000 bacilli are given off into 1,000 cubic feet of air, 
there would be ten bacilli in each cubic foot of air breathed; whereas, if 13 
the interchange of air furnished 10,000 cubic feet in t lie same length of 
time, each cubic foot of air inspired would only contain one bacillus. 
Laboratory experimentation proves beyond doubt that the quantity 
of tuberculosis material taken into the animal economy decidedly affects 
the rate of mortality. This fact is entirely consistent with the well-au. 
thenticated statistics showing a much larger mortality in crowded places 
and goes to establish the absolute necessity of interspace ventilation to 
prevent the spread of tuberculosis. 
This being the case, it goes without saying that the ventilation of the 
streets and air spaces of cities, towns, etc., is also necessary to maintain 
the health of inhabitants. 
Statistics show that in proportion as people are attracted to indoor oc- 
cupations and in proportion to the degree of closeness from want of 
proper ventilation of the buildings in which they work, in that rate is 
the ratio of deaths from tuberculosis increased. 
Dr. Bowditcli has shown us the extreme danger of dampness of the soil 
as a cause of tuberculosis, and has called our attention to the necessity 
of the more thorough drainage of the land. * * * Dr. Bowditch’s re- 
sults have been confirmed by Dr. Haviland and by the registrar general 
of Scotland. 
In the conclusions drawn from the map of distribution of tuberculosis 
in Great Britain, Dr. Haviland states: “Damp clayey soil, whether be- 
longing to the wealdou, oolitic or cretaceous formation, is coincident with 
high mortality.” 
Gastro-intestinal disorders, that so generally precede tuberculosis, 
point to the necessity of proper and sufficient foodstuffs. 
The disordered stomach may of course in a number of cases be second- 
ary to tuberculosis, yet there cannot be a doubt as to its also being one 
of the predisposing causes. 
As there is nothing that affects the wealth and happiness of the people 
of this great state more than ill-health, and as there is no one poison 
that interferes more with health than tuberculosis, which not only too 
often robs us of those in the prime of manhood and womanhood, but 
renders thousands upon thousands a burden to themselves and their fami- 
lies for years, yet it is happily a preventable disease, and this board 
should be armed with authority and means to enforce and carry out sani- 
tary laws essential to that end. 
To accomplish this most important work it must be evident, after what 
we have reviewed this evening, that you should have legislation regard- 
ing the disinfection and destruction of tuberculosis material, especially 
human tuberculosis sputum. 
There should be a law compelling passenger transportation companies 
to furnish receptacles containing either water or a germicide for sputum, 
both in their cars and stations. The same law should apply to all places 14 
where large numbers of persons gather together either for the purpose 
of work or amusement. 
To enforce the expulsion of dust in our factories and workshops. 
To compel the thorough sprinkling of the public highways immedi- 
ately before cleansing. 
To forbid spitting on the sidewalks. 
To compel the drainage of damp soils before permits for building 
dwellings are granted. 
Rules should be formulated for air space and ventilation of all build- 
ings, and the builder and architects required to submit their plans and 
specifications before the work of building can be commenced. This cer- 
tainly is quite as necessary and practicable as the present law in Phila- 
delphia and other cities regarding plumbing. 
Not only must we have a law requiring a certain air space and venti- 
lation in our buildings, but also around our dwellings, workshops, etc. 
The width of all new streets and passage ways should be of a sufficient 
breadth. Every block of buildings should have a complementary gar- 
den or park. Every building should be accompanied by a certain air 
space. 
Such topographical regulations must be insisted upon in our growing 
cities, if we mean to reduce the present alarming death-rate and suffer- 
ing from phthisis. 
This ventilation of our cities and towns by the laying out of wide and 
diagonal streets and reservations of open spaces for gardens and parks, 
is essential for the successful ventilation of our buildings. 
A pure and constantly renewed atmosphere is requisite for the pre- 
vention of consumption. This is well known and universally admitted 
beyond doubt or controversy. 
All knives, forks, spoons, cups and other eating utensils should be 
thrown into scalding water immediately after using, otherwise the 
tuberculous sputum will be carried from one person to another. 
Dentists and physicians should be required to disinfect their instru- 
ments according to a law of the state, and be subject to inspection and 
a heavy fine for a violation of the same. 
The cleansing of all public conveyances should be regulated by law. 
We should have laws regulating the ventilation of our animal stables. 
Cows, like men, require physical exercise and pure air and light to en- 
able them to resist tuberculosis. 
The hot, close, dark and dirty stables throughout our state are im- 
portant factors in promoting tuberculosis in our cattle; therefore, regu- 
lations should be formulated for ventilation, light and cleanliness of 
animal sheds and stables. These should be under the inspection of 
competent and honorable inspectors. 
Soiling of cattle should be forbidden by law. 15 
As there are at present so many cows predisposed to tuberculosis, 
and as it is more than probable that interbreeding- intensifies predispo- 
sition, it should be defined and forbidden. 
All consumptive animals should be condemned and killed after hav- 
ing- been valued and paid for by the state. The vending- of the meat of 
such animals should be made criminal. 
At present, cows suffering with this disease are constantly being sold 
in our markets for the manufacture of mince-meat and sausages. 
The breeding of tuberculous animals, the killing of which, at any time, 
should be delayed for the want of a sufficient appropriation to pay for 
the same, should not be permitted. 
The sale of the milk of such animals should be forbidden under a heavy 
penalty. 
As tuberculosis, actinomycosis, lymphadenomo and rheumatism with 
enlargement of the joints would frequently be taken the one for the other 
by the laymen, competent government inspectors should be appointed 
to make periodical and special inspection of all home cattle as well as 
those about to be brought into the state. 
All butter and milk imported into the state should be subject to in- 
spection for tuberculous material. All meat exposed for sale in our 
markets ought to be subject to inspection and condemnation. 
The law should require physicians to report tubercular cases. 
The proved transmissibility of tuberculosis from one person to another 
brings us face to face with the necessity of considering the question of 
admitting to our country tuberculous immigrants. 
Inoculation with tuberculous matter for the cure or prevention of tu- 
berculosis cannot at this stage be recommended for general practice, as 
too few test cases of cure have yet been brought to an entirely satisfac- 
tory conclusion, while immunity in some of the lower animals has been 
sufficiently demonstrated in my own laboratory, since my first publica- 
tion in the ]\[edical News of 1889, to confirm me in my behalf that it can 
and is produced to a greater or less degree. 
However, the risk of producing a diseased condition and the uncer- 
tainty of degree and duration of immunity are at present unknown quan- 
tities to me; therefore, I cannot now recommend that which my results 
on the lower animals gives me reason to believe I will at some future 
time be able to advise as a public measure. 
By the agency of the tubercle bacillus, I believe we will have a means 
to prevent tuberculosis, and to diagnose and cure those who have fallen 
victims to the malady, yet at present I am of exactly the same opinion 
as I was two years ago, when I cured my first tuberculous animal, which 
animal happily still lives to speak for itself