THE NATIONAL MEDICAL REVIEW. 
REPORT OF COMMITTEE ON “ THE RESTRICTION AND PREVENTION 
OF TUBERCULOSIS.” 
Your committee, appointed for the 
purpose of reporting on what measures, 
if any, can be taken by this Society for 
the prevention and restriction of tuber- 
culosis, beg leave to report as follows : 
It has been proven beyond a doubt 
that consumption is a disease which is 
communicable from man to man, from 
man to animals and from animals to 
man. The agent which conveys the dis- 
ease, the bacillus tuberculosis, may enter 
the system through the lungs, the stom- 
ach or some other absorbing surface. 
Every existing case must arise from some 
other pre-existing case. 
Based upon these facts it follows that 
consumption is a preventable disease. In 
fact, it appears that there is no other 
disease known which is more easily 
prevented than this. The power of man 
to control the spread of the disease is 
absolute when he himself is the victim. 
Your committee scarcely believes it 
necessary to report in this communica- 
tion upon the terrible ravages of this 
disease. Yet it might be well to call 
attention to a few facts. From July 
i860, to April, 1892, there were 76,272 
deaths from consumption in the city of 
Philadelphia alone. In Vermont one 
death in every five is due to consump- 
tion ; while the rate is nearly as high in 
the other New England States. Through- 
out the whole world one death in every 
seven is due to consumption. Dr. Biggs 
of the New York City Health Depart- 
ment found evidences of the existence 
of tubercular disease in more than 60 
per cent of the autopsies in the charity 
hospitals. Over 2,000 children under 
two years of age die annually in Paris 
of tuberculosis. In Michigan there are 
about 3,000 deaths annually from this 
disease. One writer declares that 
“ probably 5,000,000 people die annually 
throughout the world from tuberculosis.” 
The editor of the Record says that “con- 
sumption kills twelve per cent of the 
population.” In a report recently is- 
sued by the Health Department of New 
York City is the statement that “ con- 
sumption causes about one-fourth of all 
the deaths occurring in the human being 
during adult life and more than one-half 
of the entire adult population at some 
time in life acquires it.’' And yet this 
is most decidedly a preventable disease. 
The following statement of mortality 
from tuberculosis in the District of Co- 
lumbia, for ten years, 1883-1892 inclu- 
sive, by sex, color and with percentages, 
has been prepared by the Health Office: 
has been prepared 
t’ls. 
To- 
Avg 
00 00 00 00 00 00 00 00 00 00 
vo vo VO oooooooooooooo 
to m O vo On On 4* 04 
Years. 
• 00 
o 
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CO 00 GO 00 00^4 
10 »o O ON-4*- 0004 I0U> Q\ 
M On04 m C/i to On O OnO* 
Total deaths from tu- 
berculosis. 
it 
MHHHHHMH 
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to w 
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£* 00 
White—Males. 
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4* 4<* UN vO vo 00 O VO h h 
White—Females. 
: 1 
• 04 
MMMMmhIOIOHw 
10 10 (0 04 COh 0*0 00 
to 4* toCn m c/i O OJ Vi On 
Colored—Males 
• KJ 
• 04 
• VO 
totototototototo 
ONVO MU O O h^O 
to to 
ON to 
On 00 
Colored—Females. 
vP 
00 
-4 
04 4* 4k. 4* 4*. ON *4 On 
C/i 4* 4*. 004*. 00 
ON On4» On Vi MvO hMO 
Per cent to deaths from 
all causes. 
to 
on 
O 
tototo^totototoc 
to to m vO On Onvo 
to 04 On OnO) \0 vo On 
/4 to 
O O' 
to On 
On On 
On Co 
/I M 
Ratio to each i,ooo pop- 
ulation, whites. 
On 
00 
4- 
C/i Vi C/t C/i Vi Vi On On 
m C/l 4* 04 CO M 
Vi Vi VO C/i 00 O to 04 
Ratio to each 1,000 pop- 
ulation, colored. 
On 
« ! ON On 
O mOOn On 42 COM 
h-< vo to OnVi 4* vO m 00 
M CO O to O C/i 4* 004* ON 
Deaths from all causes. 
Whites—3.707. 
Colored—4,312. 
Per cent of deaths from tuberculosis to all deaths 15.S7 
in ten years. 
As the successful treatment of tuber- 
culosis depends largely upon the early 
diagnosis of the disease; as said diag- 
nosis is now readily made by a micro- 
scopical examination of the sputa ; and 
as not all physicians have the necessary 
outfit to make this examination, your 
committee trusts that some one of the 
laboratories of this city will open its 
doors for the free examination of all sus- 
pected cases or specimens which the phy- 
sicians of the District may refer to them. 
We understand that this free examina- 
tion of the sputa is now offered to the 
profession of New York City. 
That the disease is very prevalent 
among cattle is now proven beyond 
question. The statement is made that 
the number of animals infected with tu- 
berculosis exceeds all other diseases put THE NATIONAL MEDICAL REVIEW. 
together. In Massachusetts the propor- 
tion of cows afflicted with tuberculosis 
is about 4 per cent. In one district in 
Scotland per cent of the cattle 
have been found to be tuberculous. 
Royal Agricultural College, found 80 per 
cent of the cows suffering from it in some 
degree. In Germany, where the inspec- 
tion is very strict, in two years 26,352 
tuberculous animals were found among 
those brought to be slaughtered. In 
Russia tuberculosis is widely prevalent 
in the herds. It is a peculiarity also of 
the disease that it is most prevalent 
among the better class of stock, and 
where extra care is devoted to dairying. 
From a letter received from Prof. A. E. 
de Schweinitz of the Biochemic Labora- 
tory of the Agricultural Department we 
learn that two herds have been examined 
in the District of Columbia and were 
found to be badly diseased. He says it 
is probable that the cattle all over the 
country are to a greater or less extent 
affected with tuberculosis. Professor de 
Schweinitz makes the startling statement 
that “ in nearly all cases where the dis- 
ease has been discovered, from 50 to 70 
per cent of the whole herd has been 
found infected.” He also says that al- 
though the milk from tuberculous cattle 
may not necessarily contain the germ of 
the disease, yet, even in its absence the 
milk from such animals has been found 
very injurious to young children and the 
sick. He also says that the Board of 
Health of this district is in sympathy 
with the work of the Bureau of Animal 
Industry and that arrangements are now 
being made which will result in a sys- 
tematic investigation to determine the 
presence of tuberculosis. 
While tuberculous meat and milk may 
be one important source of danger, yet, 
as a rule, the important source is from 
man himself. We know that the breath 
of tubercular patients is not an element 
of danger, neither is the moist sputum. 
The great source of danger lies in the 
dried sputum. The expectorated mat- 
ter of tubercular patients lodges where 
it afterward dries, becomes pulverized, 
floats in the air as dust, and as such is 
inhaled. Or the sputum may become 
dry on handkerchiefs, or articles of the 
wearing apparel. It has been proved 
that the sputum may dry upon the lips 
of the infected person, as after wiping 
the lips with a handkerchief in which 
has been placed some expectorated mat- 
ter, or simply dry on the lips as the in- 
fected matter passed over them in pro- 
cess of expectoration. Remaining on 
the lips in this way the germs are easily 
transferred to the lips of another by 
kissing, etc.. But it must be distinctly 
understood that the moist sputum is free 
from danger. From this it is readily 
seen how, if it were only possible to de- 
stroy all discharges from the mouth im 
mediately after their exit, by far the 
greatest danger of communication from 
man to man would be prevented. In 
fact, it would probably reduce the num- 
ber of cases of this disease at once to a 
most gratifying extent. 
Mr. Frijs of Copenhagen, in a recent 
article, says that in a lot of 30 cows, from 
which the milk was regularly sold, he 
found nearly all diseased. He believes 
the danger of infection through milk to 
be so great that there is no safety except 
in avoiding the use of milk which has 
not been submitted to a temperature 
sufficient to destroy the tubercle bacilli. 
When we consider that the milk from one 
infected animal is likely to be mixed 
with the milk from the whole herd, it 
follows that by the use of the milk from 
one large dairy, hundreds of children 
may be exposed to tuberculosis. 
The consumptive patient does not 
understand that he is constantly re-in- 
fecting himself. He either swallows 
some of the matter from the lungs, thus 
exposing himself to tuberculosis of the 
abdominal organs, or, by not destroying 
the sputum, is surrounding himself with 
the infected dust to be inhaled with the 
air. It follows then that the consump- 
tive must disinfect his own sputa for his 
own protection, as well as for the pro- 
In England the Department of Agri- 
culture, under the Pleuro-Pneumonia act 
in 1891, slaughtered some 12,000 ani- 
mals, and an examination showed 16.09 
per cent of the cows, 1.53 per cent of the 
bulls, 2.77 per cent of other cattle and 
1.2 per cent of those under one year to 
be affected with tuberculosis. In Den- 
mark the disease is most common. Dr. 
Bang, chief veterinary officer of the THE NATIONAL MEDICAL REVIEW, 
tection of those about him. The public 
should be taught that disinfection of the 
sputa is the great desideratum. 
pie and easily applied measures, your 
committee would recommend the follow- 
ing : 
First. That a committee be appointed 
to prepare the MS. for circulars or pam- 
phlets, with the view of having the same 
distributed among the people setting 
forth the facts that each person having 
consumption is a constant source of 
danger to others not thus afflicted ; that 
the disease is curable ; and, above all, 
that it is easily preventable. 
Second. That the hospital authorities 
be urged to set apart certain wards for 
the exclusive use of consumptives ; al- 
though your committee believes that 
special hospitals for this purpose are 
preferable. 
Third. That physicians be especially 
requested to inform their consumptive 
patients of the necessity of thorough 
disinfection of the sputa, and of the 
methods by which this can be accom- 
plished; and further, that they insist 
that the rooms once occupied by con- 
sumptives be thoroughly disinfected be- 
fore they are again inhabited. 
Fourth. And that this Society take 
such action as will best procure the en- 
actment of a law whereby no milk can 
be offered for sale in this city until the 
cows from which said milk was taken 
have been tested and found to be free 
from tuberculosis. 
Signed by the committee. 
Chas. H. Stowell, 
J. H. Bryan, 
E. A. Balloch. 
Dr. McArdle offered the following 
amendment, which, by a vote of the 
Society, was ordered added to the above 
recommendations : 
But it must not be forgotten that 
something besides the tubercle bacillus 
is necessary in order that a case of tuber- 
culosis be developed. There must be a 
suitable soil for the reception of these 
bacilli. While it is doubtful if tuber- 
culosis is truly hereditary, at least to 
any great extent, yet there is no doubt 
that a predisposition to the disease 
can be inherited. We believe this pre- 
disposition is greatly augmented by the 
intermarriage of tubercular persons, as 
the offspring from such marriages would 
present the conditions necessary for the 
successful development of the disease. 
And while we are aware such marriages 
cannot be forbidden by law, yet we 
believe if the laity understood these 
facts and if the profession would use 
its influence to discourage these unions, 
the number of such marriages would be 
greatly reduced. 
With respect to the establishment of 
special hospitals for consumptives, your 
committee would call attention to the 
valuable lesson taught us by England. 
In 1890 there were 7,000 free beds in 
these consumptive hospitals. The 
growth of these institutions during the 
past forty years demonstrates that as 
the accommodations for the consump- 
tive poor have increased, so in a relative 
proportion has there been a reduction 
in the rate of mortality. Dr. Detweiler 
at Falkenstein has treated 600 cases of 
consumption at his private sanitarium, 
with the result that there has been a de- 
cided and lasting gain in 81 per cent. 
It is hardly possible to estimate the pro- 
tection afforded a community and the 
wealth added to the State by this isola- 
tion of the afflicted and cure of the dis- 
eased, as a result of the existence of 
these special hospitals. 
Furthermore, that the Health Officer 
of the District of Columbia shall be re- 
quested to formulate such regulations 
as will insure to all persons purchasing 
vaccine virus in this District, a guaran- 
tee that the animals whence such ma- 
terial has been obtained were treated 
with tuberculin and proven free from 
tuberculosis. 
In view of the fact that tuberculosis 
is a communicable disease ; that it is the 
most prevalent of all diseases; that it 
causes more deaths than any other dis- 
ease ; and that it is preventable by sim-